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Grady S, Twomey C, Cullen C, Gaynor K. Does affect mediate the relationship between interpersonal trauma and psychosis? A systematic review and meta-analysis. Schizophr Res 2024; 264:435-447. [PMID: 38245930 DOI: 10.1016/j.schres.2024.01.008] [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: 08/04/2023] [Revised: 12/24/2023] [Accepted: 01/01/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION The relationship between interpersonal trauma and psychosis is well established, and research is now focused on identifying mechanisms that may explain this relationship. Models of trauma and psychosis increasingly emphasize a broad range of affective processes, yet the overall effect of these affective processes is not well understood. AIM This review systematically examined the effect of any form of long-term affective dysfunction on the relationship between interpersonal trauma and psychosis. Where possible, it used meta-analytic techniques to quantify the overall magnitude of this effect. METHOD Searches were conducted using PsychINFO, MEDLINE and CINAHL databases, and eligible studies were appraised for methodological quality. Narrative synthesis and meta-analytic methods were used to evaluate evidence. RESULTS Twenty-nine studies met criteria for inclusion. Five affective mediators were found; depression, anxiety, affective dysregulation, loneliness and attachment. Findings from both the narrative synthesis (n = 29) and meta-analysis (n = 8) indicated that, overall, affect is a small but significant mediator of the relationship between interpersonal trauma and psychosis (pooled Cohen's d = 0.178; pooled 95 % CI: 0.022-0.334). CONCLUSIONS Overall, findings support affective pathways to psychosis, though highlight the need for further research on broader affective mediators (loneliness, shame). The small effect size found in the meta-analysis also points to the potential importance of non-affective mediators. Clinically, these findings highlight the value of treatment modalities that attend to multiple mechanisms in the relationship between interpersonal trauma and psychosis. Future research should focus on the interplay and causal sequence between these mechanisms to further understand pathways between interpersonal trauma and psychosis.
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Affiliation(s)
- Shelley Grady
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland.
| | - Conal Twomey
- Dept. of Psychology, St Patrick's University Hospital, Dublin, Ireland
| | - Clare Cullen
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland
| | - Keith Gaynor
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland; DETECT, Early Intervention in Psychosis Service, Blackrock, Dublin, Ireland
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Turan S, Ermiş Ç, Eray Ş, Ağaç N, Aksoy S, Yüksel AS, Bezir Karaca A, Güler D, Tunçtürk M, Çıray RO, Mutlu C, Karaçetin G, Youngstrom EA, İnal N. Psychomotor agitation and irritability in adolescents with manic episode: Clinical data from three inpatient units. Clin Child Psychol Psychiatry 2023; 28:1266-1278. [PMID: 36052859 DOI: 10.1177/13591045221125331] [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: 11/15/2022]
Abstract
OBJECTIVES We aimed to investigate the characteristics of adolescents with Bipolar disorder-I with irritability and agitation (Mania+IA) compared to those without irritability and agitation (Mania-IA) in a multi-center representative sample. METHODS Data of 145 patients from three tertiary-care inpatient units between 2016 and 2021 were obtained. Psychomotor agitation was defined as a score of ≥3 on the YMRS "Increased Motor Activity--Energy" item, irritability as a score of ≥4 on the YMRS 'irritability' item, and severity anchors of speech and thought disturbance on the YMRS '6 and 7' items. RESULTS Previous manic episodes (p = 0.013), involuntary hospitalization (p = 0.006), psychotic features (p = 0.001), formal thought disorder (p = 0.010) and aggressive/disruptive behavior (p = 0.021) were more frequent in the Mania+IA group. Conversely, depressive episodes (p = 0.006) and family history of depression (p = 0.024) were more frequent in the Mania-IA group. The Mania+IA had poorer functioning at the time of discharge. CONCLUSIONS Irritability and agitation were closely related to complications, psychotic symptoms and thought disorder. Assessment and monitoring of psychomotor agitation and irritability may help child and adolescent psychiatrists to predict clinical difficulties and appropriate interventions.
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Affiliation(s)
- Serkan Turan
- Department of Child and Adolescent Psychiatry, Uludag University School of Medicine, Bursa, Turkey
| | | | - Şafak Eray
- Department of Child and Adolescent Psychiatry, Uludag University School of Medicine, Bursa, Turkey
| | - Nilay Ağaç
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine, İzmir, Turkey
| | - Sena Aksoy
- Balıkesir Atatürk City Hospital, Balıkesir, Turkey
| | - Ayşe Sena Yüksel
- Department of Child and Adolescent Psychiatry, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Istanbul, Turkey
| | - Ayça Bezir Karaca
- Department of Child and Adolescent Psychiatry, Uludag University School of Medicine, Bursa, Turkey
| | - Duru Güler
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine, İzmir, Turkey
| | - Mustafa Tunçtürk
- Department of Child and Adolescent Psychiatry, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Istanbul, Turkey
| | | | - Caner Mutlu
- Department of Child and Adolescent Psychiatry, Uludag University School of Medicine, Bursa, Turkey
| | - Gül Karaçetin
- Department of Child and Adolescent Psychiatry, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Istanbul, Turkey
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, USA & Helping Give Away Psychological Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Neslihan İnal
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine, İzmir, Turkey
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Pelizza L, Leuci E, Maestri D, Quattrone E, Azzali S, Paulillo G, Pellegrini P. Disorganization in first episode affective psychosis: Treatment response and clinical considerations from a 2-year follow-up study in a "real world" setting. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:151-158. [PMID: 38520114 DOI: 10.1016/j.rpsm.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Disorganization is a crucial domain in affective psychoses. However, it has received poor research attention, especially at the illness onset. The aims of this study were: (a) to monitor the longitudinal course of disorganization in young people with first episode affective psychosis (FEAP) across 2 years of follow-up, and (b) to investigate any relevant correlation of disorganized symptoms with psychopathology, functioning and the specific treatment elements of an "Early Intervention in Psychosis" (EIP) protocol along the follow-up period. MATERIALS AND METHODS Seventy-five FEAP participants (aged 12-35 years) completed the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). Spearman's rank correlation coefficients were calculated. RESULTS During the follow-up, disorganized symptoms showed significant enduring positive correlations with PANSS items representing delusional thought content and uncooperativeness, as well as a persistent negative association with the GAF score. Across the 2-year follow-up period, FEAP individuals also had a relevant reduction in disorganization levels. This symptom decrease was specifically related with the combination of antipsychotic medication with the specific psychosocial components of our EIP intervention offered to FEAP patients during the first 12 months of treatment. CONCLUSIONS Disorganization is relevant in FEAP subjects already at their enrollment in specialized EIP protocols. However, it decreases over time, together with the delivery of specific, combined (person-tailored) EIP interventions.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy.
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| | - Davide Maestri
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 43100 Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
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Harel EV, Shetreet E, Tennyson R, Fava M, Bar M. Constricted semantic relations in acute depression. J Affect Disord 2022; 311:565-571. [PMID: 35597474 DOI: 10.1016/j.jad.2022.05.100] [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: 01/04/2022] [Revised: 04/26/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND It has been suggested that mood influences the breadth of associated information available for retrieval, with positive mood broadening and negative mood constricting the scope of associations. In this study, we asked whether this mood-associations connection is related to controlled processes which were linked to clinical symptoms in depression. METHODS We used the semantic priming paradigm, which allows the dissociation of automatic and controlled processes by using short and long intervals between prime and target words. We further examined whether the strength of semantic relations (weak or strong) influence the priming effects in both neurotypical and depressed individuals. RESULTS Experiment 1, testing neurotypical individuals, showed priming effects for strong semantically-related words regardless of interval length, but priming effects for weak semantically-related words were smaller in short intervals than in long intervals. Experiment 2, testing depressed individuals in long intervals, showed smaller priming effects for weak semantically-related words than shown by neurotypicals, but priming effects for strong semantically-related words which were comparable between the groups. LIMITATIONS This study cannot determine the source for the differences in priming effects between depressed individuals and neurotypicals, and further studies are needed. CONCLUSIONS This is the first study to show priming impairments in depressed individuals. We discuss our results in light of leading theories concerning cognitive impairment in depression, as well as the newly emerged field of digital psychiatry.
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Affiliation(s)
- Eiran Vadim Harel
- Beer Yaakov Mental Health Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Shetreet
- Depratment of Linguistics, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Israel.
| | - Robert Tennyson
- Department of Anthropology, University of Washington, Seattle, WA, USA; Center for Studies of Demography and Ecology, University of Washington, Seattle, WA, USA
| | - Maurizio Fava
- Division of Clinical Research, Massachusetts General Hospital Research Institute, Boston, MA, USA
| | - Moshe Bar
- Gonda Center for Brain Research, Bar-Ilan University, Ramat Gan, Israel
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Genetic Predisposition to Schizophrenia and Depressive Disorder Comorbidity. Genes (Basel) 2022; 13:genes13030457. [PMID: 35328011 PMCID: PMC8950769 DOI: 10.3390/genes13030457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Patients with schizophrenia have an increased risk of depressive disorders compared to the general population. The comorbidity between schizophrenia and depression suggests a potential coincidence of the pathophysiology and/or genetic predictors of these mental disorders. The aim of this study was to review the potential genetic predictors of schizophrenia and depression comorbidity. Materials and Methods: We carried out research and analysis of publications in the databases PubMed, Springer, Wiley Online Library, Taylor & Francis Online, Science Direct, and eLIBRARY.RU using keywords and their combinations. The search depth was the last 10 years (2010–2020). Full-text original articles, reviews, meta-analyses, and clinical observations were analyzed. A total of 459 articles were found, of which 45 articles corresponding to the purpose of this study were analyzed in this topic review. Results: Overlap in the symptoms and genetic predictors between these disorders suggests that a common etiological mechanism may underlie the presentation of comorbid depression in schizophrenia. The molecular mechanisms linking schizophrenia and depression are polygenic. The most studied candidate genes are GRIN1, GPM6A, SEPTIN4, TPH1, TPH2, CACNA1C, CACNB2, and BCL9.Conclusion: Planning and conducting genome-wide and associative genetic studies of the comorbid conditions under consideration in psychiatry is important for the development of biological and clinical predictors and a personalized therapy strategy for schizophrenia. However, it should be recognized that the problems of predictive and personalized psychiatry in the diagnosis and treatment of schizophrenia and comorbid disorders are far from being resolved.
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Xu W, Portanova J, Chander A, Ben-Zeev D, Cohen T. The Centroid Cannot Hold: Comparing Sequential and Global Estimates of Coherence as Indicators of Formal Thought Disorder. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2021; 2020:1315-1324. [PMID: 33936508 PMCID: PMC8075468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Thought disorder (TD) as reflected in incoherent speech is a cardinal symptom of schizophrenia and related disorders. Quantification of the degree ofTD can inform diagnosis, monitoring, and timely intervention. Consequently, there has been an interest in applying methods ofdistributional semantics to quantify incoherence ofspoken language. Prior studies have generally involved few participants and utilized speech data collected in on-site structured interviews. In this paper we conduct a comprehensive evaluation ofapproaches to quantify incoherence using distributional semantics, including a novel variant that measures the global coherence oftext. This evaluation is conducted in the context of "audio diaries" collected from participants experiencing auditory verbal hallucinations using a smartphone application. Results reveal our novel global coherence metric using the centroid (weighted vector average) outperforms established approaches in their agreement with human annotators, supporting their preferential use in the context of short recordings ofunstructured and largely spontaneous speech.
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Affiliation(s)
- Weizhe Xu
- Biomedical Informatics and Medical Education
| | | | - Ayesha Chander
- Engineering (BRiTE) Center, Psychiatry and Behavioral Sciences; University of Washington, Seattle, WA
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Espiridion ED, Valent K, Qatanani A, Adesina O, Oladunjoye AO. A Rare Case of Ganser Syndrome: Psychogenic or Organic? Cureus 2020; 12:e10144. [PMID: 33014642 PMCID: PMC7526759 DOI: 10.7759/cureus.10144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Ganser syndrome (GS) is a rare neurological disorder characterized by answer approximation, clouded consciousness, somatic conversion symptoms, and visual or auditory hallucinations. The objective of this case report is to elucidate the presentation of a patient with GS and to highlight the interplay of psychological and organic determinants in this condition. We present a 66-year-old man with a history of concussion and short-term memory loss who presented with selective, remote, and recent memory loss following the death of his wife, visual hallucinations, approximation of answers regarding his current state, and limited insight into his condition. We found the patient oriented only to place and person, with impaired short-term memory and no language abnormalities. Montreal cognitive assessment (MOCA) exam showed mild-to-moderate cognitive impairment. The patient's presentation can be explained by both psychological and organic causes. Negative results from imaging and testing showed that the patient's recent emotional stressor, the death of his wife, may be contributing to the current state. However, the patient also has a history of hospitalization for traumatic brain injury (TBI) and a recent history of progressive memory loss. Therefore, the combination of psychological and organic factors likely played supplementary roles in the patient's current presentation. This case supports the literature that GS is a psychogenic disorder. However, an organic cause from the long-term sequelae of TBI needs further exploration.
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Affiliation(s)
- Eduardo D Espiridion
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA.,Psychiatry, West Virginia School of Osteopathic Medicine, Lewisburg, USA.,Psychiatry, West Virginia University School of Medicine, Martinsburg, USA.,Psychiatry, Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,Psychiatry, Reading Hospital - Tower Health, West Reading, USA
| | - Kyra Valent
- Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Anas Qatanani
- Medicine, Drexel University College of Medicine, Philadelphia, USA
| | | | - Adeolu O Oladunjoye
- Medical Critical Care, Boston Children's Hospital, Boston, USA.,Psychiatry, Reading Hospital - Tower Health, West Reading, USA
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Sandstrom A, MacKenzie L, Pizzo A, Fine A, Rempel S, Howard C, Stephens M, Patterson VC, Drobinin V, Van Gestel H, Howes Vallis E, Zwicker A, Propper L, Abidi S, Bagnell A, Lovas D, Cumby J, Alda M, Uher R, Pavlova B. Observed psychopathology in offspring of parents with major depressive disorder, bipolar disorder and schizophrenia. Psychol Med 2020; 50:1050-1056. [PMID: 31120010 DOI: 10.1017/s0033291719001089] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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 Children of parents with mood and psychotic disorders are at elevated risk for a range of behavioral and emotional problems. However, as the usual reporter of psychopathology in children is the parent, reports of early problems in children of parents with mood and psychotic disorders may be biased by the parents' own experience of mental illness and their mental state. METHODS Independent observers rated psychopathology using the Test Observation Form in 378 children and youth between the ages of 4 and 24 (mean = 11.01, s.d. = 4.40) who had a parent with major depressive disorder, bipolar disorder, schizophrenia, or no history of mood and psychotic disorders. RESULTS Observed attentional problems were elevated in offspring of parents with major depressive disorder, bipolar disorder and schizophrenia (effect sizes ranging between 0.31 and 0.56). Oppositional behavior and language/thought problems showed variable degrees of elevation (effect sizes 0.17 to 0.57) across the three high-risk groups, with the greatest difficulties observed in offspring of parents with bipolar disorder. Observed anxiety was increased in offspring of parents with major depressive disorder and bipolar disorder (effect sizes 0.19 and 0.25 respectively) but not in offspring of parents with schizophrenia. CONCLUSIONS Our results suggest that externalizing problems and cognitive and language difficulties may represent a general manifestation of familial risk for mood and psychotic disorders, while anxiety may be a specific marker of liability for mood disorders. Observer assessment may improve early identification of risk and selection of youth who may benefit from targeted prevention.
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Affiliation(s)
- A Sandstrom
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - L MacKenzie
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychology, Dalhousie University, Halifax, NS, Canada
| | - A Pizzo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - A Fine
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - S Rempel
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - C Howard
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - M Stephens
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - V C Patterson
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychology, Dalhousie University, Halifax, NS, Canada
| | - V Drobinin
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - H Van Gestel
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - E Howes Vallis
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - A Zwicker
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - L Propper
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - S Abidi
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - A Bagnell
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - D Lovas
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - J Cumby
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - R Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - B Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
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Zhang J, Magioncalda P, Huang Z, Tan Z, Hu X, Hu Z, Conio B, Amore M, Inglese M, Martino M, Northoff G. Altered Global Signal Topography and Its Different Regional Localization in Motor Cortex and Hippocampus in Mania and Depression. Schizophr Bull 2019; 45:902-910. [PMID: 30285255 PMCID: PMC6581125 DOI: 10.1093/schbul/sby138] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Bipolar disorder (BD) is a complex psychiatric disorder characterized by dominant symptom swings across different phases (manic, depressive, and euthymic). Different symptoms in BD such as abnormal episodic memory recall and psychomotor activity have been related to alterations in different regions, ie, hippocampus and motor cortex. How the abnormal regional distribution of neuronal activity relates to specific symptoms remains unclear, however. One possible neuronal mechanism of the relationship is the alteration of the global distribution of neuronal activity manifested in specific local regions; this can be measured as the correlation between the global signal (GS) and local regions. To understand the GS and its relationship to psychopathological symptoms, we here investigated the alteration of both GS variance and its regional topography in healthy controls and 3 phases of BD. We found that the variance of GS showed no significant difference between the 4 groups. In contrast, the GS topography was significantly altered in the different phases of BD, ie, the regions showing abnormally strong topographical GS contribution changed from hippocampus (and parahippocampus/fusiform gyrus) in depression to motor cortex in mania. Importantly, topographical GS changes in these regions correlated with psychopathological measures in both depression and mania. Taken together, our findings demonstrate the central importance of GS topography for psychopathological symptoms. This sheds lights on the neuronal mechanisms of specific psychopathological symptoms in BD, and its relevance in the relationship between global and local neuronal activities for behavior in general.
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Affiliation(s)
- Jianfeng Zhang
- Mental Health Center, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,Department of Brain Functioning Research, Hangzhou Seventh People’s Hospital, Hangzhou, Zhejiang, China,College of Biomedical Engineering and Instrument Sciences, Zhejiang University, Hangzhou, Zhejiang, China
| | - Paola Magioncalda
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Zirui Huang
- Department of Anesthesiology, University of Michigan, Ann Arbor MI,Center for Consciousness Science, University of Michigan, Ann Arbor, MI
| | - Zhonglin Tan
- Mental Health Center, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiwen Hu
- Mental Health Center, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhiguo Hu
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China
| | - Benedetta Conio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Neurology, University of Genoa, Genoa, Italy,Department of Neurology, Radiology, and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Matteo Martino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Georg Northoff
- Mental Health Center, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China,The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada,Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan,To whom correspondence should be addressed; Tianmu Road 305, Hangzhou, Zhejiang 310013, China; tel: 613-722-6521 ex. 6959, fax: 613-798-2982, e-mail:
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Basavaraju R, Mehta UM, Pascual-Leone A, Thirthalli J. Elevated mirror neuron system activity in bipolar mania: Evidence from a transcranial magnetic stimulation study. Bipolar Disord 2019; 21:259-269. [PMID: 30422373 PMCID: PMC7610514 DOI: 10.1111/bdi.12723] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The role of the "mirror neuron system" (MNS) in the pathophysiology of mood disorders is not well studied. Given its posited role in the often-impaired socio-emotional processes like intention detection, empathy, and imitation, we compared putative MNS-activity in patients with bipolar mania and healthy comparison subjects. We also examined the association between putative MNS-activity and hyper-imitative behaviors in patients. METHODS We studied 39 medication-free individuals diagnosed with mania and 45 healthy comparison subjects. TMS-evoked motor cortical reactivity was measured via single- and paired-pulse stimuli (assessing SICI-short and LICI-long interval intracortical inhibition) while subjects viewed a static image and goal-directed actions. Manic symptom severity and imitative behaviors were quantified using the Young's Mania Rating Scale and a modification of the Echolalia Questionnaire. RESULTS Two-way repeated measures analysis of variance demonstrated a significant group ×time interaction effect indicating greater facilitation of cortical reactivity during action-observation (putative MNS-activity) in the patient group as compared to the healthy group. While LICI-mediated MNS-activity had a significant association with manic symptom severity (r = 0.35, P = 0.038), SICI-mediated MNS-activity was significantly associated with incidental echolalia scores in a subgroup of 17 patients with incidental echolalia (r = 0.75, P < 0.001). CONCLUSIONS Our findings demonstrate that putative MNS-activity is heightened in mania, possibly because of disinhibition, and associated with behavioral consequences (incidental echolalia).
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Affiliation(s)
- Rakshathi Basavaraju
- Department of Psychiatry, National institute of Mental Health & Neurosciences (NIMHANS), Bangalore, india
| | - Urvakhsh M. Mehta
- Department of Psychiatry, National institute of Mental Health & Neurosciences (NIMHANS), Bangalore, india
| | - Alvaro Pascual-Leone
- Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jagadisha Thirthalli
- Department of Psychiatry, National institute of Mental Health & Neurosciences (NIMHANS), Bangalore, india
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Park YC, Lee MS, Si TM, Chiu HF, Kanba S, Chong MY, Tripathi A, Udomratn P, Chee KY, Tanra AJ, Rabbani G, Javed A, Kathiarachchi S, Myint WA, Cuong TV, Sim K, Yang SY, Sartorius N, Tan CH, Shinfuku N, Park SC. Psychotropic drug-prescribing correlates of disorganized speech in Asians with schizophrenia: The REAP-AP study. Saudi Pharm J 2019; 27:246-253. [PMID: 30766437 PMCID: PMC6362172 DOI: 10.1016/j.jsps.2018.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 11/12/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Although disorganized speech is seen as one of the nuclear features of schizophrenia, there have been few reports of disorganized speech-associated psychotropic drug-prescribing patterns in large samples of schizophrenia patients. OBJECTIVE We aimed to examine the prevalence of disorganized speech and its correlates in terms of psychotropic drug prescribing, using the data from the Research on Asian Psychotropic Patterns for Antipsychotics (REAP-AP) study. METHOD A total of 3744 patients with the ICD-10 diagnosis of schizophrenia were enrolled from 71 survey centers in 15 Asian countries/areas. An essential criterion of disorganized speech was that it was "severe enough to impair substantially effective communication" as defined in the DSM-5. A binary logistic model was fitted to identify the psychotropic drug-prescribing correlates of disorganized speech. RESULTS After adjusting for the potential effects of confounding variables, the binary logistic regression model showed that the presence of disorganized speech was directly associated with adjunctive use of mood stabilizers (P < 0.001) and cumulative diazepam equivalent dose (P < 0.0001), and inversely associated with adjunctive use of anti-Parkinson drugs (P < 0.0001). CONCLUSION The association between disorganized speech and adjunctive use of mood stabilizers could perhaps be understood in the context of a relationship with impulsiveness/aggressiveness, or in terms of deconstructing the Kraepelinian dualism.
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Affiliation(s)
- Yong Chon Park
- Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Min-Soo Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Tian-Mei Si
- Institute of Mental Health, Peking University, Beijing, China
| | - Helen F.K. Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan
| | - Mian-Yoon Chong
- Chang Gung Memorial Hospital, Chiayi, and Chang Gung University School of Medicine, Taiwan
| | - Adarsh Tripathi
- Department of Psychiatry, King George’s Medical University, Chowk, Lucknow, India
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkhla University, Songkhla, Thailand
| | - Kok Yoon Chee
- Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Andi J. Tanra
- Wahidin Sudirohusodo University, Makassar, Sulawesi Selatan, Indonesia
| | - Golam Rabbani
- National Institute of Mental Health, Dhaka, Bangladesh
| | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | | | - Win Aung Myint
- Department of Mental Health, University of Medicine (1), Yangon, Myanmar
| | | | - Kang Sim
- Institute of Mental Health, Singapore, Singapore
| | - Shu-yu Yang
- Deparment of Pharmacy, Songde Branch, Tapei City Hospital, Tapei, Taiwan
| | - Norman Sartorius
- Association of the Improvement of Mental Health Programs, Geneva, Switzerland
| | - Chay-Hoon Tan
- Department of Pharmacology, National University Hospital, Singapore, Singapore
| | - Naotaka Shinfuku
- Department of Social Welfare, School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Seon-Cheol Park
- Department of Psychiatry, Inje University College of Medicine and Haeundae Paik Hospital, Busan, Republic of Korea
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Tieges Z, Evans JJ, Neufeld KJ, MacLullich AM. The neuropsychology of delirium: advancing the science of delirium assessment. Int J Geriatr Psychiatry 2018; 33:1501-1511. [PMID: 28393426 PMCID: PMC6704364 DOI: 10.1002/gps.4711] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The diagnosis of delirium depends on eliciting its features through mental status examination and informant history. However, there is marked heterogeneity in how these features are assessed, from binary subjective clinical judgement to more comprehensive methods supported by cognitive testing. The aim of this article is to review the neuropsychological research in delirium and suggest future directions in research and clinical practice. METHODS We reviewed the neuropsychological literature on formal assessment and quantification of the different domains in delirium, focusing on the core feature of inattention. RESULTS Few studies have characterised and quantified the features of delirium using objective methods commonly employed in neuropsychological research. The existing evidence confirms that patients with delirium usually show impairments on objective tests of attention compared with cognitively intact controls and, in most cases, compared with patients with dementia. Further, abnormal level of arousal appears to be a specific indicator of delirium. The neuropsychological evidence base for impairments in other cognitive domains in delirium, including visual perception, language and thought processes, is small. CONCLUSIONS Delirium diagnosis requires accurate testing for its features, but there is little neuropsychological research examining the nature of these features, or evaluating the reliability, validity and discriminatory power of existing assessment processes. More research using the neuropsychological approach has enormous potential to improve and standardise delirium assessment methods of the individual features of delirium, such as inattention, and in developing more robust reference standards to enable greater comparability between studies.
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Affiliation(s)
- Zoë Tieges
- Edinburgh Delirium Research GroupUniversity of EdinburghEdinburghUK,Centre for Cognitive Ageing and Cognitive EpidemiologyUniversity of EdinburghEdinburghUK
| | | | - Karin J. Neufeld
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Alasdair M.J. MacLullich
- Edinburgh Delirium Research GroupUniversity of EdinburghEdinburghUK,Centre for Cognitive Ageing and Cognitive EpidemiologyUniversity of EdinburghEdinburghUK
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Sumner PJ, Bell IH, Rossell SL. A systematic review of task-based functional neuroimaging studies investigating language, semantic and executive processes in thought disorder. Neurosci Biobehav Rev 2018; 94:59-75. [PMID: 30142368 DOI: 10.1016/j.neubiorev.2018.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/16/2018] [Accepted: 08/09/2018] [Indexed: 01/30/2023]
Abstract
The aim of the current systematic review was to synthesise the research that has investigated thought disorder (TD) using task-based functional neuroimaging techniques to target executive, language, or semantic functions. Thirty-five pertinent studies were identified from January 1990 to August 2016. Functional correlates of TD included the superior and middle temporal, fusiform, and inferior frontal gyri bilaterally, as well as the left and right cingulate cortex, the right caudate nucleus, and the cerebellum. TD-related increases and decreases in activation were both evident in most of these regions. However, the specificity of these correlates from general clinical and cognitive influences is unknown. The cortical regions implicated overlap with those thought to contribute to language and semantic systems. Cortico-striatal circuitry may also play a role in some aspects of TD through aberrant salience representation and inappropriate attentional prioritisation. To advance the field further, greater integration across structural, functional, and behavioural measures is required, in addition to non-unitary considerations of TD.
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Affiliation(s)
- Philip J Sumner
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, VIC, Australia.
| | - Imogen H Bell
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, VIC, Australia; Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
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14
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To use the brief psychiatric rating scale to detect disorganized speech in schizophrenia: Findings from the REAP-AP study. Kaohsiung J Med Sci 2018; 34:113-119. [DOI: 10.1016/j.kjms.2017.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/01/2017] [Accepted: 09/21/2017] [Indexed: 11/23/2022] Open
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Sumner PJ, Bell IH, Rossell SL. A systematic review of the structural neuroimaging correlates of thought disorder. Neurosci Biobehav Rev 2018; 84:299-315. [DOI: 10.1016/j.neubiorev.2017.08.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/28/2017] [Accepted: 08/22/2017] [Indexed: 01/03/2023]
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Linking major depression and the neural substrates of associative processing. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2017; 16:1017-1026. [PMID: 27553369 DOI: 10.3758/s13415-016-0449-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
It has been proposed that mood correlates with the breadth of associative thinking. Here we set this hypothesis to the test in healthy and depressed individuals. Generating contextual associations engages a network of cortical regions including the parahippocampal cortex (PHC), retrosplenial complex, and medial prefrontal cortex. The link between mood, associative processing, and its underlying cortical infrastructure provides a promising avenue for elucidating the mechanisms underlying the cognitive impairments in major depressive disorder (MDD). The participants included 15 nonmedicated individuals with acute major depressive episodes and 15 healthy matched controls. In an fMRI experiment, participants viewed images of objects that were either strongly or weakly associated with a specific context (e.g., a beach chair vs. a water bottle) while rating the commonality of each object. Analyses were performed to examine the brain activation and structural differences between the groups. Consistent with our hypothesis, controls showed greater activation of the contextual associations network than did depressed participants. In addition, PHC structural volume was correlated with ruminative tendencies, and the volumes of the hippocampal subfields were significantly smaller in depressed participants. Surprisingly, depressed participants showed increased activity in the entorhinal cortex (ERC), as compared with controls. We integrated these findings within a mechanistic account linking mood and associative thinking and suggest directions for the future.
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Yalincetin B, Bora E, Binbay T, Ulas H, Akdede BB, Alptekin K. Formal thought disorder in schizophrenia and bipolar disorder: A systematic review and meta-analysis. Schizophr Res 2017; 185:2-8. [PMID: 28017494 DOI: 10.1016/j.schres.2016.12.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/03/2016] [Accepted: 12/14/2016] [Indexed: 12/29/2022]
Abstract
Historically, formal thought disorder has been considered as one of the distinctive symptoms of schizophrenia. However, research in last few decades suggested that there is a considerable clinical and neurobiological overlap between schizophrenia and bipolar disorder (BP). We conducted a meta-analysis of studies comparing positive (PTD) and negative formal thought disorder (NTD) in schizophrenia and BP. We included 19 studies comparing 715 schizophrenia and 474 BP patients. In the acute inpatient samples, there was no significant difference in the severity of PTD (d=-0.07, CI=-0.22-0.09) between schizophrenia and BP. In stable patients, schizophrenia was associated with increased PTD compared to BP (d=1.02, CI=0.35-1.70). NTD was significantly more severe (d=0.80, CI=0.52-0.1.08) in schizophrenia compared to BP. Our findings suggest that PTD is a shared feature of both schizophrenia and BP but persistent PTD or NTD can distinguish subgroups of schizophrenia from BP and schizophrenia patients with better clinical outcomes.
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Affiliation(s)
- Berna Yalincetin
- Department of Neurosciences, Dokuz Eylül University, Izmir 35340, Turkey.
| | - Emre Bora
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria 3053, Australia; Department of Psychiatry, Dokuz Eylül University Medical School, Izmir 35340, Turkey
| | - Tolga Binbay
- Department of Psychiatry, Dokuz Eylül University Medical School, Izmir 35340, Turkey
| | - Halis Ulas
- Department of Psychiatry, Dokuz Eylül University Medical School, Izmir 35340, Turkey
| | - Berna Binnur Akdede
- Department of Neurosciences, Dokuz Eylül University, Izmir 35340, Turkey; Department of Psychiatry, Dokuz Eylül University Medical School, Izmir 35340, Turkey
| | - Koksal Alptekin
- Department of Neurosciences, Dokuz Eylül University, Izmir 35340, Turkey; Department of Psychiatry, Dokuz Eylül University Medical School, Izmir 35340, Turkey
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Llewellyn S. Crossing the invisible line: De-differentiation of wake, sleep and dreaming may engender both creative insight and psychopathology. Conscious Cogn 2016; 46:127-147. [DOI: 10.1016/j.concog.2016.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 09/13/2016] [Indexed: 12/21/2022]
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Samsom JN, Wong AHC. Schizophrenia and Depression Co-Morbidity: What We have Learned from Animal Models. Front Psychiatry 2015; 6:13. [PMID: 25762938 PMCID: PMC4332163 DOI: 10.3389/fpsyt.2015.00013] [Citation(s) in RCA: 42] [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] [Received: 10/30/2014] [Accepted: 01/24/2015] [Indexed: 12/15/2022] Open
Abstract
Patients with schizophrenia are at an increased risk for the development of depression. Overlap in the symptoms and genetic risk factors between the two disorders suggests a common etiological mechanism may underlie the presentation of comorbid depression in schizophrenia. Understanding these shared mechanisms will be important in informing the development of new treatments. Rodent models are powerful tools for understanding gene function as it relates to behavior. Examining rodent models relevant to both schizophrenia and depression reveals a number of common mechanisms. Current models which demonstrate endophenotypes of both schizophrenia and depression are reviewed here, including models of CUB and SUSHI multiple domains 1, PDZ and LIM domain 5, glutamate Delta 1 receptor, diabetic db/db mice, neuropeptide Y, disrupted in schizophrenia 1, and its interacting partners, reelin, maternal immune activation, and social isolation. Neurotransmission, brain connectivity, the immune system, the environment, and metabolism emerge as potential common mechanisms linking these models and potentially explaining comorbid depression in schizophrenia.
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Affiliation(s)
- James N Samsom
- Department of Molecular Neuroscience, Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute , Toronto, ON , Canada ; Department of Pharmacology, Faculty of Medicine, University of Toronto , Toronto, ON , Canada
| | - Albert H C Wong
- Department of Molecular Neuroscience, Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute , Toronto, ON , Canada ; Department of Pharmacology, Faculty of Medicine, University of Toronto , Toronto, ON , Canada ; Department of Psychiatry, Faculty of Medicine, University of Toronto , Toronto, ON , Canada
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Russo M, Levine SZ, Demjaha A, Di Forti M, Bonaccorso S, Fearon P, Dazzan P, Pariante CM, David AS, Morgan C, Murray RM, Reichenberg A. Association between symptom dimensions and categorical diagnoses of psychosis: a cross-sectional and longitudinal investigation. Schizophr Bull 2014; 40:111-9. [PMID: 23661632 PMCID: PMC3885297 DOI: 10.1093/schbul/sbt055] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
CONTEXT Cross-sectional studies of the signs and symptoms of psychosis yield dimensional phenotypes. However, the validity and clinical utility of such dimensions remain debated. This study investigated the structure of psychotic symptomatology, the stability of the structure over time, and the concordance between symptom dimensions and categorical diagnoses. METHODS Sample consisted of 500 first-episode psychotic patients. A cross-sectional study (N = 500) investigated the organizational structure of symptom dimensions at the onset of psychosis and its concordance with categorical diagnoses; next, a nested longitudinal study (N = 100) examined the stability of the symptom dimensions structure after 5-10 years of follow-up. RESULTS Factor analyses identified 6 first-order factors (mania, negative, disorganization, depression, hallucinations, and delusions) and 2 high-order factors (affective and nonaffective psychoses). Cumulative variance accounted for by the first and high-order factors was 63%: 31% by the first-order factors and 32% by the high-order factors. The factorial structure of psychotic symptoms during first episode remained stable after 5-10 years of follow-up. The overall concordance between 4 categorical diagnostic groups (schizophrenia, mania with psychosis, psychotic depression and schizoaffective disorder) and dimensional symptom ranged from 62.2% to 73.1% (when the schizoaffective group was excluded). CONCLUSIONS Symptoms of psychosis assume a multidimensional hierarchical structure. This hierarchical model was stable over time and showed good concordance with categorical diagnoses. The combined use of dimensional and categorical approach to psychotic disorders would be of clinical and research utility.
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Affiliation(s)
- Manuela Russo
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK;,Department of Psychiatry, Mount Sinai School of Medicine, New York, NY;,*To whom correspondence should be addressed; 1 Gustave L Levy Place, Box 1230, NY 10029, US; tel: +1 212-241-0755, fax: +1 212-996-8931, e-mail:
| | - Stephen Z. Levine
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Arsime Demjaha
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Marta Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Stefania Bonaccorso
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Paul Fearon
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Carmine M. Pariante
- Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, UK
| | - Anthony S. David
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Craig Morgan
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Abraham Reichenberg
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK;,Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
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Abstract
AbstractI argued that rapid eye movement (REM) dreaming is elaborative emotional encoding for episodic memories, sharing many features with the ancient art of memory (AAOM). In this framework, during non–rapid eye movement (NREM), dream scenes enable junctions between episodic networks in the cortex and are retained by the hippocampus as indices for retrieval. The commentaries, which varied in tone from patent enthusiasm to edgy scepticism, fall into seven natural groups: debate over the contribution of the illustrative dream and disputes over the nature of dreaming (discussed in sect. R1); how the framework extends to creativity, psychopathology, and sleep disturbances (sect. R2); the compatibility of the REM dream encoding function with emotional de-potentiation (sect. R3); scepticism over similarities between REM dreaming and the AAOM (sect. R4); the function of NREM dreams in the sleep cycle (sect. R5); the fit of the junction hypothesis with current knowledge of cortical networks (sect. R6); and whether the hypothesis is falsifiable (including methodological challenges and evidence against the hypothesis) (sect. R7). Although the groups in sections R1–R6 appear quite disparate, I argue they all follow from the associative nature of dreaming.
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Abstract
BACKGROUND It was recently hypothesized by Lake (Schizophrenia Bulletin 2008; 34: 109-117) that Formal Thought Disorder (FTD) can be accounted for by a single disorder that is currently diagnosed as bipolar disorder. OBJECTIVES This study aimed to analyze the underlying dimensions of FTD and to examine to what extent FTD factors can be accounted for by clinical distractibility, attentional impairment, severity of mania, and familial liability of bipolar disorder and schizophrenia. METHODS Six hundred and sixty inpatients were assessed using a semistructured interview, and FTDs were assessed with the Thought, Language, and Communication scale. "Inattentiveness during Mental Status Testing" item of the Scale for the Assessment of Negative Symptoms scale and a composite mania score were used. The Family History-Research Diagnostic Criteria was used. RESULTS FTD is a multidimensional construct comprised at least 5 dimensions: disorganization, verbosity, poverty of speech, idiosyncratic thinking, and blocking. Clinical distractibility loadings split in 2 factors, disorganization and blocking, but it did not load on the mania-related (verbosity) factor. Attentional disturbance was significantly associated with each FTD factor except for idiosyncratic thinking, and these associations were largely independent from the severity of mania. The associations of FTDs with mania and attentional disturbances were independent from each other. FTD factors were not significantly associated with familial liability to bipolar or to schizophrenia. CONCLUSIONS Disorganization was the main FTD component. Distractibility was a core feature of FTD factors but it was not specifically accounted for by mania-related attentional impairment. The hypothesis of mutual interdependence between mania and attentional disturbance leading to FTDs could not be confirmed.
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Affiliation(s)
- Manuel J. Cuesta
- To whom correspondence should be addressed; tel: +34-848-422488, fax: +34-848-422488, e-mail:
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Llewellyn S. If waking and dreaming consciousness became de-differentiated, would schizophrenia result? Conscious Cogn 2011; 20:1059-83. [PMID: 21498086 DOI: 10.1016/j.concog.2011.03.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 03/17/2011] [Accepted: 03/22/2011] [Indexed: 12/31/2022]
Abstract
If both waking and dreaming consciousness are functional, their de-differentiation would be doubly detrimental. Differentiation between waking and dreaming is achieved through neuromodulation. During dreaming, without external sensory data and with mesolimbic dopaminergic input, hyper-cholinergic input almost totally suppresses the aminergic system. During waking, with sensory gates open, aminergic modulation inhibits cholinergic and mesocortical dopaminergic suppresses mesolimbic. These neuromodulatory systems are reciprocally interactive and self-organizing. As a consequence of neuromodulatory reciprocity, phenomenologically, the self and the world that appear during dreaming differ from those that emerge during waking. As a result of self-organizing, the self and the world in both states are integrated. Some loss of self-organization would precipitate a degree of de-differentiation between waking and dreaming, resulting in a hybrid state which would be expressed heterogeneously, both neurobiologically and phenomenologically. As a consequence of progressive de-differentiation, certain identifiable psychiatric disorders may emerge. Ultimately, schizophrenia, a disorganized-fragmented self, may result.
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Affiliation(s)
- Sue Llewellyn
- Faculty of Humanities, The University of Manchester, Booth Street West, Manchester M15 6PB, UK.
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Woods AM. Memoir and the Diagnosis of Schizophrenia: Reflections on The Center Cannot Hold, Me, Myself, and Them, and the 'Crumbling Twin Pillars' of Kraepelinian Psychiatry. Ment Health Rev (Brighton) 2011; 16:102-106. [PMID: 25729317 PMCID: PMC4340532 DOI: 10.1108/13619321111178041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 1896 Emil Kraepelin revolutionised the classification of psychosis by identifying what he argued were two natural disease entities: manic-depressive psychosis (bipolar disorder) and dementia praecox (schizophrenia). Kraepelin's twin pillars have governed psychiatric thinking, practice and research for over a century. However, a growing number of researchers, clinicians, and mental health service users argue contest the claim that there are fundamental differences between schizophrenia and bipolar disorder, and call for a symptom-led approach which prioritises subjective experience over diagnostic category. How can the published first-person accounts of experts by experience contribute to this debate? This short paper looks at the representation of psychiatric diagnosis in two much-lauded autobiographies: Kurt Snyder's Me, Myself, and Them: A Firsthand Account of One Young Person's Experience with Schizophrenia (2007) and Elyn Saks' The Center Cannot Hold: My Journey Through Madness (2007). As well as providing a prognosis and a plan for treatment, the psychiatric diagnosis of schizophrenia, for both these writers, gives shape and meaning to the illness experience and ultimately becomes the pivot or platform from which identity and memoir unfold. Saks and Snyder do not claim to speak for all people who receive a diagnosis of schizophrenia and it would be a mistake to read their texts in this way even if they did. But if the debate about the future of psychiatric nosology is going to respect subjective experience, the insights they and others offer in to the multiple meanings and effects of psychiatric diagnosis more than compel our attention.
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Affiliation(s)
- Angela M Woods
- Durham University, Centre for Medical Humanities, Elvet Hill Road, Durham University, Durham DH1 3LN,
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Abstract
There is rising interest in identifying precursors to bipolar disorder symptoms, including thought disorder. Thought disorder is identified in adults through self-report and in school-aged children through parent report and child story-telling. This study is an exploration to determine if preschoolers with mood dysregulation have evidence of disordered thoughts using a story-stem completion method. Participants included two groups of 3.5-6 year-old children: 20 with mood dysregulation including manic symptoms and 11 typically developing comparison children. Children were administered story completion narratives including one story where the child character accidentally cuts him/herself while pretending to cook. The children were asked to complete the stories and their responses were analyzed for atypical themes consistent with disordered thoughts such as violence or bizarreness outside of the story or props coming to life. Thirty-five percentage of symptomatic preschoolers versus 0% of typically developing preschoolers ascribed independent actions to inanimate props (p = 0.03). Eighty percentage of symptomatic preschoolers versus 9% of typically developing preschoolers utilized props in a violent or bizarre manner outside the central story (p < 0.001). Preschool children with symptoms of dysregulated mood express themes related to the unusual use of story props which may indicate disordered thoughts. This preschool expression of dysregulated mood appears similar to and possibly continuous with school-age and adult versions of bipolar disorder.
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Academic psychiatry's responsibility for increasing the recognition of mood disorders and risk for suicide in primary care. Curr Opin Psychiatry 2010; 23:157-66. [PMID: 19926995 DOI: 10.1097/yco.0b013e328333e195] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The authors seek solutions to better meet the healthcare needs of depressed patients in primary care by improving the recognition of depression, other mood disorders and of a risk for suicide. RECENT FINDINGS For 25 years academic psychiatry and primary care have known that only 10-50% of depressed patients are adequately treated, primarily because of the failure to recognize depression. There are substantial negative consequences including suicide. Suicide occurs during depression so the recognition of depression is the critical first step to preventing suicide. Recently noted is that one barrier to recognition is the traditional, comprehensive, psychiatric interview taught in academic departments of psychiatry that is impractical in primary care settings because it takes too much time. Some brief, initial psychiatric techniques have been developed but these typically have been introduced in primary care training programs and not by departments of psychiatry. SUMMARY A verbal four-question, 90 s screen for depression may be acceptable for routine use in primary care because it typically requires only seconds to a few minutes. Introduction of such a screening instrument to medical students on psychiatry and primary care clerkships could increase the recognition of depression and reduce death by suicide.
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Lake CR. Why the Kraepelinian Dichotomy and Schizophrenia have not Followed the Neuroses. Psychiatr Ann 2010. [DOI: 10.3928/00485713-20100303-04] [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: 11/20/2022]
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Koolschijn PCMP, van Haren NEM, Lensvelt-Mulders GJLM, Hulshoff Pol HE, Kahn RS. Brain volume abnormalities in major depressive disorder: a meta-analysis of magnetic resonance imaging studies. Hum Brain Mapp 2010; 30:3719-35. [PMID: 19441021 DOI: 10.1002/hbm.20801] [Citation(s) in RCA: 614] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE So far, there have been no attempts to integrate the growing number of all brain volumetric magnetic resonance imaging studies in depression. In this comprehensive meta-analysis the magnitude and extent of brain volume differences between 2,418 patients with major depressive disorder and 1,974 healthy individuals from 64 studies was determined. METHODS A systematic research was conducted for volumetric magnetic resonance imaging studies of patients with major depressive disorder in relation to healthy control subjects. Studies had to report sufficient data for computation of effect sizes. For each study, the Cohen's d was calculated. All analyses were performed using the random effects model. Additionally, meta-regression analyses were done to explore the effects of potential sources of heterogeneity. RESULTS Patients showed large volume reductions in frontal regions, especially in the anterior cingulate and orbitofrontal cortex with smaller reductions in the prefrontal cortex. The hippocampus, the putamen and caudate nucleus showed moderate volume reductions. CONCLUSIONS This is the first comprehensive meta-analysis in major depressive disorder demonstrating structural brain abnormalities, particularly in those brain areas that are involved in emotion processing and stress-regulation.
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Affiliation(s)
- P Cédric M P Koolschijn
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.
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Minassian A, Henry BL, Geyer MA, Paulus MP, Young JW, Perry W. The quantitative assessment of motor activity in mania and schizophrenia. J Affect Disord 2010; 120:200-6. [PMID: 19435640 PMCID: PMC2795051 DOI: 10.1016/j.jad.2009.04.018] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 04/14/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Increased motor activity is a cardinal feature of the mania of Bipolar Disorder (BD), and is thought to reflect dopaminergic dysregulation. Motor activity in BD has been studied almost exclusively with self-report and observer-rated scales, limiting the ability to objectively quantify this behavior. We used an ambulatory monitoring device to quantify motor activity in BD and schizophrenia (SCZ) patients in a novel exploratory paradigm, the human Behavioral Pattern Monitor (BPM). METHOD 28 patients in the manic phase of BD, 17 SCZ patients, and 21 nonpatient (NC) subjects were tested in the BPM, an unfamiliar room containing novel objects. Motor activity was measured with a wearable ambulatory monitoring device (LifeShirt). RESULTS Manic BD patients exhibited higher levels of motor activity when exploring the novel environment than SCZ and NC groups. Motor activity showed some modest relationships with symptom ratings of mania and psychosis and was not related to smoking or body mass index. LIMITATIONS Although motor activity did not appear to be impacted significantly by antipsychotic or mood-stabilizing medications, this was a naturalistic study and medications were not controlled, thus limiting conclusions about potential medication effects on motor activity. CONCLUSION Manic BD patients exhibit a unique signature of motoric overactivity in a novel exploratory environment. The use of an objective method to quantify exploration and motor activity may help characterize the unique aspects of BD and, because it is amenable to translational research, may further the study of the biological and genetic bases of the disease.
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Affiliation(s)
- Arpi Minassian
- University of California, Department of Psychiatry, San Diego, CA, USA.
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In two minds? Is schizophrenia a state ‘trapped’ between waking and dreaming? Med Hypotheses 2009; 73:572-9. [DOI: 10.1016/j.mehy.2009.05.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 05/05/2009] [Accepted: 05/07/2009] [Indexed: 11/21/2022]
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Abstract
Kraepelin proposed dementia praecox and manic-depressive illness as the two major psychotic disorders. This paradigm is still prevalent, but observations of overlapping boundaries between bipolar disorder and schizophrenia challenge this dichotomy. However, the concept of schizophrenia has been radically altered from the original Kraepelinian proposal. We defend the two psychoses positions, but suggest two flaws in the heuristic application: (1) overlapping features, such as psychotic symptoms, are not decisive in differential diagnosis; and (2) each disorder is a syndrome, not a disease entity. An alternative paradigm based on domains of pathology is more powerful for studies of etiology, pathophysiology, and therapeutic discovery.
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Is 'bipolar disorder' the brain's autopoietic response to schizophrenia? Med Hypotheses 2009; 73:580-4. [PMID: 19589644 DOI: 10.1016/j.mehy.2009.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 05/05/2009] [Accepted: 05/07/2009] [Indexed: 11/22/2022]
Abstract
Evidence is accumulating that schizophrenia and bipolar disorder are related conditions. This paper proposes a particular form of relatedness. If 'schizophrenia' is a mind/brain 'trapped' between waking and dreaming, in a disordered in-between state, then bipolar 'disorder' could actually be an attempt to restore order. The mind/brain is a self-producing, self-organizing system. Autopoiesis applies to such systems. Neuromodulation accomplishes self-organization in the mind/brain. If schizophrenia is a state in-between waking and dreaming, characterized by aminergic/cholinergic interpenetration and dopaminergic imbalance then bipolar 'disorder' could be a modulatory response. This autopoietic reaction may take the form of either aminergic hyperactivity aimed at producing a purer waking state, (precipitating mania in the waking state), or cholinergic hyperactivity aimed at producing a purer dreaming state, (producing depression in the waking state), or both, resulting in rapid cycling bipolar disorder. Thus bipolar activity may be an autopoietic response aimed at restoring differentiation to the in-between state of schizophrenia.
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Abstract
Psychiatric comorbidities are common among patients with schizophrenia. Substance abuse comorbidity predominates. Anxiety and depressive symptoms are also very common throughout the course of illness, with an estimated prevalence of 15% for panic disorder, 29% for posttraumatic stress disorder, and 23% for obsessive-compulsive disorder. It is estimated that comorbid depression occurs in 50% of patients, and perhaps (conservatively) 47% of patients also have a lifetime diagnosis of comorbid substance abuse. This article chronicles these associations, examining whether these comorbidities are "more than chance" and might represent (distinct) phenotypes of schizophrenia. Among the anxiety disorders, the evidence at present is most abundant for an association with obsessive-compulsive disorder. Additional studies in newly diagnosed antipsychotic-naive patients and their first-degree relatives and searches for genetic and environmental risk factors are needed to replicate preliminary findings and further investigate these associations.
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Affiliation(s)
- Peter F. Buckley
- Department of Psychiatry, Medical College of Georgia, 997 St Sebastian Way, Augusta, GA 30912,To whom correspondence should be addressed; tel: 706-721-6719, e-mail:
| | - Brian J. Miller
- Department of Psychiatry, Medical College of Georgia, 997 St Sebastian Way, Augusta, GA 30912
| | - Douglas S. Lehrer
- Wright State University Boonshoft School of Medicine and the Wallace-Kettering Neuroscience Institute
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Smith MJ, Barch DM, Csernansky JG. Bridging the gap between schizophrenia and psychotic mood disorders: Relating neurocognitive deficits to psychopathology. Schizophr Res 2009; 107:69-75. [PMID: 18786811 PMCID: PMC2647814 DOI: 10.1016/j.schres.2008.07.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 07/21/2008] [Accepted: 07/28/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The neurobiological relationship between schizophrenia and psychotic mood disorders is not well understood. Neurocognitive deficits have been described in both types of disorders and have been proposed to reflect underlying neurobiological dysfunction. Examining the relationship between neurocognitive function and psychopathology could help illuminate the neurobiological relationship between schizophrenia and psychotic mood disorders. METHODS Participants included 72 individuals with DSM-IV schizophrenia, 25 individuals with schizoaffective disorder or bipolar disorder with psychotic features, and 72 community controls. Standardized scores and correlations between four domains of neurocognition and psychopathology were examined. RESULTS Individuals with schizophrenia and psychotic mood disorders scored similarly on several dimensions of neurocognitive function and psychopathology. The relationships between neurocognitive function and psychopathology were similar in the two groups. CONCLUSIONS Individuals with schizophrenia and psychotic mood disorders were similar in terms of both the level of impairment in neurocognitive function and psychopathology, as well as in the relationship between the two dimensions of illness. These results suggest that schizophrenia and psychotic mood disorders such as schizoaffective disorder and bipolar disorder with psychotic features are on a neurobiological continuum.
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Affiliation(s)
- Matthew J Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
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Lake CR. Hypothesis: grandiosity and guilt cause paranoia; paranoid schizophrenia is a psychotic mood disorder; a review. Schizophr Bull 2008; 34:1151-62. [PMID: 18056109 PMCID: PMC2632512 DOI: 10.1093/schbul/sbm132] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Delusional paranoia has been associated with severe mental illness for over a century. Kraepelin introduced a disorder called "paranoid depression," but "paranoid" became linked to schizophrenia, not to mood disorders. Paranoid remains the most common subtype of schizophrenia, but some of these cases, as Kraepelin initially implied, may be unrecognized psychotic mood disorders, so the relationship of paranoid schizophrenia to psychotic bipolar disorder warrants reevaluation. To address whether paranoia associates more with schizophrenia or mood disorders, a selected literature is reviewed and 11 cases are summarized. Comparative clinical and recent molecular genetic data find phenotypic and genotypic commonalities between patients diagnosed with schizophrenia and psychotic bipolar disorder lending support to the idea that paranoid schizophrenia could be the same disorder as psychotic bipolar disorder. A selected clinical literature finds no symptom, course, or characteristic traditionally considered diagnostic of schizophrenia that cannot be accounted for by psychotic bipolar disorder patients. For example, it is hypothesized here that 2 common mood-based symptoms, grandiosity and guilt, may underlie functional paranoia. Mania explains paranoia when there are grandiose delusions that one's possessions are so valuable that others will kill for them. Similarly, depression explains paranoia when delusional guilt convinces patients that they deserve punishment. In both cases, fear becomes the overwhelming emotion but patient and physician focus on the paranoia rather than on underlying mood symptoms can cause misdiagnoses. This study uses a clinical, case-based, hypothesis generation approach that warrants follow-up with a larger representative sample of psychotic patients followed prospectively to determine the degree to which the clinical course observed herein is typical of all such patients. Differential diagnoses, nomenclature, and treatment implications are discussed because bipolar patients misdiagnosed with schizophrenia are severely misserved.
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Affiliation(s)
- Charles Raymond Lake
- Department of Psychiatry, University of Kansas Medical Center, Kansas City, KS 66160-7341, USA.
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