1
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Chen P, Yang HD, Wang JJ, Zhu ZH, Zhao HM, Yin XY, Cai Y, Zhu HL, Fu JL, Zhang XZ, Sun WX, Hui L, Zhang XB. Association of serum interleukin-6 with negative symptoms in stable early-onset schizophrenia. World J Psychiatry 2024; 14:794-803. [PMID: 38984340 PMCID: PMC11230098 DOI: 10.5498/wjp.v14.i6.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/28/2024] [Accepted: 05/17/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Accumulating evidence suggests that the inflammatory cytokine interleukin-6 (IL-6) contributes to the pathophysiology of psychiatric disorders. However, there was no study concerning the relationship between IL-6 concentrations and clinical features in the chronic phase of early-onset schizophrenia (EOS). AIM To investigate the relationship between serum IL-6 concentration and the clinical features of EOS. METHODS We measured serum IL-6 Levels from 74 patients with chronic schizophrenia, including 33 with age at onset < 21 years (EOS group) and 41 with onset ≥ 21 years in [adult-onset schizophrenia (AOS) group], and from 41 healthy controls. Symptom severities were evaluated using the Positive and Negative Syndrome Scale (PANSS). RESULTS Serum IL-6 concentrations were higher in both EOS and AOS groups than healthy controls (F = 22.32, P < 0.01), but did not differ significantly between EOS and AOS groups (P > 0.05) after controlling for age, body mass index, and other covariates. Negative symptom scores were higher in the EOS group than the AOS group (F = 6.199, P = 0.015). Serum IL-6 concentrations in the EOS group were negatively correlated with both total PANSS-negative symptom score (r = -0.389, P = 0.032) and avolition/asociality subscore (r = -0.387, P = 0.026). CONCLUSION Patients with EOS may have more severe negative symptoms than those with adult-onset schizophrenia during the chronic phase of the illness. IL-6 signaling may regulate negative symptoms and its avolition/asociality subsymptoms among the early-onset chronic schizophrenic patients.
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Affiliation(s)
- Peng Chen
- Suzhou Medical College of Soochow University, Suzhou 215123, Jiangsu Province, China
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Hai-Dong Yang
- Department of Psychiatry, The Fourth People’s Hospital of Lianyungang, The Affiliated Kangda College of Nanjing Medical University, Lianyungang 222003, Jiangsu Province, China
| | - Jun-Jie Wang
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Zhen-Hua Zhu
- Research Center of Biological Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Hui-Min Zhao
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou 215002, Jiangsu Province, China
| | - Xu-Yuan Yin
- Research Center of Biological Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Yuan Cai
- Research Center of Biological Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Hong-Liang Zhu
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Jia-Lin Fu
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Xin-Zhu Zhang
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Wen-Xi Sun
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Li Hui
- Research Center of Biological Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Xiao-Bin Zhang
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
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2
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Carroll D, Wales M, Rintell LS, Hojlo M, Gonzalez-Heydrich J, Berbert L, Fitzpatrick M, D'Angelo E, Reed MP. Burden Experienced by Primary Caregivers of Children With Psychotic Disorders and at Clinical High Risk for Psychosis. J Am Psychiatr Nurses Assoc 2024; 30:518-531. [PMID: 36475411 DOI: 10.1177/10783903221141883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the existing research exploring caregiver burden in adult psychosis, few studies have examined the experience of providing care to children diagnosed with psychotic disorders (PDs) and those identified as having clinical high risk for psychosis (CHR-P). AIM This study measured the level of burden in caregivers of children with PD and CHR-P and examined associated risk factors, including social support, caregiver-child relationship, severity of illness, and frequency of psychiatric hospitalizations. METHODS A total of 56 caregivers completed validated measures and provided demographic information. Measures included the Zarit Burden Interview, the Multidimensional Scale of Perceived Social Support, the Behavior Assessment System for Children, Third Edition, Parenting Relationship Questionnaire-Child and Adolescent Form (BASC-3 PRQ-CA), and the Clinical Global Impression-Severity scale. RESULTS The majority of caregivers were women (86%), mothers (84%), White (63%), married (66%), working full-time (50%), college-educated (79%), and whose mean age was 45.7 years (SD = 8.09). Nearly half of the caregivers (45%) reported a high level of caregiver burden, 39% rated their burden in the mild to moderate range, and 16% reported little to no burden. There was no significant difference in mean burden between PD and CHR-P groups. Higher caregiver burden was associated with lower levels of social support (r = -.408, p = .002), lower levels of parenting confidence (r = -.514, p < .001), higher levels of relational frustration (r = .612, p < .001), and higher severity of illness (r = .316 p = .025). CONCLUSIONS These findings underscore the critical unmet need for support for caregivers of children with PD and CHR-P. Applications to clinical practice are discussed.
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Affiliation(s)
- Devon Carroll
- Devon Carroll, PMHNP-BC, MSN, Boston Children's Hospital, Boston, MA, USA; University of Rhode Island, Providence, RI, USA
| | - Meghan Wales
- Meghan Wales, RN, BA, Boston Children's Hospital, Boston, MA, USA
| | | | - Margaret Hojlo
- Margaret Hojlo, BA, Boston Children's Hospital, Boston, MA, USA
| | - Joseph Gonzalez-Heydrich
- Joseph Gonzalez-Heydrich, MD, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Laura Berbert
- Laura Berbert, MS, Boston Children's Hospital, Boston, MA, USA
| | - Molly Fitzpatrick
- Molly Fitzpatrick, MA, Boston Children's Hospital, Boston, MA, USA; William James College, Newton, MA, USA
| | - Eugene D'Angelo
- Eugene D'Angelo, PhD, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Mary P Reed
- Mary P. Reed, PhD, RN, ANP, CNRN, NEA-BC, Boston Children's Hospital, Boston, Massachusetts, USA
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3
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Correll CU, Arango C, Fagerlund B, Galderisi S, Kas MJ, Leucht S. Identification and treatment of individuals with childhood-onset and early-onset schizophrenia. Eur Neuropsychopharmacol 2024; 82:57-71. [PMID: 38492329 DOI: 10.1016/j.euroneuro.2024.02.005] [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: 08/24/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 03/18/2024]
Abstract
Approximately 8 % of patients with schizophrenia are diagnosed before age 18, and 18 % experience their first symptoms before age 18. This narrative review explores the management of patients with early-onset schizophrenia (EOS) and childhood-onset schizophrenia (COS) from diagnosis to their transition to adult care settings. Early diagnosis of schizophrenia in children and adolescents is essential for improving outcomes, but delays are common due to overlapping of symptoms with developmental phenomena and other psychiatric conditions, including substance use, and lack of clinicians' awareness. Once diagnosed, antipsychotic treatment is key, with specific second-generation agents generally being preferred due to better tolerability and their broader efficacy evidence-base in youth. Dosing should be carefully individualized, considering age-related differences in drug metabolism and side effect liability. Clinicians must be vigilant in detecting early non-response and consider switching or dose escalation when appropriate. Since early age of illness onset is a consistent risk factor for treatment-resistant schizophrenia (TRS), clinicians need to be competent in diagnosing TRS and using clozapine. Since COS and EOS are associated with cognitive deficits and impaired functioning, psychosocial interventions should be considered to improve overall functioning and quality of life. Good long-term outcomes depend on continuous treatment engagement, and successful transitioning from pediatric to adult care requires careful planning, early preparation, and collaboration between pediatric and adult clinicians. Targeting functional outcomes and quality of life in addition to symptom remission can improve overall patient well-being. Comprehensive evaluations, age-specific assessments, and targeted interventions are needed to address the unique challenges of EOS and COS.
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Affiliation(s)
- Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY, USA.
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Birgitte Fagerlund
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Martien J Kas
- Groningen Institute for Evolutionary Life Sciences (GELIFES), Neurobiology, University of Groningen, the Netherlands
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Germany; Department of Psychiatry, Department of Psychosis Studies, and Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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4
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Konttajärvi T, Haapea M, Huhtaniska S, Björnholm L, Miettunen J, Isohanni M, Penttilä M, Murray GK, Koponen H, Vernon AC, Jääskeläinen E, Lieslehto J. The contribution of first-episode illness characteristics and cumulative antipsychotic usage to progressive structural brain changes over a long-term follow-up in schizophrenia. Psychiatry Res Neuroimaging 2024; 339:111790. [PMID: 38354478 DOI: 10.1016/j.pscychresns.2024.111790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 11/26/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024]
Abstract
Exposure to antipsychotics as well as certain first-episode illness characteristics have been associated with greater gray matter (GM) deficits in the early phase of schizophrenia. Whether the first-episode illness characteristics affect the long-term progression of the structural brain changes remain unexplored. We therefore assessed the role of first-episode illness characteristics and life-time antipsychotic use in relation to long-term structural brain GM changes in schizophrenia. Individuals with schizophrenia (SZ, n = 29) and non-psychotic controls (n = 61) from the Northern Finland Birth Cohort 1966 underwent structural MRI at the ages of 34 (baseline) and 43 (follow-up) years. At follow-up, the average duration of illness was 19.8 years. Voxel-based morphometry was used to assess the effects of predictors on longitudinal GM changes in schizophrenia-relevant brain areas. Younger age of onset (AoO), higher cumulative antipsychotic dose and severity of symptoms were associated with greater GM deficits in the SZ group at follow-up. None of the first-episode illness characteristics were associated with longitudinal GM changes during 9-year follow-up period. We conclude that a younger AoO and high life-time antipsychotic use may contribute to progression of structural brain changes in schizophrenia. Apart from AoO, other first-episode illness characteristics may not contribute to longitudinal GM changes in midlife.
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Affiliation(s)
| | - Marianne Haapea
- Research Unit of Population Health, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University of Hospital and University of Oulu, Finland; Department of Psychiatry, Oulu University of Hospital, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Sanna Huhtaniska
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Lassi Björnholm
- Department of Psychiatry, Oulu University of Hospital, Finland; Research Unit of Clinical Neuroscience, University of Oulu, Finland
| | - Jouko Miettunen
- Research Unit of Population Health, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University of Hospital and University of Oulu, Finland
| | - Matti Isohanni
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Matti Penttilä
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Hannu Koponen
- University of Helsinki, Helsinki University Hospital, Psychiatry, Helsinki, Finland
| | - Anthony C Vernon
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, London,United Kingdom
| | - Erika Jääskeläinen
- Research Unit of Population Health, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University of Hospital and University of Oulu, Finland; Department of Psychiatry, Oulu University of Hospital, Finland
| | - Johannes Lieslehto
- Research Unit of Population Health, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University of Hospital and University of Oulu, Finland; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
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5
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Cabrera-Mendoza B, Aydin N, Fries GR, Docherty AR, Walss-Bass C, Polimanti R. Estimating the direct effects of the genetic liabilities to bipolar disorder, schizophrenia, and behavioral traits on suicide attempt using a multivariable Mendelian randomization approach. Neuropsychopharmacology 2024:10.1038/s41386-024-01833-2. [PMID: 38396255 DOI: 10.1038/s41386-024-01833-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/25/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
Bipolar disorder (BD) and schizophrenia (SZ) are associated with higher odds of suicide attempt (SA). In this study, we aimed to explore the effect of BD and SZ genetic liabilities on SA, also considering the contribution of behavioral traits, socioeconomic factors, and substance use disorders. Leveraging large-scale genome-wide association data from the Psychiatric Genomics Consortium (PGC) and the UK Biobank (UKB), we conducted a two-sample Mendelian randomization (MR) analysis to evaluate the putative causal effect of BD (41,917 cases, 371,549 controls) and SZ (53,386 cases, 77,258 controls) on SA (26,590 cases, 492,022 controls). Then, we assessed the putative causal effect of BD and SZ on behavioral traits, socioeconomic factors, and substance use disorders. Considering the associations identified, we evaluated the direct causal effect of behavioral traits, socioeconomic factors, and substance use disorders on SA using a multivariable MR approach. The genetic liabilities to BD and SZ were associated with higher odds of SA (BD odds ratio (OR) = 1.24, p = 3.88 × 10-12; SZ OR = 1.09, p = 2.44 × 10-20). However, while the effect of mental distress (OR = 1.17, p = 1.02 × 10-4) and risk-taking (OR = 1.52, p = 0.028) on SA was independent of SZ genetic liability, the BD-SA relationship appeared to account for the effect of these risk factors. Similarly, the association with loneliness on SA was null after accounting for the effect of SZ genetic liability. These findings highlight the complex interplay between genetic risk of psychiatric disorders and behavioral traits in the context of SA, suggesting the need for a comprehensive mental health assessment for high-risk individuals.
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Affiliation(s)
- Brenda Cabrera-Mendoza
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, 06516, USA.
- VA CT Healthcare System, West Haven, CT, 06516, USA.
| | - Necla Aydin
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, 06516, USA
- Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gabriel R Fries
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054, Houston, TX, USA
| | - Anna R Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, Salt Lake City, UT, USA
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Consuelo Walss-Bass
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054, Houston, TX, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, 06516, USA
- VA CT Healthcare System, West Haven, CT, 06516, USA
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6
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Jepsen JRM, Rydkjaer J, Fagerlund B, Lemvigh CK, Pagsberg AK, Glenthøj BY, Oranje B. Cross-sectional associations between adaptive functioning and social cognitive and neurocognitive functions in adolescents with first-episode, early-onset schizophrenia spectrum disorders. Dev Psychopathol 2024; 36:208-218. [PMID: 36484139 DOI: 10.1017/s0954579422001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few studies have explored associations between adaptive functioning and cognition in adolescents with early-onset schizophrenia spectrum disorders (EOS). METHODS Adaptive functioning, cognition, positive, negative, and general symptoms were characterized in adolescents with EOS and healthy controls. A modified scale of negative, respectively, general symptoms was used. Bivariate analyses identified correlates of adaptive functioning to be included in multivariate analysis. RESULTS Adolescents with EOS showed significant impairments of social- and neurocognitive functions (-0.86 < Cohen´s ds < -0.58) and adaptive functioning (Cohen´s d = -2.23). Visual memory, verbal working memory, processing speed, reaction time, social cognition, and modified negative and general symptoms correlated significantly with adaptive functioning. The multiple regression analysis revealed only verbal working memory as uniquely associated with adaptive functioning (explaining 22.7 % of its variance). Verbal working memory also associated significantly with adaptive functioning in the context of the nonsignificant modified negative and the significant modified general symptoms dimension. CONCLUSIONS Adolescents with first-episode EOS had large impairments in adaptive functioning and moderate to large cognitive deficits. Verbal working memory was an important associate to concurrent adaptive functioning and may be a treatment target for trials to improve cognitive and adaptive functioning in adolescents with EOS.
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Affiliation(s)
- J R M Jepsen
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center, Glostrup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - J Rydkjaer
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center, Glostrup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - B Fagerlund
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center, Glostrup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Cecilie K Lemvigh
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center, Glostrup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - A K Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - B Y Glenthøj
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center, Glostrup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - B Oranje
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center, Glostrup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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7
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Di Luzio M, Pontillo M, Villa M, Attardi AG, Bellantoni D, Di Vincenzo C, Vicari S. Clinical features and comorbidity in very early-onset schizophrenia: a systematic review. Front Psychiatry 2023; 14:1270799. [PMID: 38152354 PMCID: PMC10752227 DOI: 10.3389/fpsyt.2023.1270799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/16/2023] [Indexed: 12/29/2023] Open
Abstract
Background Very early-onset schizophrenia (VEOS) is a form of schizophrenia that manifests before the age of 13 years and is characterized by the presence of positive, negative, and disorganized symptoms. The condition is exceptionally rare and, to date, limited studies have been conducted, resulting in incomplete information about its clinical features. Methods The present study involves a systematic review of the existing literature regarding the clinical features and comorbidities of VEOS. Results The first search retrieved 384 studies. Of these, 366 were removed following the application of exclusion criteria, resulting in 18 studies for the final set. Conclusion The results highlight that VEOS shares similarities with early-onset and adult-onset schizophrenia but also exhibits distinct and recognizable characteristics, including a more severe clinical profile (particularly in females), increased visual hallucinations, and high comorbidities with neurodevelopmental disorders. These findings may support clinicians in formulating early diagnoses and developing effective treatment strategies for pediatric and adolescent patients with psychosis.
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Affiliation(s)
- Michelangelo Di Luzio
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Pontillo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marianna Villa
- Life Sciences and Public Health Department, Catholic University, Rome, Italy
| | - Anna Gaia Attardi
- Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi", Unit of Child Neurology and Psychiatry, University of Messina, Messina, Italy
- School of Child Neurology and Psychiatry, PROMISE Department, University of Palermo, Palermo, Italy
| | - Domenica Bellantoni
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cristina Di Vincenzo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Life Sciences and Public Health Department, Catholic University, Rome, Italy
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8
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Patterson EM, Lim J, Fuchs P, Smith JR, Moussa-Tooks A, Ward HB. Use of First-Generation Antipsychotics in an Adolescent Male with Catatonic Schizophrenia. Harv Rev Psychiatry 2023; 31:267-273. [PMID: 37823777 DOI: 10.1097/hrp.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Emmy Masur Patterson
- From Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN (Drs. Patterson, Moussa-Tooks, and Ward); Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, TN (Dr. Lim); Sheppard Pratt Hospital, Baltimore, MD (Dr. Fuchs); Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN (Dr. Smith); Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN (Dr. Smith)
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9
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Michel C, Lerch S, Büetiger JR, Flückiger R, Cavelti M, Koenig J, Kaess M, Kindler J. An ecological momentary assessment study of age effects on perceptive and non-perceptive clinical high-risk symptoms of psychosis. Eur Child Adolesc Psychiatry 2023; 32:1841-1852. [PMID: 35585271 PMCID: PMC9116495 DOI: 10.1007/s00787-022-02003-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/30/2022] [Indexed: 11/15/2022]
Abstract
Among individuals with clinical high risk for psychosis (CHR), perceptive symptoms are more frequent but have less clinical significance in children/adolescents compared to adults. However, findings are based on clinical interviews relying on patient's recall capacity. Ecological momentary assessment (EMA) can be used to explore experiences in real-time in the subject's daily life. The aim of this study was to assess frequency and stability of (perceptive and non-perceptive) CHR symptoms and to explore potential age effects. EMA was used in a sample of an early detection for psychosis service in Bern, Switzerland (N = 66; 11-36 years). CHR symptoms were recorded in random time intervals for seven days: eight assessments per day per subject, minimum time between prompts set at 25 min. CHR symptoms were additionally assessed with semi-structured interviews including the 'Structured Interview for Psychosis-Risk Syndromes' and the 'Schizophrenia Proneness Instruments'. Mixed-effects linear regression analysis on the frequency of CHR symptoms revealed a significant effect of age group, and the interaction CHR symptoms x age group for both perceptive and non-perceptive symptoms. Further, regarding stability of CHR symptoms, there was a significant effect of the interaction CHR symptoms x age group for perceptive symptoms only. Based on EMA, perceptive CHR symptoms were more frequently reported but less stable in children/adolescents compared with adults. Together with previous findings, our finding of higher instability/variability of perceptive symptoms in younger persons might suggest that with advancing age and more stability of CHR symptoms, clinical relevance (reduced psychosocial functioning) may increase.
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Affiliation(s)
- C Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - S Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - J R Büetiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - R Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - M Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - J Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - M Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - J Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Dor-Nedonsel E, Fernandez A, Menard ML, Manera V, Laure G, Thümmler S, Askenazy F. Early-onset schizophrenia: studying the links between cognitive and clinical dimensions. Cogn Neuropsychiatry 2023; 28:377-390. [PMID: 37819235 DOI: 10.1080/13546805.2023.2266871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 08/30/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Early-onset schizophrenia (EOS), a rare and severe chronic psychiatric condition, is defined by an onset of schizophrenia symptoms before the age of 18. Core symptoms also include cognitive impairments. However, little is known about links between psychiatric symptoms of EOS and cognitive abilities. OBJECTIVE To explore the clinical and neurocognitive profiles of EOS patients and their links. METHOD EOS patients have been phenotyped using standardised psychiatric assessments for DSM-5 diagnoses (K-SADS-PL) and for symptoms (PANSS and SANS), together with neurocognitive evaluations. RESULTS The EOS sample (n = 27, 12.4 +/-3.2 years) presented hallucinations (83%), negative symptoms (70%) and delusion (59%). 81% of patients presented comorbidities such as anxiety disorders (33%), autism spectrum disorder (26%) and attention-deficit hyperactivity disorder (26%). Patients presented borderline intellectual deficiency (total IQ = 72.5 +/-4.7), with low performances in working memory subtest. We highlight a positive correlation between the IQ and intensity of positive symptoms (PANSS) and between the IQ and a first treatment being administered at an older age. We also highlight a negative correlation between the IQ and attention items of SANS. CONCLUSION Cognitive skills are correlated with symptom intensity in EOS patients. An older age of onset seems to be a protective factor for cognitive development.
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Affiliation(s)
- Emmanuelle Dor-Nedonsel
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
- Université Côte d'Azur, CoBTek, France
| | - Arnaud Fernandez
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
- Université Côte d'Azur, CoBTek, France
| | - Marie-Line Menard
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
- Université Côte d'Azur, CoBTek, France
| | | | - Gaëlle Laure
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
| | - Susanne Thümmler
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
- Université Côte d'Azur, CoBTek, France
| | - Florence Askenazy
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
- Université Côte d'Azur, CoBTek, France
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11
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Seitz-Holland J, Nägele FL, Kubicki M, Pasternak O, Cho KIK, Hough M, Mulert C, Shenton ME, Crow TJ, James ACD, Lyall AE. Shared and distinct white matter abnormalities in adolescent-onset schizophrenia and adolescent-onset psychotic bipolar disorder. Psychol Med 2023; 53:4707-4719. [PMID: 35796024 PMCID: PMC11119277 DOI: 10.1017/s003329172200160x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND While adolescent-onset schizophrenia (ADO-SCZ) and adolescent-onset bipolar disorder with psychosis (psychotic ADO-BPD) present a more severe clinical course than their adult forms, their pathophysiology is poorly understood. Here, we study potentially state- and trait-related white matter diffusion-weighted magnetic resonance imaging (dMRI) abnormalities along the adolescent-onset psychosis continuum to address this need. METHODS Forty-eight individuals with ADO-SCZ (20 female/28 male), 15 individuals with psychotic ADO-BPD (7 female/8 male), and 35 healthy controls (HCs, 18 female/17 male) underwent dMRI and clinical assessments. Maps of extracellular free-water (FW) and fractional anisotropy of cellular tissue (FAT) were compared between individuals with psychosis and HCs using tract-based spatial statistics and FSL's Randomise. FAT and FW values were extracted, averaged across all voxels that demonstrated group differences, and then utilized to test for the influence of age, medication, age of onset, duration of illness, symptom severity, and intelligence. RESULTS Individuals with adolescent-onset psychosis exhibited pronounced FW and FAT abnormalities compared to HCs. FAT reductions were spatially more widespread in ADO-SCZ. FW increases, however, were only present in psychotic ADO-BPD. In HCs, but not in individuals with adolescent-onset psychosis, FAT was positively related to age. CONCLUSIONS We observe evidence for cellular (FAT) and extracellular (FW) white matter abnormalities in adolescent-onset psychosis. Although cellular white matter abnormalities were more prominent in ADO-SCZ, such alterations may reflect a shared trait, i.e. neurodevelopmental pathology, present across the psychosis spectrum. Extracellular abnormalities were evident in psychotic ADO-BPD, potentially indicating a more dynamic, state-dependent brain reaction to psychosis.
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Affiliation(s)
- Johanna Seitz-Holland
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Felix L. Nägele
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Marek Kubicki
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kang Ik K. Cho
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Morgan Hough
- SANE POWIC, University Department of Psychiatry, Warneford Hospital, Oxford, UK
- Highfield Unit, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Christoph Mulert
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University, Giessen, Germany
| | - Martha E. Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy J. Crow
- SANE POWIC, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Anthony C. D. James
- SANE POWIC, University Department of Psychiatry, Warneford Hospital, Oxford, UK
- Highfield Unit, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Amanda E. Lyall
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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12
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Gupta N, Gupta M, Esang M. Lost in Translation: Challenges in the Diagnosis and Treatment of Early-Onset Schizophrenia. Cureus 2023; 15:e39488. [PMID: 37362509 PMCID: PMC10290525 DOI: 10.7759/cureus.39488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Early-onset schizophrenia (EOS) is a heterogeneous condition that has a serious, insidious clinical course and poor long-term mental health outcomes. The clinical presentations are highly complex due to the overlapping symptomatology with other illnesses, which contributes to a delay in the diagnosis. The objective of the review is to study if an earlier age of onset (AAO) of EOS has poor clinical outcomes, the diagnostic challenges of EOS, and effective treatment strategies. The review provides a comprehensive literature search of 5966 articles and summarizes 126 selected for empirical evidence to methodically consider challenges in diagnosing and treating EOS for practicing clinicians. The risk factors of EOS are unique but have been shared with many other neuropsychiatric illnesses. Most of the risk factors, including genetics and obstetric complications, are nonmodifiable. The role of early diagnosis in reducing the duration of untreated psychosis (DUP) remains critical to reducing overall morbidity. Many specific issues contribute to the risk and clinical outcomes. Therefore, issues around diagnostic ambiguity, treatment resistance, nonadherence, and rehospitalizations further extend the DUP. There is hesitancy to initiate clozapine early, even though the empirical evidence strongly supports its use. There is a growing body of research that suggests the use of long-acting injectables to address nonadherence, and these measures are largely underutilized in acute settings. The clinical presentations of EOS are complex. In addition to the presence of specific risk factors, patients with an early onset of illness are also at a higher risk for treatment resistance. While there is a need to develop tools for early diagnosis, established evidence-based measures to address nonadherence, psychoeducation, and resistance must be incorporated into the treatment planning.
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Affiliation(s)
- Nihit Gupta
- Psychiatry, Dayton Children's Hospital, Dayton, USA
| | - Mayank Gupta
- Psychiatry and Behavioral Sciences, Southwood Psychiatric Hospital, Pittsburgh, USA
| | - Michael Esang
- Psychiatry and Behavioral Sciences, Clarion Psychiatric Center, Clarion, USA
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13
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Hojlo MA, Ghebrelul M, Genetti CA, Smith R, Rockowitz S, Deaso E, Beggs AH, Agrawal PB, Glahn DC, Gonzalez-Heydrich J, Brownstein CA. Children with Early-Onset Psychosis Have Increased Burden of Rare GRIN2A Variants. Genes (Basel) 2023; 14:779. [PMID: 37107537 PMCID: PMC10138040 DOI: 10.3390/genes14040779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/16/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Children and adolescents with early-onset psychosis (EOP) have more rare genetic variants than individuals with adult-onset forms of the illness, implying that fewer EOP participants are needed for genetic discovery. The Schizophrenia Exome Sequencing Meta-analysis (SCHEMA) study predicted that 10 genes with ultra-rare variation were linked to adult-onset schizophrenia. We hypothesized that rare variants predicted "High" and "Moderate" by the Variant Effect Predictor Algorithm (abbreviated as VEPHMI) in these 10 genes would be enriched in our EOP cohort. METHODS We compared rare VEPHMI variants in individuals with EOP (N = 34) with race- and sex-matched controls (N = 34) using the sequence kernel association test (SKAT). RESULTS GRIN2A variants were significantly increased in the EOP cohort (p = 0.004), with seven individuals (20% of the EOP cohort) carrying a rare VEPHMI variant. The EOP cohort was then compared to three additional control cohorts. GRIN2A variants were significantly increased in the EOP cohort for two of the additional control sets (p = 0.02 and p = 0.02), and trending towards significance for the third (p = 0.06). CONCLUSION Despite a small sample size, GRIN2A VEPHMI variant burden was increased in a cohort of individuals with EOP in comparison to controls. GRIN2A variants have been associated with a range of neuropsychiatric disorders including adult-onset psychotic spectrum disorder and childhood-onset schizophrenia. This study supports the role of GRIN2A in EOP and emphasizes its role in neuropsychiatric disorders.
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Affiliation(s)
- Margaret A. Hojlo
- Early Psychosis Investigation Center (EPICenter), Boston Children’s Hospital, Boston, MA 02115, USA
- Tommy Fuss Center for Neuropsychiatric Disease Research, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA 02115, USA
- The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Merhawi Ghebrelul
- The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA 02115, USA
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Casie A. Genetti
- The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA 02115, USA
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Richard Smith
- Early Psychosis Investigation Center (EPICenter), Boston Children’s Hospital, Boston, MA 02115, USA
- Tommy Fuss Center for Neuropsychiatric Disease Research, Boston Children’s Hospital, Boston, MA 02115, USA
- The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA 02115, USA
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Shira Rockowitz
- The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA 02115, USA
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115, USA
- Research Computing, Information Technology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Emma Deaso
- Early Psychosis Investigation Center (EPICenter), Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Alan H. Beggs
- The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA 02115, USA
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Pankaj B. Agrawal
- The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA 02115, USA
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Holtz Children’s Hospital, Jackson Health System, Miami, FL 33136, USA
| | - David C. Glahn
- Early Psychosis Investigation Center (EPICenter), Boston Children’s Hospital, Boston, MA 02115, USA
- Tommy Fuss Center for Neuropsychiatric Disease Research, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA 02115, USA
- The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA 02115, USA
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Joseph Gonzalez-Heydrich
- Early Psychosis Investigation Center (EPICenter), Boston Children’s Hospital, Boston, MA 02115, USA
- Tommy Fuss Center for Neuropsychiatric Disease Research, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA 02115, USA
- The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Catherine A. Brownstein
- Early Psychosis Investigation Center (EPICenter), Boston Children’s Hospital, Boston, MA 02115, USA
- Tommy Fuss Center for Neuropsychiatric Disease Research, Boston Children’s Hospital, Boston, MA 02115, USA
- The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA 02115, USA
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
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14
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Ceylan MF, Tural Hesapcioglu S, Kanoğlu Yüksekkaya S, Erçin G, Yavas CP, Neşelіoğlu S, Erel O. Changes in neurofilament light chain protein (NEFL) in children and adolescents with Schizophrenia and Bipolar Disorder: Early period neurodegeneration. J Psychiatr Res 2023; 161:342-347. [PMID: 37003244 DOI: 10.1016/j.jpsychires.2023.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/08/2022] [Accepted: 03/16/2023] [Indexed: 04/03/2023]
Abstract
AIM Neurofilament light chain protein (NEFL), is defined as a structural protein which exists particularly in axones of neurons and is released to the cerum in consequence of neuroaxonal damage. The aim of this study is to investigate the peripheral cerumNEFLlevels of children and adolescents with early onset schizophrenia and bipolar disorder. METHOD In this study, we evaluated serum levels of NEFL in children and adolescents (13-17 years) with schizophrenia, bipolar disorder and healthy control group. The study is conducted with 35 schizophrenia, 38 bipolar disorder manic episode patients and 40 healthy controls. RESULTS The median age of the patient and control groups was 16 (IQR- Interquartile Range: 2). There was no statistical difference in median age (p = 0.52) and gender distribution(p = 0.53) between groups. NEFL levels of the patients with schizophrenia were significantly higher than the controls. NEFL levels of the patients with bipolar disorder were significantly higher than the controls. Serum levels of NEFL of the schizophrenia were higher than the bipolar disorder; however, the difference was not statistically significant. CONCLUSION In conclusion, serum NEFL level, as a confidential marker of neural damage, is increased in the children and adolescents with bipolar disorder and schizophrenia. This result may indicatea degenerative period in neurons of children and adolescents with schizophrenia or bipolar disorder and may play a role in the pathophisiology of these disorders. This result shows that there is neuronal damage in both diseases, but neuronal damage may be more in schizophrenia.
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Affiliation(s)
- Mehmet Fatih Ceylan
- Ankara Yildirim Beyazit University, Faculty of Medicine, Child and Adolescent Psychiatry Department, Ankara, Turkey.
| | - Selma Tural Hesapcioglu
- Ankara Yildirim Beyazit University, Faculty of Medicine, Child and Adolescent Psychiatry Department, Ankara, Turkey
| | - Seda Kanoğlu Yüksekkaya
- Ankara Yildirim Beyazit University, Faculty of Medicine, Child and Adolescent Psychiatry Department, Ankara, Turkey
| | - Görkem Erçin
- Ankara Yildirim Beyazit University, Faculty of Medicine, Child and Adolescent Psychiatry Department, Ankara, Turkey
| | - Cansu Pınar Yavas
- Ankara Yildirim Beyazit University, Faculty of Medicine, Child and Adolescent Psychiatry Department, Ankara, Turkey
| | - Salim Neşelіoğlu
- Ankara Yildirim Beyazit University, Faculty of Medicine, Clinical Biochemistry Department, Ankara, Turkey
| | - Ozcan Erel
- Ankara Yildirim Beyazit University, Faculty of Medicine, Clinical Biochemistry Department, Ankara, Turkey
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15
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Cuñat O, Del Hoyo-Buxo B, Vila-Badia R, Serra-Arumí C, Butjosa A, Del Cacho N, Colomer-Salvans A, Dolz M, Cuevas-Esteban J, Iglesias-González M, Usall J, Profep Group. Negative symptoms in drug-naive patients with a first-episode psychosis (FEP). Asian J Psychiatr 2023; 81:103448. [PMID: 36652842 DOI: 10.1016/j.ajp.2023.103448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/02/2023] [Accepted: 01/02/2023] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Negative symptoms are nuclear features of schizophrenia that may be present from the onset of the disease. In recent years, it has been described 2 subdomains of negative symptoms: experiential and expressive deficits. The aim of the study is to examine the relationship between negative symptoms and demographic and clinical variables in patients with first-episode psychosis. Also, to explore whether there are differences in the association among these variables and negative symptoms when divided into both subdomains. MATERIAL AND METHODS A cross-sectional study was performed in 160 patients (52 females and 108 males) with a diagnosis of a first episode psychosis. A questionnaire was administered to collect demographic and clinical variables. RESULTS A backward stepwise linear regressions analysis was performed in order to observe potential associations between demographic and clinical variables and the presence of negative symptoms. All three models are predicted by worse PSP score, a higher CDSS, a higher disorganized factor score and a lower excited factor score. A longer duration of untreated psychosis (DUP) is associated to a higher score in the experiential deficit subdomain only. CONCLUSIONS Our work highlights some clinical and phenomenological differences between experiential and expressive deficits. We think that taking into account both subdomains in future studies may lead to more accurate clinical assessment and interventions.
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Affiliation(s)
- O Cuñat
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain.
| | - B Del Hoyo-Buxo
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
| | - R Vila-Badia
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - C Serra-Arumí
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - A Butjosa
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Hospital Infanto-juvenil Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, CIBERSAM, Esplugues de Llobregat, Spain
| | - N Del Cacho
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - A Colomer-Salvans
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - M Dolz
- Hospital Infanto-juvenil Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, CIBERSAM, Esplugues de Llobregat, Spain
| | - J Cuevas-Esteban
- Hospital Universitari Germans Trias i Pujol, CIBERSAM, Badalona, Spain; Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - M Iglesias-González
- Hospital Universitari Germans Trias i Pujol, CIBERSAM, Badalona, Spain; Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - J Usall
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Profep Group
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
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16
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Barth C, Kelly S, Nerland S, Jahanshad N, Alloza C, Ambrogi S, Andreassen OA, Andreou D, Arango C, Baeza I, Banaj N, Bearden CE, Berk M, Bohman H, Castro-Fornieles J, Chye Y, Crespo-Facorro B, de la Serna E, Díaz-Caneja CM, Gurholt TP, Hegarty CE, James A, Janssen J, Johannessen C, Jönsson EG, Karlsgodt KH, Kochunov P, Lois NG, Lundberg M, Myhre AM, Pascual-Diaz S, Piras F, Smelror RE, Spalletta G, Stokkan TS, Sugranyes G, Suo C, Thomopoulos SI, Tordesillas-Gutiérrez D, Vecchio D, Wedervang-Resell K, Wortinger LA, Thompson PM, Agartz I. In vivo white matter microstructure in adolescents with early-onset psychosis: a multi-site mega-analysis. Mol Psychiatry 2023; 28:1159-1169. [PMID: 36510004 PMCID: PMC10005938 DOI: 10.1038/s41380-022-01901-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
Emerging evidence suggests brain white matter alterations in adolescents with early-onset psychosis (EOP; age of onset <18 years). However, as neuroimaging methods vary and sample sizes are modest, results remain inconclusive. Using harmonized data processing protocols and a mega-analytic approach, we compared white matter microstructure in EOP and healthy controls using diffusion tensor imaging (DTI). Our sample included 321 adolescents with EOP (median age = 16.6 years, interquartile range (IQR) = 2.14, 46.4% females) and 265 adolescent healthy controls (median age = 16.2 years, IQR = 2.43, 57.7% females) pooled from nine sites. All sites extracted mean fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) for 25 white matter regions of interest per participant. ComBat harmonization was performed for all DTI measures to adjust for scanner differences. Multiple linear regression models were fitted to investigate case-control differences and associations with clinical variables in regional DTI measures. We found widespread lower FA in EOP compared to healthy controls, with the largest effect sizes in the superior longitudinal fasciculus (Cohen's d = 0.37), posterior corona radiata (d = 0.32), and superior fronto-occipital fasciculus (d = 0.31). We also found widespread higher RD and more localized higher MD and AD. We detected significant effects of diagnostic subgroup, sex, and duration of illness, but not medication status. Using the largest EOP DTI sample to date, our findings suggest a profile of widespread white matter microstructure alterations in adolescents with EOP, most prominently in male individuals with early-onset schizophrenia and individuals with a shorter duration of illness.
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Affiliation(s)
- Claudia Barth
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Sinead Kelly
- Department of Psychosis Studies, King's College London, London, UK
| | - Stener Nerland
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Neda Jahanshad
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Clara Alloza
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, Madrid, Spain
| | - Sonia Ambrogi
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Center for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Dimitrios Andreou
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Inmaculada Baeza
- Department Child and Adolescent Psychiatry and Psychology, 2017SGR881 Institute of Neuroscience, Hospital Clinic Barcelona. CIBERSAM. August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Nerisa Banaj
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- Department of Psychology, UCLA, Los Angeles, CA, USA
| | - Michael Berk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Hannes Bohman
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Josefina Castro-Fornieles
- Department Child and Adolescent Psychiatry and Psychology, 2017SGR881 Institute of Neuroscience, Hospital Clinic Barcelona. CIBERSAM. August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Yann Chye
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Benedicto Crespo-Facorro
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Department of Psychiatry, CIBERSAM, IBiS-CSIC, Sevilla, Spain
| | - Elena de la Serna
- Department Child and Adolescent Psychiatry and Psychology, 2017SGR881 Institute of Neuroscience, Hospital Clinic Barcelona. CIBERSAM. August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Tiril P Gurholt
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Center for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Anthony James
- Highfield Unit, Warneford Hospital, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Joost Janssen
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, Madrid, Spain
| | - Cecilie Johannessen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik G Jönsson
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
| | - Katherine H Karlsgodt
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- Department of Psychology, UCLA, Los Angeles, CA, USA
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MA, USA
| | - Noemi G Lois
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | - Mathias Lundberg
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Anne M Myhre
- Section of Child and Adolescent Mental Health Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Saül Pascual-Diaz
- Magnetic Resonance Imaging Core Facility, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Runar E Smelror
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gianfranco Spalletta
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Therese S Stokkan
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gisela Sugranyes
- Department Child and Adolescent Psychiatry and Psychology, 2017SGR881 Institute of Neuroscience, Hospital Clinic Barcelona. CIBERSAM. August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Chao Suo
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Diana Tordesillas-Gutiérrez
- Department of Radiology, Marqués de Valdecilla University Hospital, Valdecilla Biomedical Research Institute IDIVAL, Santander (Cantabria), Spain
- Advanced Computing and e-Science, Instituto de Física de Cantabria (UC-CSIC), Santander (Cantabria), Spain
| | - Daniela Vecchio
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Kirsten Wedervang-Resell
- Norwegian Center for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Laura A Wortinger
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Ingrid Agartz
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
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Neurodevelopmental Disorders, Schizophrenia Spectrum Disorders and Catatonia: The "Iron Triangle" Rediscovered in a Case Report. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010077. [PMID: 36670628 PMCID: PMC9856853 DOI: 10.3390/children10010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023]
Abstract
Catatonia is a complex neuropsychiatric syndrome, occurring in the context of different psychiatric and neurodevelopmental disorders, in neurological and medical disorders, and after substance abuse or withdrawal. The relationship between Autism Spectrum Disorder (ASD), Schizophrenia Spectrum Disorders (SSDs) and catatonia has been previously discussed, with the three disorders interpreted as different manifestations of the same underlying brain disorder (the "Iron Triangle"). We discuss in this paper the diagnostic, clinical and therapeutic implications of this complex relationship in an adolescent with ASD, who presented an acute psychotic onset with catatonia, associated with mixed mood symptoms. Second-generation antipsychotics were used to manage psychotic, behavioral and affective symptoms, with worsening of the catatonic symptoms. In this clinical condition, antipsychotics may be useful at the lowest dosages, with increases only in the acute phases, especially when benzodiazepines are ineffective. Mood stabilizers with higher GABAergic effects (such as Valproate and Gabapentin) and Lithium salts may be more useful and well tolerated, given the frequent association of depressive and manic symptoms with mixed features.
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Positiv psychotische Symptome in Kindheit und Jugend. Prax Kinderpsychol Kinderpsychiatr 2022; 71:640-657. [DOI: 10.13109/prkk.2022.71.7.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Salazar de Pablo G, Moreno D, Gonzalez-Pinto A, Paya B, Castro-Fonieles J, Baeza I, Graell M, Arango C, Rapado-Castro M, Moreno C. Affective symptom dimensions in early-onset psychosis over time: a principal component factor analysis of the Young Mania Rating Scale and the Hamilton Depression Rating Scale. Eur Child Adolesc Psychiatry 2022; 31:1715-1728. [PMID: 34052909 DOI: 10.1007/s00787-021-01815-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/23/2021] [Indexed: 12/11/2022]
Abstract
Early-onset psychosis (EOP) is a complex disorder characterized by a wide range of symptoms, including affective symptoms. Our aim was to (1) examine the dimensional structure of affective symptoms in EOP, (2) evaluate the predominance of the clinical dimensions and (3) assess the progression of the clinical dimensions over a 2-year period. STROBE-compliant prospective principal component factor analysis of Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale-21 (HDRS-21) at baseline, 6-months, 1-year and 2-year follow-up. We included 108 EOP individuals (mean age = 15.5 ± 1.8 years, 68.5% male). The factor analysis produced a four-factor model including the following dimensions: mania, depression/anxiety, sleep and psychosis. It explained 47.4% of the total variance at baseline, 60.6% of the total variance at 6-months follow-up, 54.5% of the total variance at 1-year follow-up and 49.5% of the total variance at 2-year follow-up. According to the variance explained, the mania factor was predominant at baseline (17.4%), 6-month follow-up (23.5%) and 2-year follow-up (26.1%), while the depression/anxiety factor was predominant at 1-year follow-up (23.1%). The mania factor was the most stable; 58.3% items that appeared in this factor (with a load > 0.4) at any time point appeared in the same factor at ≥ 3/4 time points. Affective symptoms are frequent and persistent in EOP. Mania seems to be the most predominant and stable affective dimension. However, depression and anxiety may gain predominance with time. A comprehensive evaluation of the dimensional structure and the progression of affective symptoms may offer clinical and therapeutic advantages.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain.,Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dolores Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain
| | - Ana Gonzalez-Pinto
- Department of Psychiatry, Biomedical Research Networking Centre in Mental Health, BioAraba Research Institute, OSI Araba-University Hospital, University of the Basque Country (EHU/UPV), CIBERSAM, Vitoria, Spain
| | - Beatriz Paya
- Department of Child Psychiatry, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Josefina Castro-Fonieles
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Neurosciences Institute, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Neurosciences Institute, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Montserrat Graell
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Infantil Universitario Niño Jesús, School of Medicine, Universidad Autónoma, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain
| | - Marta Rapado-Castro
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain. .,Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Victoria, Australia.
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain
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20
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Brownstein CA, Douard E, Mollon J, Smith R, Hojlo MA, Das A, Goldman M, Garvey E, Cabral K, Li J, Bowen J, Rao AS, Genetti C, Carroll D, Knowles EEM, Deaso E, Agrawal PB, Beggs AH, D'Angelo E, Almasy L, Alexander-Bloch A, Saci Z, Moreau CA, Huguet G, Deo AJ, Jacquemont S, Glahn DC, Gonzalez-Heydrich J. Similar Rates of Deleterious Copy Number Variants in Early-Onset Psychosis and Autism Spectrum Disorder. Am J Psychiatry 2022; 179:853-861. [PMID: 36000218 PMCID: PMC9633349 DOI: 10.1176/appi.ajp.21111175] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Copy number variants (CNVs) are strongly associated with neurodevelopmental and psychotic disorders. Early-onset psychosis (EOP), where symptoms appear before 18 years of age, is thought to be more strongly influenced by genetic factors than adult-onset psychotic disorders. However, the prevalence and effect of CNVs in EOP is unclear. METHODS The authors documented the prevalence of recurrent CNVs and the functional impact of deletions and duplications genome-wide in 137 children and adolescents with EOP compared with 5,540 individuals with autism spectrum disorder (ASD) and 16,504 population control subjects. Specifically, the frequency of 47 recurrent CNVs previously associated with neurodevelopmental and neuropsychiatric illnesses in each cohort were compared. Next, CNV risk scores (CRSs), indices reflecting the dosage sensitivity for any gene across the genome that is encapsulated in a deletion or duplication separately, were compared between groups. RESULTS The prevalence of recurrent CNVs was significantly higher in the EOP group than in the ASD (odds ratio=2.30) and control (odds ratio=5.06) groups. However, the difference between the EOP and ASD groups was attenuated when EOP participants with co-occurring ASD were excluded. CRS was significantly higher in the EOP group compared with the control group for both deletions (odds ratio=1.30) and duplications (odds ratio=1.09). In contrast, the EOP and ASD groups did not differ significantly in terms of CRS. CONCLUSIONS Given the high frequency of recurrent CNVs in the EOP group and comparable CRSs in the EOP and ASD groups, the findings suggest that all children and adolescents with a psychotic diagnosis should undergo genetic screening, as is recommended in ASD.
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Affiliation(s)
- Catherine A Brownstein
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Elise Douard
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Josephine Mollon
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Richard Smith
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Margaret A Hojlo
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Ananth Das
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Maria Goldman
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Emily Garvey
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Kristin Cabral
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Jianqiao Li
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Joshua Bowen
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Abhijit S Rao
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Casie Genetti
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Devon Carroll
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Emma E M Knowles
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Emma Deaso
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Pankaj B Agrawal
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Alan H Beggs
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Eugene D'Angelo
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Laura Almasy
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Aaron Alexander-Bloch
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Zohra Saci
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Clara A Moreau
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Guillaume Huguet
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Anthony J Deo
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Sébastien Jacquemont
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - David C Glahn
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
| | - Joseph Gonzalez-Heydrich
- Early Psychosis Investigation Center (Brownstein, Mollon, Smith, Hojlo, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Division of Genetics and Genomics (Brownstein, Smith, Cabral, Li, Bowen, Rao, Genetti, Agrawal, Beggs, Glahn), Manton Center for Orphan Disease Research (Brownstein, Smith, Cabral, Li, Bowen, Genetti, Agrawal, Beggs, Glahn), Department of Psychiatry and Behavioral Sciences (Mollon, Hojlo, Das, Goldman, Garvey, Carroll, Knowles, Deaso, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Tommy Fuss Center for Neuropsychiatric Disease Research (Deo, Glahn, Gonzalez-Heydrich), and Division of Newborn Medicine (Agrawal), Boston Children's Hospital, Boston; Department of Pediatrics (Brownstein, Smith, Genetti, Agrawal, Beggs, Deo) and Department of Psychiatry (Mollon, Carroll, Knowles, D'Angelo, Deo, Glahn, Gonzalez-Heydrich), Harvard Medical School, Boston; Department of Pediatrics (Jacquemont) and Department of Neuroscience (Douard, Moreau), Université de Montréal, Montreal; Sainte-Justine Hospital Research Center, Montreal (Douard, Saci, Moreau, Huguet, Jacquemont); Department of Biomedical and Health Informatics (Almasy) and Department of Psychiatry (Alexander-Bloch), Children's Hospital of Philadelphia, Philadelphia; Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, N.J. (Deo); Rutgers University Behavioral Health Care, Piscataway, N.J. (Deo). Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia (Almasy); Department of Genetics, University of Pennsylvania, Philadelphia (Almasy); Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago (Smith)
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21
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Johnson KA, Shrier LA, Eiduson R, Parsa N, Lilly M, D'Angelo E, Straus JH, Woodberry KA. Depressive symptom screening and endorsement of psychosis risk-related experiences in a diverse adolescent and young adult outpatient clinic in the US. Schizophr Res 2022; 248:353-360. [PMID: 34840005 DOI: 10.1016/j.schres.2021.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/05/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early identification and intervention is a gold standard for psychotic disorders, for which delays in care can have serious consequences. Screening for psychosis in primary care may circumvent barriers related to stigma and facilitate shorter pathways to care. Yet, there is debate regarding the benefit-risk balance for psychosis screening in general adolescent populations. METHODS Primary care patients of an adolescent/young adult medical clinic in the US ages 14-21 self-administered surveys assessing age, sex, receipt of psychotherapy, and occurrence, frequency (1-5), and distress (0-3) for 23 psychosis risk (PR) symptoms, including 6 general/nonspecific items and 17 psychosis-specific items. Participants also completed the 9-item Patient Health Questionnaire (PHQ-9); scores of ≥10 suggested clinically significant depressive symptoms. Analyses characterized PR symptoms and examined associations of PR symptom distress with current therapy and depressive symptom severity. RESULTS Of 212 patients who completed the survey, 75% endorsed ≥1 PR symptom and 27% rated ≥3 on distress for psychosis-specific items. Those with high PHQ-9 scores reported higher PR distress overall (t = -6.1, df = 52.3, p < 0.001) but not on psychosis-specific items such as hallucinations and suspiciousness. One in 9 participants reported heightened PR distress without being in therapy or having high depressive symptoms. CONCLUSIONS Most adolescents in this primary care sample endorsed symptoms associated with PR. Distress related to these symptoms was less common but occurred even in the absence of depressive symptoms. PR screening only in youth with high depressive symptom screens or in mental health care may miss youth needing further assessment for psychosis.
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Affiliation(s)
- Kelsey A Johnson
- Beth Israel Deaconess Medical Center Department of Psychiatry, Boston, MA, USA; Boston Children's Hospital, Boston, MA, USA.
| | - Lydia A Shrier
- Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - Megan Lilly
- Beth Israel Deaconess Medical Center Department of Psychiatry, Boston, MA, USA
| | - Eugene D'Angelo
- Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - John H Straus
- Massachusetts Behavioral Health Partnership, Beacon Health Options, Boston, MA, USA
| | - Kristen A Woodberry
- Beth Israel Deaconess Medical Center Department of Psychiatry, Boston, MA, USA; Maine Medical Center, Center for Psychiatric Research, Portland, ME, USA; Tufts School of Medicine, USA; Harvard Medical School, Boston, MA, USA
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22
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Karakuş OB, Ermiş Ç, Tunçtürk M, Yüksel AS, Alarslan S, Sağlam Y, Görmez V, Karaçetin G. Identifying clinical and psychological correlates of persistent negative symptoms in early-onset psychotic disorders. Clin Child Psychol Psychiatry 2022; 27:1288-1302. [PMID: 35227101 DOI: 10.1177/13591045221075531] [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] [Indexed: 01/09/2023]
Abstract
Persistent negative symptoms (PNS) contribute to impairment in psychosis. The characteristics of PNS seen in youth remained under-investigated. We aimed to demonstrate clinical, treatment-related, and psychosocial characteristics of PNS in early-onset schizophrenia-spectrum disorders (EOSD). 132 patients with EOSD were assessed with Positive and Negative Symptom Scale, Brief Negative Symptom Scale, Calgary Depression Scale for Schizophrenia, and Simpson-Angus Scale. Parenting skills and resilience were evaluated using Parental Attitude Research Instrument and Child and Youth Resilience Measure-12. Longer duration of untreated psychosis (DUP) and prodromal phase were found in primary and secondary PNS groups, compared to the non-PNS group. The primary PNS group was characterized by earlier age-onset, lower smoking rates, and more common clozapine use. Resilience and egalitarian/democratic parenting were negatively correlated with symptoms related to motivation/pleasure and blunted expression. More blunted expression-related symptoms and longer DUP in the first episode significantly predicted primary/secondary PNS at follow-up. Using the data from total negative symptom scores and DUP, Receiver Operating Characteristic analyses significantly differentiated primary/secondary PNS groups from the non-PNS counterparts. PNS associated with blunted expression and low motivation/pleasure in the first episode could persist into clinical follow-up. Effective pharmacological treatment and psychosocial interventions are needed in youth.
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Affiliation(s)
- Oğuz Bilal Karakuş
- Department of Child and Adolescent Psychiatry, 147007University of Health Sciences, Istanbul Erenkoy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Çağatay Ermiş
- Department of Child and Adolescent Psychiatry, Diyarbakir Children's Hospital, Diyarbakir, Turkey
| | - Mustafa Tunçtürk
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Ayşe Sena Yüksel
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Sezen Alarslan
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Yeşim Sağlam
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Vahdet Görmez
- Faculty of Medicine, Department of Child and Adolescent PsychiatryIstanbul Medeniyet University, Istanbul, Turkey
| | - Gül Karaçetin
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
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23
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Kaga I, Iwata H, Tokushige A, Akata T, Ueda S. Duration of the untreated period affects bone mineral density in psychiatric patients requiring long-term hospitalization: A cross-sectional study. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2022; 1:e25. [PMID: 38868695 PMCID: PMC11114306 DOI: 10.1002/pcn5.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/05/2022] [Accepted: 05/29/2022] [Indexed: 06/14/2024]
Abstract
Aim Osteoporosis and bone fractures occur often on psychiatric wards. Although recent studies showed that bone mineral density (BMD) decreases in psychiatric patients, many risk factors remain unknown. This study aimed to explore the risk factors for decreased BMD in long-term psychiatric inpatients in a closed ward. Methods A cross-sectional study of psychiatric inpatients hospitalized for over 20 weeks was conducted. Patients were divided into three groups according to BMD: normal, osteopenia, and osteoporosis. Psychiatric symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS). The relevant history of psychiatric diseases was collected, and biomarkers related to osteoporosis were measured. Univariable and multivariable ordinal logistic regression analyses were performed to identify variables significantly associated with BMD category. Additional analyses evaluated the associations between an identified clinical variable and biomarkers and psychiatric symptoms that may be related to osteoporosis. Results Seventy-one patients (28 normal BMD, 17 osteopenia, and 26 osteoporosis) participated in the study. The multivariable ordinal logistic analysis showed that the duration of untreated psychosis (DUP) was a risk factor (odds ratio = 0.77, 95% confidence interval: 0.63-0.91, p = 0.006), adjusting for the major confounders of sex and age. Additional analysis showed significant differences in BPRS, BPRS Negative Symptom score, and the Cu/Zn ratio between the short-DUP group (DUP ≤ 1 year) and the long-DUP group (DUP > 1 year). Conclusion The DUP may affect BMD in long-term psychiatric inpatients, presumably partly through increased severity of negative symptoms and micronutrient abnormalities. Shortening the untreated period might reduce the risk of osteoporosis.
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Affiliation(s)
- Itsuka Kaga
- Department of Clinical Research and Quality ManagementUniversity of the Ryukyus Graduate School of MedicineOkinawaJapan
- Department of PsychiatryGunma Prefectural Psychiatric Medical CenterIsesakiJapan
| | - Hiroyoshi Iwata
- Department of Clinical Pharmacology and TherapeuticsUniversity of the Ryukyus Graduate School of MedicineOkinawaJapan
| | - Akihiro Tokushige
- Department of Clinical Pharmacology and TherapeuticsUniversity of the Ryukyus Graduate School of MedicineOkinawaJapan
- Department of Prevention and Analysis of Cardiovascular DiseasesKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Takushiro Akata
- Department of PsychiatryGunma Prefectural Psychiatric Medical CenterIsesakiJapan
| | - Shinichiro Ueda
- Department of Clinical Research and Quality ManagementUniversity of the Ryukyus Graduate School of MedicineOkinawaJapan
- Department of Clinical Pharmacology and TherapeuticsUniversity of the Ryukyus Graduate School of MedicineOkinawaJapan
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24
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Arango C, Buitelaar JK, Correll CU, Díaz-Caneja CM, Figueira ML, Fleischhacker WW, Marcotulli D, Parellada M, Vitiello B. The transition from adolescence to adulthood in patients with schizophrenia: Challenges, opportunities and recommendations. Eur Neuropsychopharmacol 2022; 59:45-55. [PMID: 35550205 DOI: 10.1016/j.euroneuro.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Abstract
Schizophrenia is a severely debilitating neurodevelopmental disorder that requires continuous multidisciplinary treatment. Early onset schizophrenia (EOS, onset before 18) is associated with poorer outcomes than the adult-onset type. The transition from adolescent to adult mental healthcare services (AMHS) poses various challenges for maintaining continuity of care. The heterogeneous availability of specialized mental health services and resources for people with schizophrenia across Europe and the inadequacy of training programs in creating a shared culture and knowledge base between child and adult mental health professionals are major challenges at the policy level. More flexible and individualized transition timing is also needed. While changes in the relationship between patients, caregivers and mental health professionals at a time when young people should acquire full responsibility for their own care are challenges common to all mental health disorders, these are particularly relevant to the care of schizophrenia because of the severe associated disability. This Expert Opinion Paper examines the main aspects of transitioning of care in schizophrenia with the aim of identifying the challenges and the potential approaches that could enhance continuity of care.
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Affiliation(s)
- Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid 28009, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid 28029, Spain.
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, the Netherlands
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid 28009, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid 28029, Spain
| | | | | | - Daniele Marcotulli
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid 28009, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid 28029, Spain
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
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25
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de Jong Y, Boon AE, Gouw D, van der Gaag M, Mulder CL. Improving screening methods for psychosis in an adolescent help-seeking population using the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR) versus the Prodromal Questionnaire -16 items version (PQ-16). Child Adolesc Psychiatry Ment Health 2022; 16:25. [PMID: 35361241 PMCID: PMC8973987 DOI: 10.1186/s13034-022-00459-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Screening methods for detecting Ultra High Risk status (UHR) or psychosis should be improved, especially in adolescent samples. We therefore tested whether the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR) add value to the Prodromal Questionnaire-16 items version (PQ-16) for detecting UHR status or psychosis. METHODS We included help-seeking adolescents who had completed the PQ-16, YSR, CBCL, and a Comprehensive Assessment of an At Risk Mental States (CAARMS) interview, and used independent samples t-tests and binary logistic regression analyses to determine the scales contributing to the prediction of UHR status or of having reached the psychosis threshold (PT). Cutoff scores were determined using ROC analyses. RESULTS Our sample comprised 270 help-seeking adolescents (mean age 14.67; SD 1.56, range 12-17); 67.8% were girls and 66.3% were of Dutch origin. The Thought Problems syndrome scales of both the YSR and the CBCL best predicted UHR or PT, and had screening values comparable to the PQ-16. Other syndrome scales did not improve screening values. Although combining measures reduced the number of false negatives, it also increased the number of adolescents to be interviewed. The best choice was to combine the YSR Thought Problems scale and the PQ-16 as a first-step screener. CONCLUSIONS Combining measures improves the detection of UHR or PT in help-seeking adolescents. The Thought Problems subscales of the YSR and CBCL can both be used as a first-step screener in the detection of UHR and/or psychosis. Trial registration Permission was asked according to the rules of the Ethics Committee at Leiden. This study is registered as NL.44180.058.13.
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Affiliation(s)
- Yvonne de Jong
- Parnassia Psychiatric Institute, Rotterdam and The Hague, the Netherlands. .,Department of Psychiatry, Epidemiological and Psychiatric Research Institute, Erasmus MC, Rotterdam, the Netherlands.
| | - Albert E. Boon
- grid.476585.d0000 0004 0447 7260Parnassia Psychiatric Institute, Rotterdam and The Hague, the Netherlands ,grid.10419.3d0000000089452978LUMC Curium - Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniek Gouw
- grid.476585.d0000 0004 0447 7260Parnassia Psychiatric Institute, Rotterdam and The Hague, the Netherlands
| | - Mark van der Gaag
- grid.476585.d0000 0004 0447 7260Parnassia Psychiatric Institute, Rotterdam and The Hague, the Netherlands ,grid.12380.380000 0004 1754 9227Department of Clinical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Cornelis L. Mulder
- grid.476585.d0000 0004 0447 7260Parnassia Psychiatric Institute, Rotterdam and The Hague, the Netherlands ,grid.5645.2000000040459992XDepartment of Psychiatry, Epidemiological and Psychiatric Research Institute, Erasmus MC, Rotterdam, the Netherlands
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26
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Schultze-Lutter F, Walger P, Franscini M, Traber-Walker N, Osman N, Walger H, Schimmelmann BG, Flückiger R, Michel C. Clinical high-risk criteria of psychosis in 8–17-year-old community subjects and inpatients not suspected of developing psychosis. World J Psychiatry 2022; 12:425-449. [PMID: 35433326 PMCID: PMC8968502 DOI: 10.5498/wjp.v12.i3.425] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/26/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In children and adolescents compared to adults, clinical high-risk of psychosis (CHR) criteria and symptoms are more prevalent but less psychosis-predictive and less clinically relevant. Based on high rates of non-converters to psychosis, especially in children and adolescents, it was suggested that CHR criteria were: (1) Pluripotential; (2) A transdiagnostic risk factor; and (3) Simply a severity marker of mental disorders rather than specifically psychosis-predictive. If any of these three alternative explanatory models were true, their prevalence should differ between persons with and without mental disorders, and their severity should be associated with functional impairment as a measure of severity.
AIM To compare the prevalence and severity of CHR criteria/symptoms in children and adolescents of the community and inpatients.
METHODS In the mainly cross-sectional examinations, 8–17-year-old community subjects (n = 233) randomly chosen from the population register of the Swiss Canton Bern, and inpatients (n = 306) with primary diagnosis of attention-deficit/hyperactivity disorder (n = 86), eating disorder (n = 97), anxiety including obsessive–compulsive disorder (n = 94), or autism spectrum disorder (n = 29), not clinically suspected to develop psychosis, were examined for CHR symptoms/criteria. Positive items of the Structured Interview for Psychosis-Risk Syndromes (SIPS) were used to assess the symptomatic ultra-high-risk criteria, and the Schizophrenia Proneness Instrument, Child and Youth version (SPI-CY) was used to assess the 14 basic symptoms relevant to basic symptom criteria. We examined group differences in frequency and severity of CHR symptoms/criteria using χ2 tests and nonparametric tests with Cramer’s V and Rosenthal’s r as effect sizes, and their association with functioning using correlation analyses.
RESULTS The 7.3% prevalence rate of CHR criteria in community subjects did not differ significantly from the 9.5% rate in inpatients. Frequency and severity of CHR criteria never differed between the community and the four inpatient groups, while the frequency and severity of CHR symptoms differed only minimally. Group differences were found in only four CHR symptoms: suspiciousness/persecutory ideas of the SIPS [χ2 (4) = 9.425; P = 0.051, Cramer’s V = 0.132; and Z = -4.281, P < 0.001; Rosenthal’s r = 0.184], and thought pressure [χ2 (4) = 11.019; P = 0.026, Cramer’s V = 0.143; and Z = -2.639, P = 0.008; Rosenthal’s r = 0.114], derealization [χ2 (4) = 32.380; P < 0.001, Cramer’s V = 0.245; and Z = -3.924, P < 0.001; Rosenthal’s r = 0.169] and visual perception disturbances [χ2 (4) = 10.652; P = 0.031, Cramer’s V = 0.141; and Z = -2.822, P = 0.005; Rosenthal’s r = 0.122] of the SPI-CY. These were consistent with a transdiagnostic risk factor or dimension, i.e., displayed higher frequency and severity in inpatients, in particular in those with eating, anxiety/obsessive–compulsive and autism spectrum disorders. Low functioning, however, was at most weakly related to the severity of CHR criteria/symptoms, with the highest correlation yielded for suspiciousness/persecutory ideas (Kendall’s tau = -0.172, P < 0.001).
CONCLUSION The lack of systematic differences between inpatients and community subjects does not support suggestions that CHR criteria/symptoms are pluripotential or transdiagnostic syndromes, or merely markers of symptom severity.
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Affiliation(s)
- Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya 60286, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
| | - Petra Walger
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
| | - Maurizia Franscini
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich 8032, Germany
| | - Nina Traber-Walker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich 8032, Germany
| | - Naweed Osman
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
| | - Helene Walger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich 80336, Bavaria, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
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Veru F, MacDonald K, Malla A, Pruessner M, King S, Joober R, Shah J, Iyer SN. The effects of childhood adversity on treatment delays and its components in first-episode psychosis. Psychiatry Res 2022; 308:114341. [PMID: 34953203 DOI: 10.1016/j.psychres.2021.114341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/19/2022]
Abstract
Apart from increasing risk for psychotic disorders, childhood adversity has been associated with worse outcomes. One way in which childhood adversity may worsen outcomes is by lengthening treatment delays, which are associated with negative impacts. We tested the influence of childhood trauma on treatment delays, measured as the duration of untreated psychosis (DUP), and its help-seeking and referral components, in a first-episode psychosis cohort (N = 203). We accounted for pertinent social (e.g., migrant status) and other determinants (i.e., age at onset, diagnosis, symptoms) of treatment delays. Multiple linear regression analyses revealed that for a one-unit increase in Childhood Trauma Questionnaire (CTQ) scores, average overall DUP increased by 25%. Higher CTQ scores also significantly predicted help-seeking and referral DUPs. Patients with schizophrenia-spectrum psychosis had longer help-seeking and total DUPs than those with affective psychosis. More severe positive symptoms predicted longer help-seeking DUPs, while more severe negative symptoms predicted longer referral DUPs. Indicators of social disadvantage did not affect DUP. Our results show that childhood trauma increases DUP by prolonging the help-seeking process and delaying access to mental healthcare even after help is sought. Early identification of psychosis among populations with trauma histories seems warranted and can likely positively impact outcomes.
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Affiliation(s)
- Franz Veru
- Department of Psychiatry, McGill University, Montréal, Canada; Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
| | - Kathleen MacDonald
- Department of Psychiatry, McGill University, Montréal, Canada; Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montréal, Canada; Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
| | - Marita Pruessner
- Department of Psychiatry, McGill University, Montréal, Canada; Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Suzanne King
- Department of Psychiatry, McGill University, Montréal, Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montréal, Canada; Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
| | - Jai Shah
- Department of Psychiatry, McGill University, Montréal, Canada; Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montréal, Canada; Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada.
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28
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Long-term safety and effectiveness of open-label lurasidone in antipsychotic-Naïve versus previously treated adolescents with Schizophrenia: A post-hoc analysis. Schizophr Res 2022; 240:205-213. [PMID: 35032906 DOI: 10.1016/j.schres.2021.12.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/16/2021] [Accepted: 12/27/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is a relative lack of long-term, prospective data evaluating the safety and effectiveness of treatment in early-onset adolescent patients with schizophrenia who are treatment-naïve. The aim of this post-hoc analysis was to examine the long-term safety and effectiveness of lurasidone in adolescents with schizophrenia who were antipsychotic treatment-naïve (TN; at the time of enrolment in the initial study) compared to adolescents treated previously (TP) with an antipsychotic. METHODS Patients aged 13-17 who completed 6 weeks of double-blind (DB), placebo-controlled treatment with lurasidone were enrolled in a 2-year, open-label (OL), flexible-dose (20-80 mg/day) lurasidone study. RESULTS The long-term analysis sample consisted of 50 TN and 221 TP patients, of whom 40% and 43%, respectively, discontinued prematurely. The three most common adverse events for TN and TP patients, respectively, were headache (26.0%, 23.5%); schizophrenia (14.0%, 12.2%), dizziness (16.0%, 4.1%), and nausea (16.0%, 11.8%). At endpoint, mean increase in weight was similar to expected weight gain based on growth charts for both TN (+4.5 kg vs. + 5.7 kg) and TP (+4.6 kg vs. + 6.6 kg) patients. Minimal changes were observed for each group in metabolic parameters and prolactin. Mean improvement was consistently greater in the TN vs. TP group (-19.2 vs. -15.9; effect size of 0.33) for between-group change in PANSS total score at Week 104. CONCLUSIONS In both TN and TP adolescents with schizophrenia, long-term treatment with lurasidone was associated with minimal effects on body weight, lipids, glycemic indices, and prolactin, with generally small differences noted in rates of reported AEs. Continued improvement in symptoms of schizophrenia was evident for both the TN and TP groups. These data indicate that lurasidone is a safe and efficacious treatment option for treatment-naïve youth with schizophrenia, who are generally most sensitive to antipsychotic adverse effects.
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29
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Omelchenko MA, Arutyunova EV, Butashin AD, Ivanova EM. [Testing of the Russian-language version of the Thought, Language and Communication Scale]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:116-120. [PMID: 36279237 DOI: 10.17116/jnevro2022122101116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To analyze the possibilities of using the Russian version of the Thought, Language and Communication Scale (TLC) for early recognition of thought disorders in patients at clinical high-risk for schizophrenia. MATERIAL AND METHODS For the main group, the study included 30 adolescent male patients (19.2±2.2 years) hospitalized with the first depressive episode (ICD-10: F32.1, F32.2, F32.28, F32.8), who demonstrated attenuated schizophrenic symptoms (ASS) in the structure of the depression, which made it possible to attribute the patients to the group of clinical high-risk for schizophrenia. The control group consisted of 27 mentally healthy adolescent males (20.0±2.3 years). In both groups, the severity of thought impairment was assessed using the TLC scale. Psychopathological, psychometric and statistical methods were used. RESULTS The median values of the severity of thought impairment using the TLC scale were 20 points [19.75; 26] in the main group, 10.5 points [9.25; 13] in the control group, with a high degree of statistical significance (p<0.001). The most significant differences (p<0.001) were found in following parameters: Incoherence (2 [1; 3] vs 1 [0; 1]), Tangentiality (2 [2; 2] vs 1 [0; 2]), Derailment (2 [1.25; 2] vs 1 [0.5; 2]), Illogical thinking (2 [2; 2.75] vs 0 [0; 1]), Loss of goal (1 [0; 2] vs 0 [0; 0]) and Blocking (1 [0; 1] vs 0 [0; 0] accordingly). CONCLUSION Specific, not related to depression, disorders of thinking in patients of the clinical group, which indicates signs of disorganization of thinking and suggests the beginning of the endogenous process of the schizophrenic pole were found. The results show that the TLC scale can be used to detect early cognitive disorders in patients at risk of schizophrenia.
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Affiliation(s)
| | | | - A D Butashin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E M Ivanova
- Pirogov Russian National Research Medical University, Moscow, Russia
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30
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Bretthauer J, Canu D, Thiemann U, Fleischhaker C, Brauner H, Müller K, Smyrnis N, Biscaldi M, Bender S, Klein C. Attention for Emotion-How Young Adults With Neurodevelopmental Disorders Look at Facial Expressions of Affect. Front Psychiatry 2022; 13:842896. [PMID: 35782441 PMCID: PMC9240263 DOI: 10.3389/fpsyt.2022.842896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
While Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD) and Schizophrenia (SCZ) differ in many clinically relevant features such as symptomatology and course, they may also share genetic underpinnings, affective problems, deviancies in social interactions, and are all characterized by some kind of cognitive impairment. This situation calls for a joint investigation of the specifics of cognitive (dys-)functions of the three disorders. Such endeavor should focus, among other domains, on the inter-section of processing cognitive, affective and social information that is crucial in effective real-life interactions and can be accomplished when attentional preferences for human facial expressions of emotions is studied. To that end, attention to facial expressions of basic emotions was examined in young adults with ASD, ADHD, or SCZ in the present study. The three clinical groups were compared with an age-matched group of typically-developing participants (TD) during the free contemplation of five different facial emotions presented simultaneously, by varying identities, through the registration of eye movements. We showed, that dwell times and fixation counts differed for the different emotions in TD and in a highly similar way in ADHD. Patients with ASD differed from TD by showing a stronger differentiation between emotions and partially different attentional preferences. In contrast, the SCZ group showed an overall more restricted scanning behavior and a lack of differentiation between emotions. The ADHD group, showed an emotion-specific gazing pattern that was highly similar to that of controls. Thus, by analyzing eye movements, we were able to differentiate three different viewing patterns that allowed us to distinguish between the three clinical groups. This outcome suggests that attention for emotion may not tap into common pathophysiological processes and argues for a multi-dimensional approach to the grouping of disorders with neurodevelopmental etiology.
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Affiliation(s)
- Jana Bretthauer
- Department of Child and Adolescent Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Daniela Canu
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ulf Thiemann
- Clinic for Psychiatry, Psychosomatics und Psychotherapy in Children and Adolescents, LVR Hospital, Bonn, Germany
| | - Christian Fleischhaker
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Heike Brauner
- Kinder- und Jugendwohnheim Leppermühle, Buseck, Germany
| | | | - Nikolaos Smyrnis
- Second Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", Athens, Greece
| | - Monica Biscaldi
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Stephan Bender
- Department of Child and Adolescent Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Christoph Klein
- Department of Child and Adolescent Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany.,Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Second Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", Athens, Greece
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31
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Correll CU, Fusar-Poli P, Leucht S, Karow A, Maric N, Moreno C, Nordentoft M, Raballo A. Treatment Approaches for First Episode and Early-Phase Schizophrenia in Adolescents and Young Adults: A Delphi Consensus Report from Europe. Neuropsychiatr Dis Treat 2022; 18:201-219. [PMID: 35177905 PMCID: PMC8843859 DOI: 10.2147/ndt.s345066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Although first-episode psychosis (FEP) in youth, particularly early-onset schizophrenia (EOS), is managed similarly to adult-onset schizophrenia, few antipsychotics are approved for people aged 13-18 years. We aimed to explore areas of uncertainty in EOS management and provide evidence-based recommendations to mental health specialists. We used the Delphi methodology to gain knowledge in areas lacking evidence-based strategies. This standardized methodology consists of the development of a questionnaire by content experts, which is then submitted to a broader panel of professionals (panelists) to survey their level of agreement on the topics proposed. MATERIALS AND METHODS The developed questionnaire covered patient management from diagnosis to maintenance treatment and was administered to a broader panel of specialists across Europe. Based on an analysis of responses received in this first round, the items that needed further insight were submitted to the panel for a second round and then reanalysed. RESULTS An initial set of 90 items was developed; in round I, consensus was reached for 83/90 items (92%), while it was reached for 7/11 (64%) of the items sent out for rerating in round II. Feedback for rounds I and II was obtained from 54/92 and 48/54 approached experts, respectively. There was broad agreement on diagnostic standards, multimodal approaches and focus on adverse events, but uncertainty in terms of pharmacological strategies (including clozapine) in case of failure and antipsychotic dosing in younger patients. CONCLUSION Despite knowledge about diagnostic clues and integrated management of EOS, this study highlights the lack of standardization in treating EOS, with safety arguments having a major role in the decision-making process. Targeted clinical trials and systematic dissemination across Europe of current scientific evidence on the value of early intervention services is hoped to contribute to standardized and improved quality care for patients with early-phase psychosis and schizophrenia.
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Affiliation(s)
- Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,OASIS service, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Stefan Leucht
- Section Evidence-Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Nadja Maric
- Faculty of Medicine, University of Belgrade and Institute of Mental Health, Belgrade, Serbia
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Merete Nordentoft
- CORE-Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region, Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy.,Centre for Translational, Phenomenological and Developmental Psychopathology (CTPDP), Perugia University Hospital, Perugia, Italy
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Romero S, de la Serna E, Baeza I, Valli I, Pariente JC, Picado M, Bargalló N, Sugranyes G, Castro-Fornieles J. Altered White Matter Integrity at Illness Onset in Adolescents With a First Episode of Psychosis. Front Psychiatry 2022; 13:876793. [PMID: 35619614 PMCID: PMC9127302 DOI: 10.3389/fpsyt.2022.876793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Disruption in white matter integrity has been consistently observed in individuals with psychosis. However, whether such abnormalities are already present at illness onset or are related to downstream processes remains elusive. The study of adolescents with a recent onset of psychosis provides the opportunity to evaluate white matter integrity proximally to disease onset. METHODS Twenty-six adolescents (aged 15.9 ± 1.3 years) with a first episode of psychosis (FEP) (less than 6 months duration) were compared with 26 age and sex-matched healthy controls (HC) (16.8 ± 2 years). In participants with a FEP, clinical diagnoses were confirmed after a minimum of 1 year follow-up (main categories: schizophrenia, bipolar disorder, or schizoaffective disorder). Anatomical images and diffusion tensor sequences were acquired using a 1.5T scanner. Whole brain, voxel-wise group differences in fractional anisotropy (FA) were investigated between participants with a FEP and controls. RESULTS Relative to HC, FEP participants displayed decreased FA in the right posterior cingulate gyrus, encompassing the right superior and posterior corona radiata, and the right parahippocampal gyrus, including the cingulum and fornix. FEP patients showed no areas of increased FA relative to HC. The results remained significant after controlling for medication, cannabis use and intelligence. CONCLUSION Our findings indicate that adolescents with recent onset of psychotic disorders show decreased white matter integrity in circuits implicated in cognitive functions and emotion regulation.
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Affiliation(s)
- Soledad Romero
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena de la Serna
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Isabel Valli
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José Carlos Pariente
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marisol Picado
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic Barcelona, Barcelona, Spain
| | - Nuria Bargalló
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Image Diagnostic Center, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
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Vita A, Barlati S, Bellomo A, Poli PF, Masi G, Nobili L, Serafini G, Zuddas A, Vicari S. Patterns of Care for Adolescent With Schizophrenia: A Delphi-Based Consensus Study. Front Psychiatry 2022; 13:844098. [PMID: 35432022 PMCID: PMC9007083 DOI: 10.3389/fpsyt.2022.844098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The current conceptualization of schizophrenia as neurodevelopmental disorder should lead to innovative public health policies in terms of a reorganization of the mental health care systems, particularly in the transition from adolescence to adulthood, to reduce personal, familiar, and social costs and burdens. The purpose of the project was to perform a survey among a panel of Italian schizophrenia experts, to share evidence-based information on adolescent schizophrenia and explore the degree of consensus among professionals in the following four macro-areas: early diagnosis; pharmacological treatment; health care system organization and transition process from adolescent to adulthood; and psychosocial interventions. METHODS The consensus process consisted of a two-step web-based Delphi method, which took place between June and November 2021. The survey was developed by a panel of four psychiatrists and four child neuropsychiatrists, identified as key opinion leaders (KOLs). The KOLs identified 21 statements involving a total of 70 items with a major need of clarification on early-onset schizophrenia (EOS). The survey was distributed to 86 specialists in psychiatry and child neuropsychiatry. RESULTS The results revealed a large agreement among the expert group on all the investigated areas of adolescent schizophrenia patterns of care and management. Consensus was ultimately reached for 67 items of the Delphi survey (95.7%), while negative consensus was reached for 2 items and no consensus was reached for 1 item. CONCLUSIONS Overall, results showed a significant gap between the acquired scientific knowledge and clinical practice. In this scenario, it should be necessary to plan specific initiatives at a multiple level, to edit recommendations on clinical decision-making, as well as to prompt changes at the political and organizational levels, also involving scientific societies, patients, and family associations, to overcome the barriers that delay the implementation process.
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Affiliation(s)
- Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Paolo Fusar Poli
- Department of Nervous System and Behavior Sciences, University of Pavia, Pavia, Italy
| | - Gabriele Masi
- Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Lino Nobili
- Child Neuropsychiatry, Genoa and Department of Neuroscience (DINOGMI), IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy
| | | | - Alessandro Zuddas
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefano Vicari
- Department of Life Sciences and Publich Health, Catholic University and Bambino Gesù, Rome, Italy.,Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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Schultze-Lutter F, Kindler J, Ambarini TK, Michel C. Positive psychotic symptoms in childhood and adolescence. Curr Opin Psychol 2021; 45:101287. [PMID: 35016089 DOI: 10.1016/j.copsyc.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/21/2021] [Accepted: 11/24/2021] [Indexed: 11/30/2022]
Abstract
Based on the assumption of a universal neurodevelopmental model of psychosis, especially of the schizophrenia spectrum, the diagnosis (and treatment) of psychosis in minors commonly follows those in adults. Yet, as our review demonstrates, recent years have seen an emergence of studies of minors indicating that developmental aspects may play a crucial role in the prevalence and appraisal of diagnostically relevant positive psychotic symptoms in their full-blown and subthreshold forms, including neurobiogenetic and other risk factors, such as migration. Thus, caution is advised to not overpathologize potentially transient and clinically irrelevant occurrence of (subthreshold) positive psychotic symptoms in the diagnosis and treatment of psychotic disorders and their clinical high-risk states in minors. More studies on developmental aspects are urgently needed.
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Affiliation(s)
- Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Bergische Landstraße 2, 40470 Düsseldorf, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr, 111, 3000 Bern 60, Switzerland; Department of Psychology, Faculty of Psychology, Airlangga University, Airlangga 4-6, Surabaya 60286, Indonesia.
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr, 111, 3000 Bern 60, Switzerland
| | - Tri Kurniati Ambarini
- Department of Psychology, Faculty of Psychology, Airlangga University, Airlangga 4-6, Surabaya 60286, Indonesia
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr, 111, 3000 Bern 60, Switzerland
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Camprodon-Boadas P, de la Serna E, Baeza I, Puig O, Ilzarbe D, Sugranyes G, Borras R, Castro-Fornieles J. Cognitive reserve in patients with first-episode psychosis as outcome predictor at 5-year follow-up. Eur Child Adolesc Psychiatry 2021; 30:1959-1967. [PMID: 33113026 DOI: 10.1007/s00787-020-01668-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 10/18/2020] [Indexed: 12/13/2022]
Abstract
Cognitive reserve (CR) is the premorbid brain capacity to cope with neural damage. People with good CR can tolerate higher levels of pathological brain injuries before displaying clinical symptoms than others. This study aimed to analyze CR in a sample of patients diagnosed with first-episode psychosis (FEP) during childhood or adolescence, comparing them to a community control group (CC) and assessing the predictive value of CR regarding psychosocial functioning, clinical symptoms and neuropsychological variables at the 5-year follow-up. 57 patients diagnosed with FEP during childhood or adolescence and 37 controls completed clinical, neuropsychological, and psychosocial functioning assessments at baseline and 5-year follow-up. CR was assessed in both groups at baseline. The FEP group showed lower CR scores than the CC group. Higher CR in the FEP group was associated with fewer psychotic negative symptoms, total psychotic symptoms and depressive symptoms, higher psychosocial functioning, and less impaired memory and attention at the 5-year follow-up. CR is associated with long-term clinical, neuropsychological and psychosocial functioning outcomes in patients diagnosed with FEP during childhood or adolescence.
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Affiliation(s)
- Patricia Camprodon-Boadas
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Villarroel, 170, 08036, Barcelona, Spain.,Fundació Clínic Per a La Recerca Biomèdica, Barcelona, Spain
| | - Elena de la Serna
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Villarroel, 170, 08036, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Villarroel, 170, 08036, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Institut D´Investigació Biomèdica August Pi I Sunyer, IDIBAPS, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Olga Puig
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Villarroel, 170, 08036, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Daniel Ilzarbe
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Villarroel, 170, 08036, Barcelona, Spain.,Institut D´Investigació Biomèdica August Pi I Sunyer, IDIBAPS, Barcelona, Spain
| | - Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Villarroel, 170, 08036, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Institut D´Investigació Biomèdica August Pi I Sunyer, IDIBAPS, Barcelona, Spain
| | - Roger Borras
- Institut D´Investigació Biomèdica August Pi I Sunyer, IDIBAPS, Barcelona, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Villarroel, 170, 08036, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain. .,Institut D´Investigació Biomèdica August Pi I Sunyer, IDIBAPS, Barcelona, Spain. .,Department of Medicine, University of Barcelona, Barcelona, Spain.
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Cheng X, Zhang H, Zhang J, Xu P, Jin P, Fang H, Chu K, Ke X. Comparison of clinical characteristics and treatment efficacy in childhood-onset schizophrenia and adolescent-onset schizophrenia in mainland China: A retrospective study. Early Interv Psychiatry 2021; 15:1721-1729. [PMID: 33465837 DOI: 10.1111/eip.13121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 12/23/2022]
Abstract
AIM The comparative study of childhood-onset schizophrenia (COS) and adolescent-onset schizophrenia (AOS) is scarce. This study aimed to examine the differences in clinical presentations and treatment efficacy between COS and AOS and further analyse the factors affecting the efficacy of early-onset schizophrenia (EOS). METHODS A total of 582 electronic medical records of inpatients with EOS (216 COS and 366 AOS inpatients) between 2012 and 2019 were retrospectively analysed. The positive and negative syndrome scale (PANSS) was used to assess psychotic symptoms. Logistic regression analysis was performed to analyse the predictors of efficacy. RESULTS The mean age of onset of EOS was 12.87 ± 2.19 years. The importance of better diagnosing COS appeared in a longer illness course, more frequently insidious onset, less frequent delusions, more severe negative symptoms and bizarre behaviours than AOS. Besides, COS had more frequent visual hallucinations and impulsive behaviours than AOS. After hospitalization, the improvement rate of psychotic symptoms in COS and AOS were 38.3% and 47.8%, respectively. The difference of efficacy between the two groups was statistically significant. Days of hospitalization, age of onset, presence of flat affect, PANSS total and negative score at admission were predictors of treatment efficacy in EOS individuals. CONCLUSIONS COS inpatients suffer more obvious negative symptoms, bizarre behaviours, visual hallucinations and impulsive behaviours and worse efficacy than AOS inpatients. The severity of negative symptoms and age of onset seem the most noteworthy predictors of efficacy. These findings highlight the importance of early detection and early intervention.
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Affiliation(s)
- Xin Cheng
- The Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Huihui Zhang
- The Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jiuping Zhang
- The Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ping Xu
- Department of Psychiatry, Nanjing Lishui Psychiatric Hospital, Nanjing, China
| | - Peiying Jin
- The Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Fang
- The Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Kangkang Chu
- The Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoyan Ke
- The Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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Catalan A, Richter A, Salazar de Pablo G, Vaquerizo-Serrano J, Mancebo G, Pedruzo B, Aymerich C, Solmi M, González-Torres MÁ, Gil P, McGuire P, Fusar-Poli P. Proportion and predictors of remission and recovery in first-episode psychosis: Systematic review and meta-analysis. Eur Psychiatry 2021; 64:e69. [PMID: 34730080 PMCID: PMC8668449 DOI: 10.1192/j.eurpsy.2021.2246] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background To determine the proportion of patients in symptomatic remission and recovery following a first-episode of psychosis (FEP). Methods A multistep literature search using the Web of Science database, Cochrane Central Register of Reviews, Ovid/PsychINFO, and trial registries from database inception to November 5, 2020, was performed. Cohort studies and randomized control trials (RCT) investigating the proportion of remission and recovery following a FEP were included. Two independent researchers searched, following PRISMA and MOOSE guidelines and using a PROSPERO protocol. We performed meta-analyses regarding the proportion of remission/recovery (symptomatic plus functional outcomes). Heterogeneity was measured employing Q statistics and I2 test. To identify potential predictors, meta-regression analyses were conducted, as well as qualitative reporting of studies included in a systematic review. Sensitivity analyses were performed regarding different times of follow-up and type of studies. Results One hundred articles (82 cohorts and 18 RCTs) were included in the meta-analysis. The pooled proportion of symptomatic remission was 54% (95%CI [30, 49–58]) over a mean follow-up period of 43.57 months (SD = 51.82) in 76 studies. After excluding RCT from the sample, the proportion of remission remained similar (55%). The pooled proportion of recovery was 32% (95%CI [27–36]) over a mean follow-up period of 71.85 months (SD = 73.54) in 40 studies. After excluding RCT from the sample, the recovery proportion remained the same. No significant effect of any sociodemographic or clinical predictor was found. Conclusions Half of the patients are in symptomatic remission around 4 years after the FEP, while about a third show recovery after 5.5 years.
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Affiliation(s)
- Ana Catalan
- Mental Health Department, Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Facultad de Medicina y Odontología, Campus de Leioa, University of the Basque Country, UPV/EHU, Barakaldo, Spain.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Anja Richter
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain.,Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Julio Vaquerizo-Serrano
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gonzalo Mancebo
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Borja Pedruzo
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Claudia Aymerich
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry, University of Ottawa, Ontario, Canada.,Department of Mental Health, The Ottawa Hospital, Ontario, Canada.,Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario
| | - Miguel Á González-Torres
- Mental Health Department, Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Facultad de Medicina y Odontología, Campus de Leioa, University of the Basque Country, UPV/EHU, Barakaldo, Spain
| | - Patxi Gil
- Mental Health Department, Biocruces Bizkaia Health Research Institute, Early Intervention Service, Bizkaia Mental Health System, Bilbao, Spain
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Cross-Sectional Descriptive Pilot Study on the Risk of Psychotic Disorders among Adolescents. CHILDREN-BASEL 2021; 8:children8100916. [PMID: 34682181 PMCID: PMC8534931 DOI: 10.3390/children8100916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/16/2021] [Accepted: 10/12/2021] [Indexed: 11/26/2022]
Abstract
Background: Adolescence is a key stage for the development of different mental disorders, particularly psychotic disorders. This stage of life is accompanied by new habits or behaviours that can make a person more vulnerable to developing a psychotic disorder or, on the contrary, play a protective role. Objective: To study the vulnerability to developing a psychotic disorder in adolescents and to analyse the main risk factors. Materials and methods: This is an observational, descriptive and cross-sectional study. The data collection was conducted using the Prodromal Questionnaire Brief Version (PQ-B) test and a self-developed questionnaire based on the vulnerability–stress model. Results: Of the total sample (n = 44), 65.9% were male and 100% lived in a rural environment. In general, among risk factors (stress, alcohol and cannabis consumption, history, bullying, traumatic event and sedentary lifestyle), alcohol consumption and the presence of stress were found to have high values. Furthermore, a risk of psychosis was found in 38.6% of the studied population. Of this percentage of adolescents at risk, 64.7% consumed alcohol (p = 0.99) and 82.4% suffered from stress (p = 0.7161). The protective factor (physical activity) was found in more than half (59% p = 0.16). Conclusions: There is a high risk of psychosis among the young adolescents assessed in this study, where the explanatory factors identified with higher values were alcohol consumption and the presence of stress.
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Fagerlund B, Pantelis C, Jepsen JRM, Raghava JM, Rostrup E, Thomas MB, Nielsen MØ, Bojesen K, Jensen KG, Stentebjerg-Decara M, Klauber DG, Rudå D, Ebdrup BH, Jessen K, Sigvard A, Tangmose K, Jeppesen P, Correll CU, Fink-Jensen A, Pagsberg AK, Glenthøj BY. Differential effects of age at illness onset on verbal memory functions in antipsychotic-naïve schizophrenia patients aged 12-43 years. Psychol Med 2021; 51:1570-1580. [PMID: 32156323 DOI: 10.1017/s0033291720000409] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The typical onset of schizophrenia coincides with the maturational peak in cognition; however, for a significant proportion of patients the onset is before age 18 and after age 30 years. While cognitive deficits are considered core features of schizophrenia, few studies have directly examined the impact of age of illness onset on cognition. METHODS The aim of the study was to examine if the effects of age on cognition differ between healthy controls (HCs) and patients with schizophrenia at illness onset. We examined 156 first-episode antipsychotic-naïve patients across a wide age span (12-43 years), and 161 age- and sex-matched HCs. Diagnoses were made according to ICD-10 criteria. Cognition was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS), and IQ was estimated using subtests from the Wechsler adult- or child-intelligence scales. Multivariate analysis of covariance (MANCOVA) was used to examine linear and quadratic effects of age on cognitive scores and interactions by group, including sex and parental socioeconomic status as covariates. RESULTS There was a significant overall effect of age on BACS and IQ (p < 0.001). Significant group-by-age interactions for verbal memory (for age-squared, p = 0.009), and digit sequencing (for age, p = 0.01; age-squared, p < 0.001), indicated differential age-related trajectories between patients and HCs. CONCLUSIONS Cognitive functions showing protracted maturation into adulthood, such as verbal memory and verbal working memory, may be particularly impaired in both early- and late-schizophrenia onset. Our findings indicate a potential interaction between the timing of neurodevelopmental maturation and a possible premature age effect in late-onset schizophrenia.
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Affiliation(s)
- Birgitte Fagerlund
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Christos Pantelis
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Jens Richardt Møllegaard Jepsen
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark
- Mental Health Services, Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
| | - Jayachandra Mitta Raghava
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark
- Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Glostrup, 2600 Glostrup, Denmark
| | - Egill Rostrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark
| | - Marie Bjerregaard Thomas
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark
| | - Mette Ødegaard Nielsen
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark
| | - Kirsten Bojesen
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark
| | - Karsten Gjessing Jensen
- Mental Health Services, Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark
| | - Marie Stentebjerg-Decara
- Mental Health Services, Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark
| | - Dea Gowers Klauber
- Mental Health Services, Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark
| | - Ditte Rudå
- Mental Health Services, Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark
| | - Bjørn H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark
| | - Kasper Jessen
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark
| | - Anne Sigvard
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark
| | - Karen Tangmose
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark
| | - Pia Jeppesen
- Mental Health Services, Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
- Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Anders Fink-Jensen
- University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark
- Mental Health Center Copenhagen, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anne Katrine Pagsberg
- Mental Health Services, Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark
| | - Birte Yding Glenthøj
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark
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Liu J, Zheng L, Fang T, Li R, Ma X, Sun Y, Wang L, Tian H, Jiang D, Zhuo C. Exploration of the cortical pathophysiology underlying visual disturbances in schizophrenia comorbid with depressive disorder-An evidence from mouse model. Brain Behav 2021; 11:e02113. [PMID: 33729680 PMCID: PMC8119859 DOI: 10.1002/brb3.2113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/01/2021] [Accepted: 03/01/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Patients with schizophrenia frequently present with visual disturbances including hallucination, and this symptom is particularly prevalent in individuals with comorbid depressive disorders. Currently, little is known about the neurobiological mechanisms of such psychiatric symptoms, and few explanations for the co-occurrence of schizophrenia, depression, and visual disturbances are available. METHODS In this study, we generated a mouse schizophrenia model in which depressive symptoms were also induced. We adopted in vivo two-photon calcium imaging and ex vivo electrophysiological recording of the primary visual cortex to reveal the synaptic transmission and neural activity in the mouse schizophrenia model. RESULTS In vivo two-photon calcium imaging and ex vivo electrophysiological recording of the primary visual cortex revealed impaired synaptic transmission and abnormal neural activity in the schizophrenia model, but not in the depression model. These functional deficits were most prominent in the combined schizophrenia and depression model. CONCLUSION Overall, our data support a mechanism by which the visual cortex plays a role in visual disturbances in schizophrenia.
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Affiliation(s)
- Jian Liu
- Laboratory of Psychiatric-Neuroimaging-Genetic and Cor-morbidity (PNGC_Lab), Tianjin Anding Hospital, Mental Health Centre of Tianjin, Affiliated Teaching Hospital of Tianjin Medical University, Tianjin, China
| | - Lidan Zheng
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Tao Fang
- Key Laboratory of Real-Time Tracing of Brain Circuits of Neurology and Psychiatry (RTBNB_Lab), Tianjin Fourth Centre Hospital, Tianjin Medical University Affiliated Tianjin Fourth Centre Hospital, Nankai University Affiliated Fourth Hospital, Tianjin, China
| | - Ranli Li
- Laboratory of Psychiatric-Neuroimaging-Genetic and Cor-morbidity (PNGC_Lab), Tianjin Anding Hospital, Mental Health Centre of Tianjin, Affiliated Teaching Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaoyan Ma
- Laboratory of Psychiatric-Neuroimaging-Genetic and Cor-morbidity (PNGC_Lab), Tianjin Anding Hospital, Mental Health Centre of Tianjin, Affiliated Teaching Hospital of Tianjin Medical University, Tianjin, China
| | - Yun Sun
- Laboratory of Psychiatric-Neuroimaging-Genetic and Cor-morbidity (PNGC_Lab), Tianjin Anding Hospital, Mental Health Centre of Tianjin, Affiliated Teaching Hospital of Tianjin Medical University, Tianjin, China
| | - Lina Wang
- Laboratory of Psychiatric-Neuroimaging-Genetic and Cor-morbidity (PNGC_Lab), Tianjin Anding Hospital, Mental Health Centre of Tianjin, Affiliated Teaching Hospital of Tianjin Medical University, Tianjin, China
| | - Hongjun Tian
- Key Laboratory of Real-Time Tracing of Brain Circuits of Neurology and Psychiatry (RTBNB_Lab), Tianjin Fourth Centre Hospital, Tianjin Medical University Affiliated Tianjin Fourth Centre Hospital, Nankai University Affiliated Fourth Hospital, Tianjin, China
| | - Deguo Jiang
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Chuanjun Zhuo
- Laboratory of Psychiatric-Neuroimaging-Genetic and Cor-morbidity (PNGC_Lab), Tianjin Anding Hospital, Mental Health Centre of Tianjin, Affiliated Teaching Hospital of Tianjin Medical University, Tianjin, China.,Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China.,Key Laboratory of Real-Time Tracing of Brain Circuits of Neurology and Psychiatry (RTBNB_Lab), Tianjin Fourth Centre Hospital, Tianjin Medical University Affiliated Tianjin Fourth Centre Hospital, Nankai University Affiliated Fourth Hospital, Tianjin, China
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De Berardis D, De Filippis S, Masi G, Vicari S, Zuddas A. A Neurodevelopment Approach for a Transitional Model of Early Onset Schizophrenia. Brain Sci 2021; 11:brainsci11020275. [PMID: 33672396 PMCID: PMC7926620 DOI: 10.3390/brainsci11020275] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/16/2022] Open
Abstract
In the last decades, the conceptualization of schizophrenia has dramatically changed, moving from a neurodegenerative process occurring in early adult life to a neurodevelopmental disorder starting be-fore birth, showing a variety of premorbid and prodromal symptoms and, in relatively few cases, evolving in the full-blown psychotic syndrome. High rates of co-occurring different neurodevelopmental disorders such as Autism spectrum disorder and ADHD, predating the onset of SCZ, and neurobio-logical underpinning with significant similarities, support the notion of a pan-developmental disturbance consisting of impairments in neuromotor, receptive language, social and cognitive development. Con-sidering that many SCZ risk factors may be similar to symptoms of other neurodevelopmental psychi-atric disorders, transition processes from child & adolescent to adult systems of care should include both high risk people as well as subject with other neurodevelopmental psychiatric disorders with different levels of severity. This descriptive mini-review discuss the need of innovative clinical approaches, re-considering specific diagnostic categories, stimulating a careful analysis of risk factors and promoting the appropriate use of new and safer medications.
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Affiliation(s)
- Domenico De Berardis
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini,” National Health Service (NHS), 64100 ASL 4 Teramo, Italy
- Department of Neurosciences and Imaging, University “G. D’Annunzio”, 66100 Chieti, Italy
- Correspondence:
| | - Sergio De Filippis
- Department of Neuropsychiatry, Villa von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, 100045 Rome, Italy;
| | - Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56128 Pisa, Italy;
| | - Stefano Vicari
- Department of Life Sciences and Publich Health, Catholic University, 00135 Rome, Italy;
- Child & Adolescent Psychiatry, Bambino Gesù Children’s Hospital, 00168 Rome, Italy
| | - Alessandro Zuddas
- Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Sciences, University of Cagliari and “A Cao” Paediatric Hospital, “G Brotzu” Hospital Trust, 109134 Cagliari, Italy;
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Adolescent Neurodevelopment and Vulnerability to Psychosis. Biol Psychiatry 2021; 89:184-193. [PMID: 32896384 PMCID: PMC9397132 DOI: 10.1016/j.biopsych.2020.06.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 12/28/2022]
Abstract
Adolescence is characterized by significant changes in several domains, including brain structure and function, puberty, and social and environmental factors. Some of these changes serve to increase the likelihood of psychosis onset during this period, while others may buffer this risk. This review characterizes our current knowledge regarding the unique aspects of adolescence that may serve as risk factors for schizophrenia spectrum disorders. In addition, we provide potential future directions for research into adolescent-specific developmental mechanisms that impart vulnerability to psychosis and the possibility of interventions that capitalize on adolescents' unique characteristics. Specifically, we explore the ways in which gray and white matter develop throughout adolescence in typically developing youth as well as in those with psychosis spectrum disorders. We also discuss current views on the function that social support and demands, as well as role expectations, play in risk for psychosis. We further highlight the importance of considering biological factors such as puberty and hormonal changes as areas of unique vulnerability for adolescents. Finally, we discuss cannabis use as a factor that may have a unique impact during adolescent neurodevelopment, and subsequently potentially impact psychosis onset. Throughout, we include discussion of resilience factors that may provide unique opportunities for intervention during this dynamic life stage.
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Raballo A, Schultze-Lutter F, Armando M. Editorial: Children, Adolescents and Families With Severe Mental Illness: Toward a Comprehensive Early Identification of Risk. Front Psychiatry 2021; 12:812229. [PMID: 34992558 PMCID: PMC8724427 DOI: 10.3389/fpsyt.2021.812229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/03/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology (CTPDP), Perugia University Hospital, Perugia, Italy
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.,Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marco Armando
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Mørch-Johnsen L, Smelror RE, Andreou D, Barth C, Johannessen C, Wedervang-Resell K, Wortinger LA, Díaz R, Victoria G, Ueland T, Andreassen OA, Myhre AM, Rund BR, Ulloa RE, Agartz I. Negative Symptom Domains Are Associated With Verbal Learning in Adolescents With Early Onset Psychosis. Front Psychiatry 2021; 12:825681. [PMID: 35069300 PMCID: PMC8777217 DOI: 10.3389/fpsyt.2021.825681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/16/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Early-onset psychosis (EOP) is among the leading causes of disease burden in adolescents. Negative symptoms and cognitive deficits predicts poorer functional outcome. A better understanding of the association between negative symptoms and cognitive impairment may inform theories on underlying mechanisms and elucidate targets for development of new treatments. Two domains of negative symptoms have been described in adult patients with schizophrenia: apathy and diminished expression, however, the factorial structure of negative symptoms has not been investigated in EOP. We aimed to explore the factorial structure of negative symptoms and investigate associations between cognitive performance and negative symptom domains in adolescents with EOP. We hypothesized that (1) two negative symptom factors would be identifiable, and that (2) diminished expression would be more strongly associated with cognitive performance, similar to adult psychosis patients. Methods: Adolescent patients with non-affective EOP (n = 169) were included from three cohorts: Youth-TOP, Norway (n = 45), Early-Onset Study, Norway (n = 27) and Adolescent Schizophrenia Study, Mexico (n = 97). An exploratory factor analysis was performed to investigate the underlying structure of negative symptoms (measured with the Positive and Negative Syndrome Scale (PANSS)). Factor-models were further assessed using confirmatory factor analyses. Associations between negative symptom domains and six cognitive domains were assessed using multiple linear regression models controlling for age, sex and cohort. The neurocognitive domains from the MATRICS Consensus Cognitive Battery included: speed of processing, attention, working memory, verbal learning, visual learning, and reasoning and problem solving. Results: The exploratory factor analysis of PANSS negative symptoms suggested retaining only a single factor, but a forced two factor solution corroborated previously described factors of apathy and diminished expression in adult-onset schizophrenia. Results from confirmatory factor analysis indicated a better fit for the two-factor model than for the one-factor model. For both negative symptom domains, negative symptom scores were inversely associated with verbal learning scores. Conclusion: The results support the presence of two domains of negative symptoms in EOP; apathy and diminished expression. Future studies on negative symptoms in EOP should examine putative differential effects of these symptom domains. For both domains, negative symptom scores were significantly inversely associated with verbal learning.
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Affiliation(s)
- Lynn Mørch-Johnsen
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry and Department of Clinical Research, Østfold Hospital, Grålum, Norway
| | - Runar Elle Smelror
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Dimitrios Andreou
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Claudia Barth
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Cecilie Johannessen
- Department of Neurohabilitation, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kirsten Wedervang-Resell
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laura A Wortinger
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ricardo Díaz
- Research Department, Arete Proyectos y Administración, Mexico City, Mexico
| | - Gamaliel Victoria
- Planning of Prevention Programs in the Directorate of Integral Attention to Girls, Boys and Adolescents, System for the Integral Development of the Family, Mexico City, Mexico
| | - Torill Ueland
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway
| | - Anne M Myhre
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway.,Research Department, Vestre Viken Hospital Trust, Drammen, Norway
| | - Rosa Elena Ulloa
- Developmental Psychopharmacology at the Research Division, Child Psychiatric Hospital, Mexico City, Mexico
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Institute of Clinical Medicine, K.G. Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
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45
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Arif Önder, Adanır AS, Çoban ÖG, Bilaç Ö, Kavurma C. Elevated Neutrophil/Lymphocyte Ratio in Adolescents with Early-onset Schizophrenia. NEUROCHEM J+ 2020. [DOI: 10.1134/s1819712420330016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Alves MR, Bergamaschi CDC, Sorrilha FB, Fulone I, Barberato-Filho S, Mayer RCF, Melo DOD, Lopes L. Critical appraisal and comparison of recommendations of clinical practice guidelines for treatment of schizophrenia in children and adolescents: a methodological survey protocol. BMJ Open 2020; 10:e038646. [PMID: 32938601 PMCID: PMC7497528 DOI: 10.1136/bmjopen-2020-038646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The number of clinical practice guidelines (CPGs) have increased substantially mainly in the paediatric area of mental health. However, little is known about the quality or how recommendations for the treatment of disorders such as schizophrenia in children and adolescents have changed over time. The aim of this study will be to assess the quality of the development of CPGs for the treatment and management of schizophrenia in children and adolescents over time using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and to compare the recommendations and interventions described in these documents. METHODS AND ANALYSIS CPGs will be identified using a prospective protocol through a systematic search of multiple databases (Medline, Embase, Health Systems Evidence, Epistemonikos, Lilacs, etc) and guideline websites from 2004 to December 2020. The quality of the guidelines will be assessed by three reviewers, independently using the AGREE II. CPGs will be considered of high-quality if they scored ≥60% in four or more domains of the AGREE II instrument. Non-parametric tests will be used to test for the change of quality over time. We will summarise the different evidence grading systems and compare the recommendations. ETHICS AND DISSEMINATION Ethical approval is not required since it is a literature-based study. Future results of the research can be submitted for publication in scientific journals of high impact, peer reviewed and also published in national and international conferences. The results derived from this study will contribute to the improvement of health institutions and policies, informing about existing recommendation guidelines and about deficiencies and qualities found in those. This study may also identify key areas for future research. This study may guide the search and choice for high quality CPGs by health policy makers and health professionals and subsidise future adaptations. PROTOCOL REGISTRATION NUMBER CRD42020164899.
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Affiliation(s)
- Maíra Ramos Alves
- Graduate Course of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, São Paulo, Brazil
| | | | - Flávia Blaseck Sorrilha
- Graduate Course of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, São Paulo, Brazil
| | - Izabela Fulone
- Graduate Course of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, São Paulo, Brazil
| | - Silvio Barberato-Filho
- Graduate Course of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, São Paulo, Brazil
| | | | - Daniela Oliveira de Melo
- Graduate Course of Pharmaceutical Sciences, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Luciane Lopes
- Graduate Course of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, São Paulo, Brazil
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Reduced levels of circulating adhesion molecules in adolescents with early-onset psychosis. NPJ SCHIZOPHRENIA 2020; 6:20. [PMID: 32811840 PMCID: PMC7434772 DOI: 10.1038/s41537-020-00112-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
Abstract
It is suggested that neurodevelopmental abnormalities are involved in the disease mechanisms of psychotic disorders. Although cellular adhesion molecules (CAMs) participate in neurodevelopment, modulate blood–brain barrier permeability, and facilitate leukocyte migration, findings concerning their systemic levels in adults with psychosis are inconsistent. We examined plasma levels and mRNA expression in peripheral blood mononuclear cells (PBMCs) of selected CAMs in adolescents with early-onset psychosis (EOP) aged 12–18 years (n = 37) and age-matched healthy controls (HC) (n = 68). EOP patients exhibited significantly lower circulating levels of soluble platelet selectin (~−22%) and soluble vascular cell adhesion molecule-1 (~−14%) than HC. We found no significant associations with symptom severity. PSEL mRNA expression was increased in PBMCs of patients and significantly negatively correlated to duration of illness. These findings suggest a role for CAMs in the pathophysiology of psychotic disorders.
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Dor-Nedonsel E, Menard ML, Fernandez A, Sakarovitch C, Fontas E, Salle-Collemiche X, Poinso F, Tosello AL, Maria F, Manera V, Askenazy F, Thümmler S. Early-Onset Schizophrenia in a paediatric population of French psychiatric and medico-social care centres: A cross sectional study. PLoS One 2020; 15:e0236241. [PMID: 32716957 PMCID: PMC7384631 DOI: 10.1371/journal.pone.0236241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/01/2020] [Indexed: 11/19/2022] Open
Abstract
Background Early-Onset Schizophrenia (EOS) is rare but severe mental health disorder in children and adolescents. Diagnosis of schizophrenia before the age of 18 years remains complex and challenging, especially in young children. In France, there are no recent reliable epidemiological data about the prevalence of EOS. The present study evaluates the EOS rate in a target clinical population of children and adolescents in psychiatric and medico-social care centres in the South-East of France. Methods Psychiatric and medico-social centres for children and adolescent in the geographical area have been contacted, and after receiving their agreement to participate in the study, eligible patients corresponding to inclusion criteria were selected based on patients’ medical records. Main inclusion criteria were age 7 to 17 years and intelligence quotient > 35. EOS categorical diagnosis was assessed by Kiddie-SADS Present and Lifetime psychosis section. Results 37 centres participated and 302 subjects have been included in the study. The main result was the categorical diagnosis of EOS in 27 subjects, corresponding to a rate of 8.9% in the study population. Half of the patients presented mild to moderate intellectual deficiency. Interestingly, only 2.3% had a diagnosis of schizophrenia spectrum disorder noted in their medical records before standardized assessment. Conclusions The results of the study highlight the importance of using a standardized diagnostic tool for the diagnosis of schizophrenia in the paediatric population. In fact, EOS might be underdiagnosed in children and adolescents with neurodevelopmental disorders and subnormal cognitive functioning. Trial registration NCT01512641. Registered 19 January 2012; https://clinicaltrials.gov/ct2/show/NCT01512641
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Affiliation(s)
- Emmanuelle Dor-Nedonsel
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, University Côte d’Azur, Nice, France
- * E-mail:
| | - Marie-Line Menard
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, University Côte d’Azur, Nice, France
| | - Arnaud Fernandez
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, University Côte d’Azur, Nice, France
| | | | - Eric Fontas
- Direction de la Recherche Clinique, University Hospital, Nice, France
| | - Xavier Salle-Collemiche
- University Department of Child and Adolescent Psychiatry, Public Assistance- Hospitals of Marseille, France
| | - François Poinso
- University Department of Child and Adolescent Psychiatry, Public Assistance- Hospitals of Marseille, France
| | - Anne-Lise Tosello
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
| | - Fanny Maria
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
| | | | - Florence Askenazy
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, University Côte d’Azur, Nice, France
| | - Susanne Thümmler
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, University Côte d’Azur, Nice, France
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Engen K, Wortinger LA, Jørgensen KN, Lundberg M, Bohman H, Smelror RE, Myhre AM, Jacobson L, Vincent A, Agartz I. Autoantibodies to the N-Methyl-D-Aspartate Receptor in Adolescents With Early Onset Psychosis and Healthy Controls. Front Psychiatry 2020; 11:666. [PMID: 32765314 PMCID: PMC7381144 DOI: 10.3389/fpsyt.2020.00666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Autoantibodies to the N-methyl-D-aspartate receptor (NMDAR-Abs) in autoimmune encephalitis have been associated with prominent psychiatric symptoms. The aims of the present study are to identify the prevalence of NMDAR-Abs in adolescents with early onset psychosis disorders (EOP) and healthy controls (HC) and examine its clinical significance. METHOD Plasma samples were acquired from 46 adolescent EOP patients and 69 age- and sex matched HC, and assessed for the presence of immunoglobulin G NMDAR-Abs. All participants underwent psychiatric evaluation, neurological examination and head magnetic resonance imaging. RESULTS NMDAR-Abs were detected in three of 46 (6.5%) EOP patients and in two of 69 (2.9%) HC. One NMDAR-Abs EOP patient presented with unusual psychopathology and minor T1 weighted lesions of vasculopathological origin located bi-frontally and in the basal ganglia, and had a recent diagnosis of a separate autoimmune disease. One NMDAR-Ab HC displayed a T2 weighted FLAIR hyperintensity lesion in the left frontal lobe. The remaining three NMDAR-Ab participants were two EOP patients without neurological or radiological findings, and one HC without any clinical findings. CONCLUSIONS We report that a small number of EOP patients and HC have NMDAR-Abs with a similar frequency in both groups. The presence of the antibodies was not associated with any distinctive clinical or radiological features. Detection of the antibodies had no diagnostic implication, and a positive NMDAR antibody test must be carefully interpreted and reviewed within the individual clinical context.
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Affiliation(s)
- Kristine Engen
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laura Anne Wortinger
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjetil Nordbø Jørgensen
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mathias Lundberg
- Department of Neuroscience, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Hannes Bohman
- Department of Neuroscience, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Runar Elle Smelror
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Margrethe Myhre
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Leslie Jacobson
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Ingrid Agartz
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Vernal DL, Boldsen SK, Lauritsen MB, Correll CU, Nielsen RE. Long-term outcome of early-onset compared to adult-onset schizophrenia: A nationwide Danish register study. Schizophr Res 2020; 220:123-129. [PMID: 32299717 DOI: 10.1016/j.schres.2020.03.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 01/09/2020] [Accepted: 03/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Early-onset schizophrenia (EOS) may have worse outcomes than adult-onset schizophrenia (AOS), but data are scarce. We compared outcomes of EOS vs. AOS. METHODS Longitudinal, register-based study of patients diagnosed with schizophrenia in Denmark between 1996 and 2012, with follow-up until 12/2014. Co-primary outcomes were psychiatric inpatient days during the initial two years after schizophrenia diagnosis and mean number of annual inpatient days for the remaining follow-up. RESULTS Altogether, 16,337 patients with schizophrenia were included (EOS = 1223, AOS = 15,114, mean follow-up = 9.5 ± 5.0 years). EOS were hospitalized longer during the first two years than AOS (180.9 ± 171.0 vs 163.4 ± 183.1 days, p < 0.005; IRR = 1.27, 95% CI = 1.19-1.35, p < 0.001), but duration and annual rates thereafter did not differ (EOS = 26.8 ± 57.1 days, AOS = 26.6 ± 56.2 days, p = 0.95; IRR = 1.07, 95% CI = 0.94-1.23, p = 0.30). Fewer EOS patients were never psychiatrically hospitalized (EOS = 17.2%, AOS = 20.1%, p < 0.001), but with no difference in re-admissions in patients diagnosed during hospitalization (EOS = 77.1% vs AOS = 78.1%, p = 0.56). More EOS patients were admitted involuntarily (41% vs. 36%, p < 0.02). AOS patients had more often comorbid substance use disorders during follow-up than EOS (EOS = 21.7%, AOS = 34.2%, p < 0.001). Substance use disorders and out-of-home placement were significantly associated with more inpatient days during both short- and long-term follow-up. CONCLUSION Although EOS was associated with more inpatient days in the first two years after diagnosis, results do not seem to support a generally poorer long-term outcome of EOS compared to AOS. Longer initial hospitalization may be driven by different treatment patterns in child and adolescent vs. adult psychiatry. These data suggest that patient characteristics other than age of onset significantly affect outcomes.
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Affiliation(s)
- Ditte Lammers Vernal
- Aalborg University Hospital, Research Unit for Child and Adolescent Psychiatry, North Denmark Region, Denmark.
| | - Søren Kjærgaard Boldsen
- Aalborg University Hospital, Research Unit for Child and Adolescent Psychiatry, North Denmark Region, Denmark.
| | - Marlene Briciet Lauritsen
- Aalborg University Hospital, Research Unit for Child and Adolescent Psychiatry, North Denmark Region, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, NY 11004, USA; Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany.
| | - René Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Aalborg University Hospital, Department of Psychiatry, Unit for Psychiatric Research, Aalborg, Denmark.
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