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Garcia-de la Cruz DD, Juarez-Rojop IE, Tovilla-Zarate CA, Nicolini H, Genis-Mendoza AD. Circulating Cell-Free Mitochondrial DNA in Plasma of Individuals with Schizophrenia and Cognitive Deficit in Mexican Population. Neuropsychiatr Dis Treat 2024; 20:1757-1765. [PMID: 39323935 PMCID: PMC11423824 DOI: 10.2147/ndt.s460554] [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: 01/20/2024] [Accepted: 09/06/2024] [Indexed: 09/27/2024] Open
Abstract
Purpose Cognitive domains are affected in patients with schizophrenia. Mitochondrial dysfunction has been proposed as a possible origin of these symptoms. Cell-free mitochondrial DNA (cf-mtDNA) is an indicator of cellular stress, and it can be identified in individuals with age-associated disorders, this study aimed to explore the presence of cf-mtDNA in plasma of schizophrenia patients and its association with cognitive deficit. Patients and Methods Ninety-nine subjects were clinically evaluated; the case group included 60 patients diagnosed with schizophrenia and 39 randomly-individuals without psychiatric disorders were included in the comparison group. Cognitive status (MoCA scale) and cell-free mtDNA in blood plasma were assessed and quantified in both groups. Results From the original sample, cf-mtDNA was identified in 43 subjects, 40 patients with schizophrenia and 3 controls (Χ2 = 31.10, p-value < 0.0001). Thirty-nine out of forty patients with schizophrenia had a cognitive deficit. Conclusion According to our findings, cognitive impairment and presence of cf-mtDNA were related in subjects with schizophrenia. Thus, while the cognitive deficit might reflect an accelerated aging process, the cf-mtDNA plays a role as a potential biomarker in this mechanism.
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Affiliation(s)
- Dulce Dajheanne Garcia-de la Cruz
- Unidad de Enseñanza e Investigación, Hospital Regional de Alta Especialidad de Salud Mental Villahermosa, Tabasco, México
- Laboratorio de Metabolismo de Lípidos, Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
| | - Isela Esther Juarez-Rojop
- Laboratorio de Metabolismo de Lípidos, Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
| | | | - Humberto Nicolini
- Laboratorio de Genómica de las Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Ciudad de México, México
| | - Alma Delia Genis-Mendoza
- Laboratorio de Genómica de las Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Ciudad de México, México
- Hospital Psiquiátrico Infantil, Dr. Juan N. Navarro, Ciudad de México, México
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Adachi N, Kato M, Onuma T, Ito M, Okazaki M, Hara K, Adachi T, Matsubara R. Different psychopathological courses between chronic interictal psychosis and schizophrenia. Epilepsy Behav 2024; 158:109956. [PMID: 39059138 DOI: 10.1016/j.yebeh.2024.109956] [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: 05/06/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE The clinical course of interictal psychosis (IIP) has not yet been investigated. We aimed to compared the psychopathology and time-relevant indices between chronic IIP (CIIP) and schizophrenia (SC) METHODS: In this comprehensive psychopathological study, patients with chronic psychosis with and without epilepsy (127 with CIIP and 187 with SC) were compared. Psychopathology was measured using the Brief Psychiatric Rating Scale (BPRS): total, negative symptoms (NSs), positive symptoms (PSs), and anxiety-depressive symptoms (ADSs). Time-relevant indices included age at the time of evaluation, age at the onset of psychosis, and duration of psychosis. The psychopathology of psychosis types and time-relevant indices were analyzed using Pearson's correlation coefficient analysis of covariance. RESULTS Age at the time of evaluation was significantly correlated with NS, and ADS scores. Age-relevant trajectories significantly interacted with psychosis types. As age advanced, patients with SC exhibited increased scores, whereas patients with CIIP often exhibited decreased (or unchanged) scores. Age at onset of psychosis was significantly correlated with NS and ADS outcomes in patients with CIIP, whereas it was not correlated in patients with SC. There were significant interactions between age at onset and psychosis types. Patients with early-onset CIIP exhibited higher NS and lower ADS scores, whereas patients with SC exhibited no particular trajectory. The duration of psychosis significantly interacted with the psychosis types in the BPRS total, NSs and PSs. As duration increased, patients with CIIP exhibited no significant relationship, whereas patients with SC exhibited significantly higher psychotic scores. CONCLUSION Psychopathological courses differ between patients with CIIP and SC. Although patients with SC often exhibit deteriorations in psychotic symptoms, patients with CIIP exhibit no distinct deterioration. These findings can contribute psychiatric nosology, treatment strategies, and prediction outcomes.
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Affiliation(s)
| | | | | | | | - Mitsutoshi Okazaki
- National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
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Agid O. Re-evaluating the prognosis of schizophrenia: tackling the issue of inadequate treatment. Expert Rev Neurother 2024; 24:831-835. [PMID: 38879827 DOI: 10.1080/14737175.2024.2365943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/05/2024] [Indexed: 08/09/2024]
Affiliation(s)
- Ofer Agid
- Schizophrenia Program, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada
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Tang B, Yao L, Strawn JR, Zhang W, Lui S. Neurostructural, Neurofunctional, and Clinical Features of Chronic, Untreated Schizophrenia: A Narrative Review. Schizophr Bull 2024:sbae152. [PMID: 39212651 DOI: 10.1093/schbul/sbae152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Studies of individuals with chronic, untreated schizophrenia (CUS) can provide important insights into the natural course of schizophrenia and how antipsychotic pharmacotherapy affects neurobiological aspects of illness course and progression. We systematically review 17 studies on the neuroimaging, cognitive, and epidemiological aspects of CUS individuals. These studies were conducted at the Shanghai Mental Health Center, Institute of Mental Health at Peking University, and Huaxi MR Research Center between 2013 and 2021. CUS is associated with cognitive impairment, severe symptoms, and specific demographic characteristics and is different significantly from those observed in antipsychotic-treated individuals. Furthermore, CUS individuals have neurostructural and neurofunctional alterations in frontal and temporal regions, corpus callosum, subcortical, and visual processing areas, as well as default-mode and somatomotor networks. As the disease progresses, significant structural deteriorations occur, such as accelerated cortical thinning in frontal and temporal lobes, greater reduction in fractional anisotropy in the genu of corpus callosum, and decline in nodal metrics of gray mater network in thalamus, correlating with worsening cognitive deficits and clinical outcomes. In addition, striatal hypertrophy also occurs, independent of antipsychotic treatment. Contrasting with the negative neurostructural and neurofunctional effects of short-term antipsychotic treatment, long-term therapy frequently results in significant improvements. It notably enhances white matter integrity and the functions of key subcortical regions such as the amygdala, hippocampus, and striatum, potentially improving cognitive functions. This narrative review highlights the progressive neurobiological sequelae of CUS, the importance of early detection, and long-term treatment of schizophrenia, particularly because treatment may attenuate neurobiological deterioration and improve clinical outcomes.
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Affiliation(s)
- Biqiu Tang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH
| | - Li Yao
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Jeffrey R Strawn
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH
| | - Wenjing Zhang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Su Lui
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
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Borgogna NC, Owen T, Aita SL. The absurdity of the latent disease model in mental health: 10,130,814 ways to have a DSM-5-TR psychological disorder. J Ment Health 2024; 33:451-459. [PMID: 37947129 DOI: 10.1080/09638237.2023.2278107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/21/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Latent disease classification is currently the accepted approach to mental illness diagnosis. In the United States, this takes the form of the Diagnostic and Statistical Manual of Mental Disorders-5-Text Revision (DSM-5-TR). Latent disease classification has been criticized for reliability and validity problems, particularly regarding diagnostic heterogeneity. No authors have calculated the scope of the heterogeneity problem of the entire DSM-5-TR. AIMS We addressed this issue by calculating the unique diagnostic profiles that exist for every DSM-5-TR diagnosis. METHODS We did this by applying formulas previously used in smaller heterogeneity analyses to all diagnoses within the DSM-5-TR. RESULTS We found that there are 10,130,814 ways to be diagnosed with a mental illness using DSM-5-TR criteria. When specifiers are considered, this number balloons to over 161 septillion unique diagnostic presentations (driven mainly by bipolar II disorder). Additionally, there are 1,951,065 ways to present with psychiatric symptoms, yet not meet diagnostic criteria. CONCLUSIONS Latent disease classification leads to considerable heterogeneity in possible presentations. We provide examples of how latent disease classification harms research and treatment programs. We echo recommendations for the dismissal of latent disease classification as a mental illness diagnostic program.
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Affiliation(s)
- Nicholas C Borgogna
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Tyler Owen
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Stephen L Aita
- Department of Psychology, University of Maine, Orono, ME, USA
- Department of Mental Health, VA Maine Healthcare System, Augusta, ME, USA
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Serra-Arumí C, Golay P, Bonnarel V, Alerci L, Abrahamyan Empson L, Conus P, Alameda L. Risk and protective factors for recovery at 3-year follow-up after first-episode psychosis onset: a multivariate outcome approach. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1255-1267. [PMID: 37861709 PMCID: PMC11178637 DOI: 10.1007/s00127-023-02579-w] [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: 05/17/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE Recovery in people with first-episode psychosis (FEP) remains a major issue. When risk factors are studied in relation to the disorder, potential protective factors should also be considered since they can modulate this relationship. This study is aimed at exploring which premorbid and baseline characteristics are associated with a good and poor global recovery in patients with FEP at 3-year follow-up. METHODS We categorized patients' outcome by using a Latent Class Analysis (LCA) considering a multimodal set of symptomatic and functional outcomes. A Mixed effects Models Repeated Measures analysis of variance (MMRM) was used to highlight group differences over time on symptomatic and functional outcomes assessed during the 3-year follow-up. RESULTS A total of 325 patients with FEP aged between 18 and 35 years were included. Two groups were identified. A total of 187 patients (57.5%) did not achieve recovery, and 138 patients (42.5%) achieved recovery. Recovered patients had generally a better premorbid and baseline profile in comparison with non-recovered patients (as among which shorter duration of untreated psychosis (DUP), higher degree of insight, better functional level and lower illness severity at baseline). The trajectories for the psychopathological and functional outcomes over 36 months differed between the non-recovered and the recovered group of patients. CONCLUSIONS Our results pointed to some variables associated with recovery, acting as potential protective factors. These should be considered for early intervention programs to promote psychological resilience specifically in those with a worse prognosis in order to mitigate the effects of the variables that make them more vulnerable to poorer outcome.
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Affiliation(s)
- Clara Serra-Arumí
- Etiopathogenesis and Treatment of Severe Mental Disorders (MERITT), Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Philippe Golay
- Department of Psychiatry, General Psychiatry Service, Treatment and Early Intervention in Psychosis Program, Centre Hospitalier Universitaire Vaudois (CHUV), Place Chauderon, 18, 1003, Lausanne, Switzerland
| | - Vincent Bonnarel
- Department of Psychiatry, General Psychiatry Service, Treatment and Early Intervention in Psychosis Program, Centre Hospitalier Universitaire Vaudois (CHUV), Place Chauderon, 18, 1003, Lausanne, Switzerland
| | - Livia Alerci
- Department of Psychiatry, General Psychiatry Service, Treatment and Early Intervention in Psychosis Program, Centre Hospitalier Universitaire Vaudois (CHUV), Place Chauderon, 18, 1003, Lausanne, Switzerland
| | - Lilith Abrahamyan Empson
- Department of Psychiatry, General Psychiatry Service, Treatment and Early Intervention in Psychosis Program, Centre Hospitalier Universitaire Vaudois (CHUV), Place Chauderon, 18, 1003, Lausanne, Switzerland
| | - Philippe Conus
- Department of Psychiatry, General Psychiatry Service, Treatment and Early Intervention in Psychosis Program, Centre Hospitalier Universitaire Vaudois (CHUV), Place Chauderon, 18, 1003, Lausanne, Switzerland
| | - Luis Alameda
- Department of Psychiatry, General Psychiatry Service, Treatment and Early Intervention in Psychosis Program, Centre Hospitalier Universitaire Vaudois (CHUV), Place Chauderon, 18, 1003, Lausanne, Switzerland.
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Departamento de Psiquiatría, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain.
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Wilson JC, Liu KY, Jones K, Mahmood J, Arya U, Howard R. Biomarkers of neurodegeneration in schizophrenia: systematic review and meta-analysis. BMJ MENTAL HEALTH 2024; 27:e301017. [PMID: 38796179 PMCID: PMC11129036 DOI: 10.1136/bmjment-2024-301017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/07/2024] [Indexed: 05/28/2024]
Abstract
QUESTION Does neurodegenerative disease underlie the increased rate of dementia observed in older people with schizophrenia? Several studies have reported a higher prevalence of dementia in people with schizophrenia compared with the general population. This may reflect a higher risk of developing neurodegenerative diseases such as vascular dementia or Alzheimer's disease (AD). Alternatively, this may reflect non-pathological, age-related cognitive decline in a population with low cognitive reserve. STUDY SELECTION AND ANALYSIS We reviewed papers that compared postmortem findings, hippocampal MRI volume or cerebrospinal fluid (CSF) markers of AD, between patients with schizophrenia with evidence of cognitive impairment (age ≥45 years) with controls. We subsequently performed a meta-analysis of postmortem studies that compared amyloid-β plaques (APs) or neurofibrillary tangles (NFTs) in cognitively impaired patients with schizophrenia to normal controls or an AD group. FINDINGS No studies found a significant increase of APs or NFTs in cognitively impaired patients with schizophrenia compared with controls. All postmortem studies that compared APs or NFTs in patients with schizophrenia to an AD group found significantly more APs or NFTs in AD. No studies found a significant differences in CSF total tau or phosphorylated tau between patients with schizophrenia and controls. The two studies which compared CSF Aβ42 between patients with schizophrenia and controls found significantly decreased CSF Aβ42 in schizophrenia compared with controls. Hippocampal volume findings were mixed. CONCLUSIONS Studies have not found higher rates of AD-related pathology in cognitively impaired individuals with schizophrenia compared with controls. Higher rates of dementia identified in population studies may reflect a lack of specificity in clinical diagnostic tools used to diagnose dementia.
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Affiliation(s)
| | - Kathy Y Liu
- Division of Psychiatry, University College London, London, UK
| | - Katherine Jones
- Camden and Islington NHS Foundation Trust, London, London, UK
| | | | - Utkarsh Arya
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Rob Howard
- Division of Psychiatry, University College London, London, UK
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Raina S. Schizophrenia: Communication Disorders and Role of the Speech-Language Pathologist. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1099-1112. [PMID: 38266230 DOI: 10.1044/2023_ajslp-23-00287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
PURPOSE This clinical focus article aims to provide a comprehensive overview of schizophrenia and understanding of communication disorders resulting from its psychopathology. Schizophrenia is a spectrum disorder with varying levels of symptom expression. It is characterized by positive and negative symptoms that can cause communication disorders of different severity levels. Communication difficulties manifest as a range of symptoms such as alogia, disorganized speech, and impaired social communication. These challenges may result in receptive and expressive language deficits that lead to misunderstandings, reduced social interactions, and difficulties expressing thoughts and emotions effectively. The purpose of this clinical focus article is to explore the role of the speech-language pathologist (SLP) in assessing and treating communication disorders presented in schizophrenia. CONCLUSIONS In order to understand the role of the SLP in assessing and treating communication disorders in schizophrenia, it is imperative to understand the overall course, etiology, assessment, and treatment consideration of this condition. SLPs can provide services in the areas of social skills training and community-based intervention contexts.
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Affiliation(s)
- Shivani Raina
- Department of Communication Disorders and Deafness, Kean University, Union, NJ
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Isayeva U, Manchia M, Collu R, Primavera D, Deriu L, Caboni E, Iaselli NM, Sundas D, Tusconi M, Pinna F, Paribello P, Scherma M, Pisanu C, Meloni A, Zai CC, Congiu D, Squassina A, Fratta W, Fadda P, Carpiniello B. Symptomatic remission and recovery in major psychosis: Is there a role for BDNF? A secondary analysis of the LABSP cohort data. Schizophr Res 2024; 266:197-204. [PMID: 38422890 DOI: 10.1016/j.schres.2024.02.019] [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: 02/01/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
Remission, relapse prevention, and clinical recovery are crucial areas of interest in schizophrenia (SCZ) research. Although SCZ is a chronic disorder with poor overall outcomes, years of research demonstrated that recovery is possible. There are considerable data linking brain-derived neurotrophic factor (BDNF) to SCZ, however, evidence on the role of BDNF in remission in SCZ is scarce. This secondary analysis of the Longitudinal Assessment of BDNF in Sardinian patients (LABSP) data aimed to investigate the relationship between serum BDNF levels and symptomatic remission, simultaneous clinical and functional remission, and recovery in patients with SCZ. A total of 105 patients with SCZ or schizoaffective disorder were recruited for a longitudinal assessment of BDNF levels over 24 months. Longitudinal data were analyzed using mixed-effects linear regression models. The study found significant associations between use of long acting injectables (χ2 = 7.075, df = 1, p = 0.008), baseline serum BDNF levels (U = 701, z = -2.543, p = 0.011), and "childhood" (U = 475, z = -2.124, p = 0.034) and "general" (U = 55, z = -2.014, p = 0.044) subscales of the Premorbid Adjustment Scale (PAS) with patients maintaining remission and recovery. The diagnosis of SCZ was significantly associated with lower BDNF levels for patients with simultaneous clinical and functional remission (Z = 2.035, p = 0.0419) and recovery (Z = 2.009, p = 0.0445) compared to those without. There were no significant associations between remission in the entire sample and longitudinal serum BDNF levels or genetic variants within the BDNF gene. These findings provide further insight into the complex relationship between BDNF and SCZ.
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Affiliation(s)
- Ulker Isayeva
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Roberto Collu
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Diego Primavera
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Deriu
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Edoardo Caboni
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Novella Maria Iaselli
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Davide Sundas
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Massimo Tusconi
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federica Pinna
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Maria Scherma
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Claudia Pisanu
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Anna Meloni
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Clement C Zai
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Institute of Medical Science, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Donatella Congiu
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Alessio Squassina
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Walter Fratta
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy; Centre of Excellence "Neurobiology of Dependence", University of Cagliari, Cagliari, Italy
| | - Paola Fadda
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy; Centre of Excellence "Neurobiology of Dependence", University of Cagliari, Cagliari, Italy
| | - Bernardo Carpiniello
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
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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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Slováková A, Kúdelka J, Škoch A, Jakob L, Fialová M, Fürstová P, Bakštein E, Bankovská Motlová L, Knytl P, Španiel F. Time is the enemy: Negative symptoms are related to even slight differences in the duration of untreated psychosis. Compr Psychiatry 2024; 130:152450. [PMID: 38241816 DOI: 10.1016/j.comppsych.2024.152450] [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: 09/11/2023] [Revised: 12/26/2023] [Accepted: 01/12/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Negative symptoms (NS) represent a detrimental symptomatic domain in schizophrenia affecting social and occupational outcomes. AIMS We aimed to identify factors from the baseline visit (V1) - with a mean illness duration of 0.47 years (SD = 0.45) - that predict the magnitude of NS at the follow-up visit (V3), occurring 4.4 years later (mean +/- 0.45). METHOD Using longitudinal data from 77 first-episode schizophrenia spectrum patients, we analysed eight predictors of NS severity at V3: (1) the age at disease onset, (2) age at V1, (3) sex, (4) diagnosis, (5) NS severity at V1, (6) the dose of antipsychotic medication at V3, (7) hospitalisation days before V1 and; (8) the duration of untreated psychosis /DUP/). Secondly, using a multiple linear regression model, we studied the longitudinal relationship between such identified predictors and NS severity at V3 using a multiple linear regression model. RESULTS DUP (Pearson's r = 0.37, p = 0.001) and NS severity at V1 (Pearson's r = 0.49, p < 0.001) survived correction for multiple comparisons. The logarithmic-like relationship between DUP and NS was responsible for the initial stunning incremental contribution of DUP to the severity of NS. For DUP < 6 months, with the sharpest DUP/NS correlation, prolonging DUP by five days resulted in a measurable one-point increase in the 6-item negative symptoms PANSS domain assessed 4.9 (+/- 0.6) years after the illness onset. Prolongation of DUP to 14.7 days doubled this NS gain, whereas 39 days longer DUP tripled NS increase. CONCLUSION The results suggest the petrification of NS during the early stages of the schizophrenia spectrum and a crucial dependence of this symptom domain on DUP. These findings are clinically significant and highlight the need for primary preventive actions.
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Affiliation(s)
- Andrea Slováková
- National Institute of Mental Health, Klecany, Czech Republic; 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Jan Kúdelka
- National Institute of Mental Health, Klecany, Czech Republic
| | - Antonín Škoch
- National Institute of Mental Health, Klecany, Czech Republic; Institute for Clinical and Experimental Medicine, Department of Diagnostic and Interventional Radiology, Prague, Czech Republic.
| | - Lea Jakob
- National Institute of Mental Health, Klecany, Czech Republic.
| | - Markéta Fialová
- National Institute of Mental Health, Klecany, Czech Republic; 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Petra Fürstová
- National Institute of Mental Health, Klecany, Czech Republic.
| | - Eduard Bakštein
- National Institute of Mental Health, Klecany, Czech Republic.
| | | | - Pavel Knytl
- National Institute of Mental Health, Klecany, Czech Republic.
| | - Filip Španiel
- National Institute of Mental Health, Klecany, Czech Republic; 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
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Fuentes-Claramonte P, Estradé A, Solanes A, Ramella-Cravaro V, Garcia-Leon MA, de Diego-Adeliño J, Molins C, Fung E, Valentí M, Anmella G, Pomarol-Clotet E, Oliver D, Vieta E, Radua J, Fusar-Poli P. Biomarkers for Psychosis: Are We There Yet? Umbrella Review of 1478 Biomarkers. SCHIZOPHRENIA BULLETIN OPEN 2024; 5:sgae018. [PMID: 39228676 PMCID: PMC11369642 DOI: 10.1093/schizbullopen/sgae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Background and Hypothesis This umbrella review aims to comprehensively synthesize the evidence of association between peripheral, electrophysiological, neuroimaging, neuropathological, and other biomarkers and diagnosis of psychotic disorders. Study Design We selected systematic reviews and meta-analyses of observational studies on diagnostic biomarkers for psychotic disorders, published until February 1, 2018. Data extraction was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Evidence of association between biomarkers and psychotic disorders was classified as convincing, highly suggestive, suggestive, weak, or non-significant, using a standardized classification. Quality analyses used the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Study Results The umbrella review included 110 meta-analyses or systematic reviews corresponding to 3892 individual studies, 1478 biomarkers, and 392 210 participants. No factor showed a convincing level of evidence. Highly suggestive evidence was observed for transglutaminase autoantibodies levels (odds ratio [OR] = 7.32; 95% CI: 3.36, 15.94), mismatch negativity in auditory event-related potentials (standardized mean difference [SMD] = 0.73; 95% CI: 0.5, 0.96), P300 component latency (SMD = -0.6; 95% CI: -0.83, -0.38), ventricle-brain ratio (SMD = 0.61; 95% CI: 0.5, 0.71), and minor physical anomalies (SMD = 0.99; 95% CI: 0.64, 1.34). Suggestive evidence was observed for folate, malondialdehyde, brain-derived neurotrophic factor, homocysteine, P50 sensory gating (P50 S2/S1 ratio), frontal N-acetyl-aspartate, and high-frequency heart rate variability. Among the remaining biomarkers, weak evidence was found for 626 and a non-significant association for 833 factors. Conclusions While several biomarkers present highly suggestive or suggestive evidence of association with psychotic disorders, methodological biases, and underpowered studies call for future higher-quality research.
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Affiliation(s)
- Paola Fuentes-Claramonte
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Andrés Estradé
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Aleix Solanes
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain
| | - Valentina Ramella-Cravaro
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Maria Angeles Garcia-Leon
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Javier de Diego-Adeliño
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Conrad Molins
- Psychiatric Service, Hospital Universitari Santa Maria, Lleida, Catalonia, Spain
| | - Eric Fung
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Marc Valentí
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Gerard Anmella
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Dominic Oliver
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford OX3 7JX, UK
- OPEN Early Detection Service, Oxford Health NHS Foundation Trust, Oxford OX3 7JX, UK
| | - Eduard Vieta
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Joaquim Radua
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
- OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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13
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Melazzini L, Mazzocchi L, Vecchio A, Paredes A, Mensi MM, Ballante E, Paoletti M, Bastianello S, Balottin U, Borgatti R, Pichiecchio A. Magnetic resonance advanced imaging analysis in adolescents: cortical thickness study to identify attenuated psychosis syndrome. Neuroradiology 2023; 65:1447-1458. [PMID: 37524967 DOI: 10.1007/s00234-023-03200-2] [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: 12/31/2022] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE Psychosis is a symptom common to several mental illnesses and a defining feature of schizophrenia spectrum disorders, whose onset typically occurs in adolescence. Neuroradiological studies have reported evidence of brain structural abnormalities in patients with overt psychosis. However, early identification of brain structural changes in young subjects at risk for developing psychosis (such as those with Attenuated Psychosis Syndrome -APS) is currently lacking. METHODS Brain 3D T1-weighted and 64 directions diffusion-weighted images were acquired on 55 help-seeking adolescents (12-17 years old) with psychiatric disorders who referred to our Institute. Patients were divided into three groups: non-APS (n = 20), APS (n = 20), and Early-Onset Psychosis (n = 15). Cortical thickness was calculated from T1w images, and Tract-Based Spatial Statistics analysis was performed to study the distribution of white matter fractional anisotropy and all diffusivity metrics. A thorough neuropsychological test battery was adopted to investigate cognitive performance in several domains. RESULTS In patients with Attenuated Psychotic Syndrome, the left superior frontal gyrus was significantly thinner compared to patients with non-APS (p = 0.048), and their right medial orbitofrontal cortex thickness was associated with lower working memory scores (p = 0.0025, r = -0.668 for the working memory index and p = 0.001, r = -0.738 for the digit span). Early-Onset Psychosis patients showed thinner left pars triangularis compared to non-APS individuals (p = 0.024), and their left pars orbitalis was associated with impaired performance at the symbol search test (p = 0.005, r = -0.726). No differences in diffusivity along main tracts were found between sub-groups (p > 0.05). CONCLUSION This study showed specific associations between structural imaging features and cognitive performance in patients with APS. Characterizing this disorder using neuroimaging could reveal useful information that may aid in the development and evaluation of preventive strategies in these individuals.
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Affiliation(s)
- Luca Melazzini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Laura Mazzocchi
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy.
| | - Arianna Vecchio
- Child and Adolescent Neuropsychiatric Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Alexandra Paredes
- Faculty of Medicine and Surgery, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Martina M Mensi
- Child and Adolescent Neuropsychiatric Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elena Ballante
- BioData Science Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Political and Social Sciences, University of Pavia, Pavia, Italy
| | - Matteo Paoletti
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefano Bastianello
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Umberto Balottin
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Renato Borgatti
- Child and Adolescent Neuropsychiatric Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Anna Pichiecchio
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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14
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Emsley R. Antipsychotics and structural brain changes: could treatment adherence explain the discrepant findings? Ther Adv Psychopharmacol 2023; 13:20451253231195258. [PMID: 37701891 PMCID: PMC10493054 DOI: 10.1177/20451253231195258] [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: 03/15/2023] [Accepted: 07/11/2023] [Indexed: 09/14/2023] Open
Abstract
Progressive structural brain changes are well documented in schizophrenia and have been linked to both illness progression and the extent of antipsychotic treatment exposure. Literature reporting longitudinal changes in brain structure in individuals with schizophrenia is selectively reviewed to assess the roles of illness, antipsychotic treatment, adherence and other factors in the genesis of these changes. This narrative review considers literature investigating longitudinal changes in brain structure in individuals with schizophrenia. The review focusses on structural changes in the cortex, basal ganglia and white matter. It also examines effects of medication non-adherence and relapse on the clinical course of the illness and on structural brain changes. Studies investigating structural magnetic resonance imaging changes in patients treated with long-acting injectable antipsychotics are reviewed. Temporal changes in brain structure in schizophrenia can be divided into those that are associated with antipsychotic treatment and those that are not. Changes associated with treatment include increases in basal ganglia and white matter volumes. Relapse episodes may be a critical factor in illness progression and brain volume reductions. Medication adherence may be an important factor that could explain the findings that brain volume reductions are associated with poor treatment response, higher intensity of antipsychotic treatment exposure and more time spent in relapse. Improved adherence via long-acting injectable antipsychotics and adherence focussed psychosocial interventions could maximize protective effects of antipsychotics against illness progression.
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Affiliation(s)
- Robin Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Tygerberg Campus, Cape Town 8000, South Africa
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15
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Hua JPY, Loewy RL, Stuart B, Fryer SL, Niendam TA, Carter CS, Vinogradov S, Mathalon DH. Cortical and subcortical brain morphometry abnormalities in youth at clinical high-risk for psychosis and individuals with early illness schizophrenia. Psychiatry Res Neuroimaging 2023; 332:111653. [PMID: 37121090 PMCID: PMC10362971 DOI: 10.1016/j.pscychresns.2023.111653] [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: 01/23/2023] [Revised: 03/27/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Abstract
Neuroimaging studies have documented morphometric brain abnormalities in schizophrenia, but less is known about them in individuals at clinical high-risk for psychosis (CHR-P), including how they compare with those observed in early schizophrenia (ESZ). Accordingly, we implemented multivariate profile analysis of regional morphometric profiles in CHR-P (n = 89), ESZ (n = 93) and healthy controls (HC; n = 122). ESZ profiles differed from HC and CHR-P profiles, including 1) cortical thickness: significant level reduction and regional non-parallelism reflecting widespread thinning, except for entorhinal and pericalcarine cortex, 2) basal ganglia volume: significant level increase and regional non-parallelism reflecting larger caudate and pallidum, and 3) ventricular volume: significant level increase with parallel regional profiles. CHR-P and ESZ cerebellar profiles showed significant non-parallelism with HC profiles. Regional profiles did not significantly differ between groups for cortical surface area or subcortical volume. Compared to CHR-P followed for ≥18 months without psychosis conversion (n = 31), CHR-P converters (n = 17) showed significant non-parallel ventricular volume expansion reflecting specific enlargement of lateral and inferolateral regions. Antipsychotic dosage in ESZ was significantly correlated with frontal cortical thinning. Results suggest that morphometric abnormalities in ESZ are not present in CHR-P, except for ventricular enlargement, which was evident in CHR-P who developed psychosis.
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Affiliation(s)
- Jessica P Y Hua
- Sierra Pacific Mental Illness Research Education and Clinical Centers, San Francisco VA Medical Center, and the University of California, San Francisco, CA, United States; Mental Health Service, San Francisco VA Medical Center, San Francisco, 94121, CA, United States; Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, 94143, CA, United States; Department of Psychological Sciences, University of Missouri, Columbia, 65211, MO, United States
| | - Rachel L Loewy
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, 94143, CA, United States
| | - Barbara Stuart
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, 94143, CA, United States
| | - Susanna L Fryer
- Mental Health Service, San Francisco VA Medical Center, San Francisco, 94121, CA, United States
| | - Tara A Niendam
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, 95616, CA, United States
| | - Cameron S Carter
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, 95616, CA, United States
| | - Sophia Vinogradov
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, 55455, MN, United States
| | - Daniel H Mathalon
- Mental Health Service, San Francisco VA Medical Center, San Francisco, 94121, CA, United States; Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, 94143, CA, United States.
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16
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Mizutani R, Saiga R, Yamamoto Y, Uesugi M, Takeuchi A, Uesugi K, Terada Y, Suzuki Y, De Andrade V, De Carlo F, Takekoshi S, Inomoto C, Nakamura N, Torii Y, Kushima I, Iritani S, Ozaki N, Oshima K, Itokawa M, Arai M. Structural aging of human neurons is opposite of the changes in schizophrenia. PLoS One 2023; 18:e0287646. [PMID: 37352288 PMCID: PMC10289376 DOI: 10.1371/journal.pone.0287646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/11/2023] [Indexed: 06/25/2023] Open
Abstract
Human mentality develops with age and is altered in psychiatric disorders, though their underlying mechanism is unknown. In this study, we analyzed nanometer-scale three-dimensional structures of brain tissues of the anterior cingulate cortex from eight schizophrenia and eight control cases. The distribution profiles of neurite curvature of the control cases showed a trend depending on their age, resulting in an age-correlated decrease in the standard deviation of neurite curvature (Pearson's r = -0.80, p = 0.018). In contrast to the control cases, the schizophrenia cases deviate upward from this correlation, exhibiting a 60% higher neurite curvature compared with the controls (p = 7.8 × 10-4). The neurite curvature also showed a correlation with a hallucination score (Pearson's r = 0.80, p = 1.8 × 10-4), indicating that neurite structure is relevant to brain function. This report is based on our 3D analysis of human brain tissues over a decade and is unprecedented in terms of the number of cases. We suggest that neurite curvature plays a pivotal role in brain aging and can be used as a hallmark to exploit a novel treatment of schizophrenia.
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Affiliation(s)
- Ryuta Mizutani
- Department of Bioengineering, Tokai University, Hiratsuka, Kanagawa, Japan
| | - Rino Saiga
- Department of Bioengineering, Tokai University, Hiratsuka, Kanagawa, Japan
| | - Yoshiro Yamamoto
- Department of Mathematics, Tokai University, Hiratsuka, Kanagawa, Japan
| | - Masayuki Uesugi
- Japan Synchrotron Radiation Research Institute (JASRI/SPring-8), Sayo, Hyogo, Japan
| | - Akihisa Takeuchi
- Japan Synchrotron Radiation Research Institute (JASRI/SPring-8), Sayo, Hyogo, Japan
| | - Kentaro Uesugi
- Japan Synchrotron Radiation Research Institute (JASRI/SPring-8), Sayo, Hyogo, Japan
| | - Yasuko Terada
- Japan Synchrotron Radiation Research Institute (JASRI/SPring-8), Sayo, Hyogo, Japan
| | - Yoshio Suzuki
- Photon Factory, High Energy Accelerator Research Organization KEK, Tsukuba, Ibaraki, Japan
| | - Vincent De Andrade
- Advanced Photon Source, Argonne National Laboratory, Lemont, IL, United States of America
| | - Francesco De Carlo
- Advanced Photon Source, Argonne National Laboratory, Lemont, IL, United States of America
| | - Susumu Takekoshi
- Department of Cell Biology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Chie Inomoto
- Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Naoya Nakamura
- Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Youta Torii
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Itaru Kushima
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Medical Genomics Center, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Shuji Iritani
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenichi Oshima
- Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo, Japan
- Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, Japan
| | - Masanari Itokawa
- Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo, Japan
- Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, Japan
| | - Makoto Arai
- Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, Japan
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17
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Andreou D, Steen NE, Jørgensen KN, Smelror RE, Wedervang-Resell K, Nerland S, Westlye LT, Nærland T, Myhre AM, Joa I, Reitan SMK, Vaaler A, Morken G, Bøen E, Elvsåshagen T, Boye B, Malt UF, Aukrust P, Skrede S, Kroken RA, Johnsen E, Djurovic S, Andreassen OA, Ueland T, Agartz I. Lower circulating neuron-specific enolase concentrations in adults and adolescents with severe mental illness. Psychol Med 2023; 53:1479-1488. [PMID: 35387700 PMCID: PMC10009386 DOI: 10.1017/s0033291721003056] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/05/2021] [Accepted: 07/13/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Both neurodegenerative and neurodevelopmental abnormalities have been suggested to be part of the etiopathology of severe mental illness (SMI). Neuron-specific enolase (NSE), mainly located in the neuronal cytoplasm, may indicate the process as it is upregulated after neuronal injury while a switch from non-neuronal enolase to NSE occurs during neuronal maturation. METHODS We included 1132 adult patients with SMI [schizophrenia (SZ) or bipolar spectrum disorders], 903 adult healthy controls (HC), 32 adolescent patients with SMI and 67 adolescent HC. Plasma NSE concentrations were measured by enzyme immunoassay. For 842 adults and 85 adolescents, we used total grey matter volume (TGMV) based on T1-weighted magnetic resonance images processed in FreeSurfer v6.0. We explored NSE case-control differences in adults and adolescents separately. To investigate whether putative case-control differences in NSE were TGMV-dependent we controlled for TGMV. RESULTS We found significantly lower NSE concentrations in both adult (p < 0.001) and adolescent patients with SMI (p = 0.007) compared to HC. The results remained significant after controlling for TGMV. Among adults, both patients with SZ spectrum (p < 0.001) and bipolar spectrum disorders (p = 0.005) had lower NSE than HC. In both patient subgroups, lower NSE levels were associated with increased symptom severity. Among adults (p < 0.001) and adolescents (p = 0.040), females had lower NSE concentrations than males. CONCLUSION We found lower NSE concentrations in adult and adolescent patients with SMI compared to HC. The results suggest the lack of progressive neuronal injury, and may reflect abnormal neuronal maturation. This provides further support of a neurodevelopmental rather than a neurodegenerative mechanism in SMI.
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Affiliation(s)
- Dimitrios Andreou
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Nils Eiel Steen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
| | - Kjetil Nordbø Jørgensen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Runar Elle Smelror
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Kirsten Wedervang-Resell
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Child and Adolescent Mental Health Research Unit, Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Stener Nerland
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Lars T. Westlye
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Terje Nærland
- K.G. Jebsen Center for Neurodevelopmental Disorders, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - Anne Margrethe Myhre
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Inge Joa
- TIPS – Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Solveig Merete Klæbo Reitan
- Faculty of Medicine and Health Sciences, Department of Mental Health, NTNU, Trondheim, Norway
- St Olavs Hospital, Department of Mental Health, Trondheim, Norway
| | - Arne Vaaler
- Faculty of Medicine and Health Sciences, Department of Mental Health, NTNU, Trondheim, Norway
- St Olavs Hospital, Department of Mental Health, Trondheim, Norway
| | - Gunnar Morken
- Faculty of Medicine and Health Sciences, Department of Mental Health, NTNU, Trondheim, Norway
- St Olavs Hospital, Department of Mental Health, Trondheim, Norway
| | - Erlend Bøen
- Psychosomatic and C-L Psychiatry, Adult, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Elvsåshagen
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Birgitte Boye
- Psychosomatic and C-L Psychiatry, Adult, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Behavioural Medicine, University of Oslo, Oslo, Norway
| | - Ulrik Fredrik Malt
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Aukrust
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Silje Skrede
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Rune Andreas Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Bergen, Norway
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- Department of Clinical Science, Norwegian Centre for Mental Disorders Research (NORMENT), University of Bergen, Bergen, Norway
| | - Ole A. Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
| | - Thor Ueland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
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18
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McEwen SC, Jarrahi B, Ventura J, Subotnik KL, Nguyen J, Woo SM, Nuechterlein KH. A combined exercise and cognitive training intervention induces fronto-cingulate cortical plasticity in first-episode psychosis patients. Schizophr Res 2023; 251:12-21. [PMID: 36527955 PMCID: PMC11245316 DOI: 10.1016/j.schres.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/02/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Schizophrenia (SZ) is characterized by neurobiological and associated cognitive and functional deficits, including pronounced cortical thinning, that lead to acute and long-term functional impairment. Research with older adults supports the role of non-pharmacological interventions, such as exercise (E) and cognitive training (CT), for cognitive impairments. This literature influenced the development of combined CT&E treatments for individuals with SZ. However, the impact of longer combined treatment duration (6 months) on neuroanatomy has yet to be explored in patients in the early course of the illness. The impact of adding exercise to cognitive training for key brain regions associated with higher-order cognition was examined here using magnetic resonance imaging (MRI) in first-episode psychosis (FEP) patients. METHODS UCLA Aftercare Research Program patients with a recent first episode of schizophrenia were randomly assigned to either combined cognitive and exercise training (CT&E) (N = 20) or cognitive training alone (CT) (N = 17) intervention. Cortical thickness was measured longitudinally and analyzed for two regions of interest using FreeSurfer. RESULTS Compared to patients in the CT group, those in the CT&E group demonstrated an increase in cortical thickness within the left anterior cingulate cortex over the six-month treatment period (ACC: F(1, 35) = 4.666, P < .04). Directional tendencies were similar in the left dorsolateral prefrontal cortex (DLPFC: F(1,35) = 4.132, P < .05). CONCLUSIONS These findings suggest that exercise and cognitive training may synergistically increase fronto-cingulate cortical thickness to mitigate progressive neural atrophy in the early course of SZ. This combined intervention appears to be a valuable adjunct to standard pharmacologic treatment in FEP patients.
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Affiliation(s)
- S C McEwen
- Pacific Brain Health Center, Pacific Neuroscience Institute, Santa Monica, CA, 90404, United States of America; atai Life Sciences, San Diego, CA, 92130, United States of America; Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, United States of America
| | - B Jarrahi
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, United States of America; Department of Anesthesia, Stanford University School of Medicine, Palo Alto, CA 94304, United States of America
| | - J Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, United States of America
| | - K L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, United States of America
| | - J Nguyen
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, United States of America
| | - S M Woo
- Graduate School of Education & Psychology, Pepperdine University, Los Angeles, CA 90045, United States of America
| | - K H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, United States of America; Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, United States of America.
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19
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Ajnakina O, Fadilah I, Quattrone D, Arango C, Berardi D, Bernardo M, Bobes J, de Haan L, Del-Ben CM, Gayer-Anderson C, Stilo S, Jongsma HE, Lasalvia A, Tosato S, Llorca PM, Menezes PR, Rutten BP, Santos JL, Sanjuán J, Selten JP, Szöke A, Tarricone I, D’Andrea G, Tortelli A, Velthorst E, Jones PB, Romero MA, La Cascia C, Kirkbride JB, van Os J, O’Donovan M, Morgan C, di Forti M, Murray RM, Stahl D. Development and Validation of Predictive Model for a Diagnosis of First Episode Psychosis Using the Multinational EU-GEI Case-control Study and Modern Statistical Learning Methods. SCHIZOPHRENIA BULLETIN OPEN 2023; 4:sgad008. [PMID: 39145333 PMCID: PMC11207766 DOI: 10.1093/schizbullopen/sgad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Background and Hypothesis It is argued that availability of diagnostic models will facilitate a more rapid identification of individuals who are at a higher risk of first episode psychosis (FEP). Therefore, we developed, evaluated, and validated a diagnostic risk estimation model to classify individual with FEP and controls across six countries. Study Design We used data from a large multi-center study encompassing 2627 phenotypically well-defined participants (aged 18-64 years) recruited from six countries spanning 17 research sites, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions study. To build the diagnostic model and identify which of important factors for estimating an individual risk of FEP, we applied a binary logistic model with regularization by the least absolute shrinkage and selection operator. The model was validated employing the internal-external cross-validation approach. The model performance was assessed with the area under the receiver operating characteristic curve (AUROC), calibration, sensitivity, and specificity. Study Results Having included preselected 22 predictor variables, the model was able to discriminate adults with FEP and controls with high accuracy across all six countries (rangesAUROC = 0.84-0.86). Specificity (range = 73.9-78.0%) and sensitivity (range = 75.6-79.3%) were equally good, cumulatively indicating an excellent model accuracy; though, calibration slope for the diagnostic model showed a presence of some overfitting when applied specifically to participants from France, the UK, and The Netherlands. Conclusions The new FEP model achieved a good discrimination and good calibration across six countries with different ethnic contributions supporting its robustness and good generalizability.
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Affiliation(s)
- Olesya Ajnakina
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, University of London, London, UK
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Ihsan Fadilah
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, University of London, London, UK
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40126 Bologna, Italy
| | - Miguel Bernardo
- Department of Psychiatry, Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Julio Bobes
- Faculty of Medicine and Health Sciences, Psychiatry, Universidad de Oviedo, ISPA, INEUROPA. CIBERSAM, Oviedo, Spain
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cristina Marta Del-Ben
- Neuroscience and Behavior Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Simona Stilo
- Department of Mental Health and Addiction Services, ASP Crotone, Crotone, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Hannah E Jongsma
- Centre for Transcultural Psychiatry Veldzicht, Balkbrug, The Netherlands
- University Centre for Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Pierre-Michel Llorca
- Université Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, F-63000 Clermont-Ferrand, France
| | - Paulo Rossi Menezes
- Department of Preventative Medicine, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
| | - Bart P Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jose Luis Santos
- Department of Psychiatry, Servicio de Psiquiatría Hospital “Virgen de la Luz”, Cuenca, Spain
| | - Julio Sanjuán
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, INCLIVA, CIBERSAM, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
| | - Andrei Szöke
- University of Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, Fondation FondaMental, F-94010 Creteil, France
| | - Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna University, Bologna, Italy
| | - Giuseppe D’Andrea
- Department of Biomedical and Neuromotor Sciences, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40126 Bologna, Italy
| | | | - Eva Velthorst
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
- CAMEO Early Intervention Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Manuel Arrojo Romero
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario s, Santiago de Compostela, Spain
| | - Caterina La Cascia
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129 Palermo, Italy
| | - James B Kirkbride
- Psylife Group, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Psychiatry, Brain Centre Rudolf Magnus, Utrecht University Medical centre, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Michael O’Donovan
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff CF24 4HQ, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Marta di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, University of London, London, UK
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20
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Peters EM, Yates K, DeVylder J, Lodhi RJ, Kelleher I. Understanding the inverse relationship between age and psychotic symptoms: The role of borderline personality traits. Acta Psychiatr Scand 2022; 146:484-491. [PMID: 35821578 DOI: 10.1111/acps.13475] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/31/2022] [Accepted: 07/09/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE There is a well-established inverse relationship between age and positive psychotic symptoms, both in patients with psychotic disorders and in general population samples with psychotic experiences. The reason for this inverse relationship is unclear. We hypothesized that life-course developmental changes in borderline personality traits, which also typically decline with age, might explain the inverse relationship between age and positive psychotic symptoms. METHODS We tested this hypothesis with data from 19,980 adults who completed 2000, 2007, and 2014 UK Adult Psychiatric Morbidity Survey studies. Hallucinations and delusions were assessed with the Psychosis Screening Questionnaire. Borderline features were assessed with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders Screening Questionnaire. Logistic regression models with effect decompositions were used to conduct the analyses. RESULTS As expected, age was negatively associated with hallucinations and delusions. These effects were wholly or mostly reduced after controlling for borderline features. Similar results were found in a subgroup of participants with a probable psychotic disorder. Repeating the analysis with a broad index of psychopathology severity instead of borderline features did not produce comparable results. Borderline factor scores reflecting identity/relationship disturbance, mood instability/anger, and self-harm/suicidality were created, all of which appeared to explain part of the inverse relationship between age and psychotic experiences. CONCLUSION Declining borderline traits throughout adulthood may account for the reduced prevalence of positive psychotic symptoms in both clinical and non-clinical populations. Future research might evaluate the impact of treatments that target borderline traits on positive psychotic symptoms.
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Affiliation(s)
- Evyn M Peters
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kathryn Yates
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, New York, USA
| | - Rohit J Lodhi
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, Ottawa, Ontario, Canada
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Lucena Clinic, St John of God Hospitaller Services, Dublin, Ireland
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21
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Watson AJ, Harrison L, Preti A, Wykes T, Cella M. Cognitive trajectories following onset of psychosis: a meta-analysis. Br J Psychiatry 2022; 221:714-721. [PMID: 36149012 DOI: 10.1192/bjp.2022.131] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cognitive impairment is a core feature of schizophrenia, associated with poor functional outcomes. The course of cognitive function in the years following illness onset has remained a subject of debate, with a previous analysis finding no worsening, providing support for the neurodevelopmental model of schizophrenia. Since then, many more studies have reported on longitudinal cognitive performance in early psychosis, with some indicating deterioration, which does not align with this view. AIMS This study aims to quantitatively review the literature on the longitudinal trajectory of cognitive deficits in the years following psychosis onset, in comparison with healthy controls. It is the first to also synthesise longitudinal data on social cognition. METHOD Electronic databases ('PubMed', 'PsycInfo' and 'Scopus') were searched (to end September 2021). Meta-analyses of 25 longitudinal studies of cognition in early psychosis were conducted (1480 patients, 789 health controls). Unlike previous analyses, randomised controlled trials and those with multiple cognitive testing periods within the first year were excluded to minimise bias (PROSPERO, ID: CRD42021241525). RESULTS Small improvements were observed for global cognition (g = 0.25, 95% CI 0.17-0.33) and individual cognitive domains, but these were comparable with healthy controls and likely an artefact of practice effects. CONCLUSIONS There is no evidence of continued cognitive decline or improvement in the early years following psychosis onset, with a need for more studies over longer follow-up periods. Practice effects highlight the importance of including control samples in longitudinal and intervention studies. Further data are needed to evaluate the course of social cognition subdomains.
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Affiliation(s)
- Andrew J Watson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Lauren Harrison
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Antonio Preti
- Dipartimento di Neuroscienze, Università degli studi di Torino, Italy
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
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22
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Ioakeimidis V, Haenschel C, Fett AK, Kyriakopoulos M, Dima D. Functional neurodevelopment of working memory in early-onset schizophrenia: A longitudinal FMRI study. Schizophr Res Cogn 2022; 30:100268. [PMID: 35967473 PMCID: PMC9372770 DOI: 10.1016/j.scog.2022.100268] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 11/01/2022] Open
Abstract
Schizophrenia, a debilitating disorder with typical manifestation of clinical symptoms in early adulthood, is characterized by cognitive impairments in executive processes such as in working memory (WM). However, there is a rare case of individuals with early-onset schizophrenia (EOS) starting before their 18th birthday, while WM and its neural substrates are still undergoing maturation. Using the WM n-back task with functional magnetic resonance imaging, we assessed the functional neurodevelopment of WM in adolescents with EOS and age- and gender-matched typically developing controls. Participants underwent neuroimaging in the same scanner twice, once at age 17 and at 21 (mean interscan interval = 4.3 years). General linear model analysis was performed to explore WM neurodevelopmental changes within and between groups. Psychopathological scores were entered in multiple regressions to detect brain regions whose longitudinal functional change was predicted by baseline symptoms in EOS. WM neurodevelopment was characterized by widespread functional reductions in frontotemporal and cingulate brain areas in patients and controls. No between-group differences were found in the trajectory of WM change. Baseline symptom scores predicted functional neurodevelopmental changes in frontal, cingulate, parietal, occipital, and cerebellar areas. The adolescent brain undergoes developmental processes such as synaptic pruning, which may underlie the refinement WM of network. Prefrontal and parietooccipital activity reduction is affected by clinical presentation of symptoms. Using longitudinal neuroimaging methods in a rare diagnostic sample of patients with EOS may help the advancement of neurodevelopmental biomarkers intended as pharmacological targets to tackle WM impairment.
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23
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Harvey PD, Bosia M, Cavallaro R, Howes OD, Kahn RS, Leucht S, Müller DR, Penadés R, Vita A. Cognitive dysfunction in schizophrenia: An expert group paper on the current state of the art. Schizophr Res Cogn 2022; 29:100249. [PMID: 35345598 PMCID: PMC8956816 DOI: 10.1016/j.scog.2022.100249] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/12/2022]
Abstract
Cognitive impairment in schizophrenia represents one of the main obstacles to clinical and functional recovery. This expert group paper brings together experts in schizophrenia treatment to discuss scientific progress in the domain of cognitive impairment to address cognitive impairments and their consequences in the most effective way. We report on the onset and course of cognitive deficits, linking them to the alterations in brain function and structure in schizophrenia and discussing their role in predicting the transition to psychosis in people at risk. We then address the assessment tools with reference to functioning and social cognition, examining the role of subjective measures and addressing new methods for measuring functional outcomes including technology based approaches. Finally, we briefly review treatment options for cognitive deficits, focusing on cognitive remediation programs, highlighting their effects on brain activity and conclude with the potential benefit of individualized integrated interventions combing cognitive remediation with other approaches.
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Affiliation(s)
- Philip D Harvey
- Division of Psychology, Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marta Bosia
- Vita-Salute San Raffaele University School of Medicine, Milan, Italy; Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Roberto Cavallaro
- Vita-Salute San Raffaele University School of Medicine, Milan, Italy; Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Oliver D Howes
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.,MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - René S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefan Leucht
- Section Evidence-Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Daniel R Müller
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Rafael Penadés
- Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel Street, 08036 Barcelona, Spain
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
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24
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Dimitrakopoulos S, Stefanatou P, Vlachos I, Selakovic M, Xenaki LA, Ralli I, Soldatos RF, Nianiakas N, Kosteletos I, Foteli S, Mantonakis L, Kollias CT, Stefanis NC. Don't blame psychosis, blame the lack of services: a message for early intervention from the Greek standard care model. BMC Psychiatry 2022; 22:565. [PMID: 35996121 PMCID: PMC9396840 DOI: 10.1186/s12888-022-04212-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Early Intervention Services (EIS) aim to reduce relapse rates and achieve better treatment and functional outcomes for first episode psychosis (FEP) patients. Existing models of services in Greece are still treatment as usual (TAU), however a reform of mental health services is underway and initial steps have been taken to shift standard care towards EIS. The purpose of the study is to address therapeutic gaps by exploring service engagement and relapse rates in the current standard care model for psychosis. METHODS We examined follow-up and relapse rates one year after initial treatment contact in the first longitudinal FEP study conducted in Greece. 225 patients were enrolled between 2015-2020. Sociodemographic, clinical and functional characteristics were assessed in association with follow-up and relapse rates. RESULTS Within a TAU follow-up setting, one year attrition rates were high. Only 87 patients (38,7%) retained contact with services after one year and within this time frame, 19 of them (21,8%) experienced a severe relapse requiring rehospitalization. Demographic, clinical and functional contributors failed to predict service engagement and relapse rates, with the exception of treatment adherence. CONCLUSION Both follow-up and one-year rehospitalization rates in our FEP sample, highlight the need for the implementation of early intervention services, that will aim at engagement maximization and relapse prevention. These indexes also provide a benchmark against which future early intervention services for psychosis in Greece will have to demonstrate superior efficacy.
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Affiliation(s)
- Stefanos Dimitrakopoulos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece.
- 414 Military Hospital of Athens, P. Penteli, Greece.
| | - Pentagiotissa Stefanatou
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Ilias Vlachos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Mirjana Selakovic
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Lida-Alkisti Xenaki
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Irene Ralli
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Rigas-Filippos Soldatos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Nikolaos Nianiakas
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Ioannis Kosteletos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Stefania Foteli
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Leonidas Mantonakis
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Costas T Kollias
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Nikos C Stefanis
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
- Neurobiology Research Institute, Theodor-Theohari Cozzika Foundation, Athens, Greece
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Janicki MP, Hendrix JA, McCallion P. Examining older adults with neuroatypical conditions for MCI/dementia: Barriers and recommendations of the Neuroatypical Conditions Expert Consultative Panel. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12335. [PMID: 35845263 PMCID: PMC9270662 DOI: 10.1002/dad2.12335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/16/2022] [Indexed: 01/04/2023]
Abstract
The Neuroatypical Conditions Expert Consultative Panel composed of numerous clinical and academic experts was convened to examine barriers to the examination of cognitive impairment in adults with a variety of neuroatypical conditions. Neuroatypical conditions affect normative intellectual development and function (such as intellectual disability and intellectual disability with conjoint psychiatric conditions), thought, moods, and cognition (such as severe mental illness), communication functions (such as the autism spectrum and hearing/vision impairments), and brain and motor function (such as cerebral palsy and acquired or traumatic brain injury). The panel concluded that current federal guidance for the assessment of cognitive impairment for mild cognitive impairment (MCI) or dementia does not sufficiently include information as to how to assess such adults. In addition, it concluded that adults with these conditions (1) challenge clinicians when attempting to discern current behavior and function from that which was pre-existing; (2) often have inherent comprehension and oral communication difficulties, motor task performance impediments, and difficulty with visuals; and (3) pose difficulties when assessed with standardized dementia measures and can benefit from the use of specialized instruments. The panel recommended that federal guidance be broadened to include adaptations of assessment practices to accommodate neuroatypical conditions; that educational packs be developed for clinicians about such conditions and on detecting and diagnosing MCI or dementia; and that research be expanded to produce more evidence-based information on both assessing adults with neuroatypical conditions for later-life adult cognitive diseases/disorders and planning post-diagnostic care.
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Affiliation(s)
- Matthew P. Janicki
- Department of Disability and Human DevelopmentUniversity of IllinoisChicagoIllinoisUSA
| | | | - Philip McCallion
- College of Public HealthTemple UniversityPhiladelphiaPennsylvaniaUSA
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Cano JF, Ortegón-Valencia J, Pedraza-Perez C, Córdoba-Rojas R, Olarte-Armenta A, Vallejo-Silva A, González-Díaz J. Functionality During the First Five Years After the Diagnosis of Schizophrenia. A Cohort Study in a Colombian Population. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:183-191. [PMID: 36154749 DOI: 10.1016/j.rcpeng.2022.08.009] [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: 03/16/2020] [Accepted: 11/02/2020] [Indexed: 06/16/2023]
Abstract
OBJECTIVE There is a lack of studies on the natural history of the initial stages of schizophrenia in Colombia. This study aims to assess functionality in the first five years after the diagnosis of schizophrenia. METHODS Naturalistic longitudinal study of 50 patients with early schizophrenia evaluated between 2011 and 2014. Data about demographic background, symptoms, introspection, treatment and adverse reactions were collected in all patients every 3 months for at least 3-5 years. Functionality was measured with the Global Assessment of Functioning (GAF) and Personal and Social Performance (PSP) scales. RESULTS Patients were followed up for a mean of 174±62.5 weeks and showed moderate difficulties in overall functioning. This functioning was modified by polypharmacy, degree of introspection, changes in antipsychotic regimens, and the number of episodes, relapses and hospitalisations. CONCLUSIONS The results suggest that functional outcomes seem to be related to the use of polypharmacy, degree of insight, changes in antipsychotic regimens, and number of episodes, relapses and hospitalisations during the first years of schizophrenia.
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Affiliation(s)
- Juan F Cano
- UR Center for Mental Health (CeRSaMe), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Centro de Investigaciones del Sistema Nervioso (CISNE), Bogotá, Colombia.
| | | | | | - Rodrigo Córdoba-Rojas
- UR Center for Mental Health (CeRSaMe), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Centro de Investigaciones del Sistema Nervioso (CISNE), Bogotá, Colombia
| | - Ana Olarte-Armenta
- Centro de Investigaciones del Sistema Nervioso (CISNE), Bogotá, Colombia
| | - Alexie Vallejo-Silva
- UR Center for Mental Health (CeRSaMe), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Clínica Nuestra Señora de la Paz, Bogotá, Colombia
| | - Jairo González-Díaz
- UR Center for Mental Health (CeRSaMe), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Clínica Nuestra Señora de la Paz, Bogotá, Colombia
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Vadiei N, El-Ali J, Delaune J, Wild C, Liu YS. Patterns and predictors of oral antipsychotic prescribing in adult patients with schizophrenia. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 6:100148. [PMID: 35755718 PMCID: PMC9218131 DOI: 10.1016/j.rcsop.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/20/2022] [Accepted: 06/02/2022] [Indexed: 11/03/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Gambogi LB, de Souza LC, Caramelli P. How to differentiate behavioral variant frontotemporal dementia from primary psychiatric disorders: practical aspects for the clinician. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:7-14. [PMID: 35976330 PMCID: PMC9491418 DOI: 10.1590/0004-282x-anp-2022-s140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Due to the early and prominent behavioral changes which characterize behavioral variant frontotemporal dementia (bvFTD), patients are more likely to seek psychiatric help and are often initially diagnosed with a primary psychiatric disorder (PPD). Differentiating these conditions is critical because of the dramatically different outcomes, differences in patient management, family counseling and caregiver education. OBJECTIVE To propose a practical guide to distinguish between bvFTD and PDD. METHODS We conducted a non-systematic review of the published manuscripts in the field, including some previous investigations from our own group and work on which we have collaborated, and summarized the main findings and proposals that may be useful for neurological practice. RESULTS The reviewed literature suggests that a comprehensive clinical history, brief cognitive and neuropsychological evaluations, detailed neurological examination with special attention to motor alterations related to bvFTD, structural and functional neuroimaging evaluation, genetic investigation in selected cases, and assistance from a multidisciplinary team, including a neurologist and a psychiatrist with expertise in bvFTD, are very helpful in differentiating these conditions. CONCLUSIONS Although the clinician may commonly face great difficulty in differentiating between bvFTD and PPD, the use of appropriate tools in a systematic way and the availability of a well-trained multidisciplinary group can significantly increase diagnostic accuracy.
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Affiliation(s)
- Leandro Boson Gambogi
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Neurologia Cognitiva e Comportamental, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
| | - Leonardo Cruz de Souza
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Neurologia Cognitiva e Comportamental, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
| | - Paulo Caramelli
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Neurologia Cognitiva e Comportamental, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
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Murray RM, Bora E, Modinos G, Vernon A. Schizophrenia: A developmental disorder with a risk of non-specific but avoidable decline. Schizophr Res 2022; 243:181-186. [PMID: 35390609 DOI: 10.1016/j.schres.2022.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 12/31/2022]
Abstract
The onset of schizophrenia is determined by biological and social risk factors operating predominantly during development. These result in subtle deviations in brain structure and cognitive function. Striatal dopamine dysregulation follows, causing abnormal salience and resultant psychotic symptoms. Most people diagnosed as having schizophrenia do not progressively deteriorate; many improve or recover. However, poor care can allow a cycle of deterioration to be established, stress increasing dopamine dysregulation, leading to more stress consequent on continuing psychotic experiences, and so further dopamine release. Additionally, long-term antipsychotics can induce dopamine supersensitivity with resultant relapse and eventually treatment resistance. Some patients suffer loss of social and cognitive function, but this is a consequence of the hazards that afflict the person with schizophrenia, not a direct consequence of genetic predisposition. Thus, brain health and cognition can be further impaired by chronic medication effects, cardiovascular and cerebrovascular events, obesity, poor diet, and lack of exercise; drug use, especially of tobacco and cannabis, are likely to contribute. Poverty, homelessness and poor nutrition which become the lot of some people with schizophrenia, can also affect cognition. Regrettably, the model of progressive deterioration provides psychiatry and its funders with an alibi for the effects of poor care.
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Affiliation(s)
- R M Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
| | - E Bora
- Dokuz Eylül Üniversitesi, Izmir, Izmir, Turkey
| | - G Modinos
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - A Vernon
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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Stone WS, Phillips MR, Yang LH, Kegeles LS, Susser ES, Lieberman JA. Neurodegenerative model of schizophrenia: Growing evidence to support a revisit. Schizophr Res 2022; 243:154-162. [PMID: 35344853 PMCID: PMC9189010 DOI: 10.1016/j.schres.2022.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/21/2022]
Abstract
Multidimensional progressive declines in the absence of standard biomarkers for neurodegeneration are observed commonly in the development of schizophrenia, and are accepted as consistent with neurodevelopmental etiological hypotheses to explain the origins of the disorder. Far less accepted is the possibility that neurodegenerative processes are involved as well, or even that key dimensions of function, such as cognition and aspects of biological integrity, such as white matter function, decline in chronic schizophrenia beyond levels associated with normal aging. We propose that recent research germane to these issues warrants a current look at the question of neurodegeneration. We propose the view that a neurodegenerative hypothesis provides a better explanation of some features of chronic schizophrenia, including accelerated aging, than is provided by neurodevelopmental hypotheses. Moreover, we suggest that neurodevelopmental influences in early life, including those that may extend to later life, do not preclude the development of neurodegenerative processes in later life, including some declines in cognitive and biological integrity. We evaluate these views by integrating recent findings in representative domains such as cognition and white and gray matter integrity with results from studies on accelerated aging, together with functional implications of neurodegeneration for our understanding of chronic schizophrenia.
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Affiliation(s)
- William S. Stone
- Harvard Medical School Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, Massachusetts,Corresponding Author: William S. Stone, Ph.D., Massachusetts Mental Health Center, 75 Fenwood Road, Boston, Massachusetts, USA,
| | - Michael R. Phillips
- Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, Shanghai, China,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Lawrence H. Yang
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York,New York University College of Global Public Health, New York, New York
| | - Lawrence S. Kegeles
- Department of Psychiatry, Columbia University, New York, New York,New York State Psychiatric Institute, New York, New York
| | - Ezra S. Susser
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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The Kraepelian concept of schizophrenia: Dying but not yet dead. Schizophr Res 2022; 242:102-105. [PMID: 34952779 DOI: 10.1016/j.schres.2021.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 12/16/2022]
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Fountoulakis KN, Stahl SM. The effect of first- and second-generation antipsychotics on brain morphology in schizophrenia: A systematic review of longitudinal magnetic resonance studies with a randomized allocation to treatment arms. J Psychopharmacol 2022; 36:428-438. [PMID: 35395911 DOI: 10.1177/02698811221087645] [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] [Indexed: 11/16/2022]
Abstract
Schizophrenia manifests as loss of brain volume in specific areas in a progressive nature and an important question concerns whether long-term treatment with medications contributes to this. The aim of the current PRISMA systematic review was to search for prospective studies involving randomization to treatment. PROSPERO ID: CRD42020197874. The MEDLINE/PUBMED was searched and it returned 2638 articles; 3 were fulfilling the inclusion criteria. A fourth was published later; they included 359 subjects, of whom 86 were healthy controls, while the rest were first-episode patients, with 91 under olanzapine, 93 under haloperidol, 48 under risperidone, 5 under paliperidone, 6 under ziprasidone, and 30 under placebo. Probably one-third of patients were suffering from a psychotic disorder other than schizophrenia. The consideration of their results suggested that there is no significant difference between these medications concerning their effects on brain structure and also in comparison to healthy subjects. There does not seem to be any strong support to the opinion that medications that treat psychosis cause loss of brain volume in patients with schizophrenia. On the contrary, the data might imply the possible presence of a protective effect for D2, 5-HT2, and NE alpha-2 antagonists (previously called SGAs). However, the literature is limited and focused research in large study samples is essential to clarify the issue, since important numerical differences do exist. The possibility of the results and their heterogeneity to be artifacts secondary to a modification of magnetic resonance imaging (MRI) signal by antipsychotics should not be easily rejected until relevant data are available.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stephen M Stahl
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,Department of Psychiatry, Cambridge University, Cambridge, UK
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Insula volumes in first-episode and chronic psychosis: A longitudinal MRI study. Schizophr Res 2022; 241:14-23. [PMID: 35074528 DOI: 10.1016/j.schres.2021.12.048] [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: 04/01/2021] [Revised: 07/21/2021] [Accepted: 12/28/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Alterations in insular grey matter (GM) volume has been consistently reported for affective and non-affective psychoses both in chronic and first-episode patients, ultimately suggesting that the insula might represent a good region to study in order to assess the longitudinal course of psychotic disorders. Therefore, in this longitudinal Magnetic Resonance Imaging (MRI) study, we aimed at further investigating the key role of insular volumes in psychosis. MATERIAL AND METHODS 68 First-Episode Psychosis (FEP) patients, 68 patients with Schizophrenia (SCZ), 47 Bipolar Disorder (BD) patients, and 94 Healthy Controls (HC) were enrolled and underwent a 1.5 T MRI evaluation. A subsample of 99 subjects (10 HC, 23 BD, 29 SCZ, 37 FEP) was rescanned after 2,53 ± 1,68 years. The insular cortex was manually traced and then divided into an anterior and posterior portion. Group and correlation analyses were then performed both at baseline and at follow-up. RESULTS At baseline, greater anterior and lower posterior insular GM volumes were observed in chronic patients. At follow-up, we found that FEP patients had a significant GM volume increase from baseline to follow-up, especially in the posterior insula whereas chronic patients showed a relative stability. Finally, significant negative correlations between illness severity and pharmacological treatment and insular GM volumes were observed in the whole group of psychotic patients. CONCLUSIONS The longitudinal assessment of both chronic and first-episode patients allowed us to detect a complex pattern of GM abnormalities in selective sub-portions of insular volumes, ultimately suggesting that this structure could represent a key biological marker of psychotic disorders.
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Agid O, Remington G, Fung C, Nightingale NM, Duclos M, Anger GJ. Real-World Utilization Patterns of Long-Acting Injectable Antipsychotics in Canada: A Retrospective Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:226-234. [PMID: 34792401 PMCID: PMC8935594 DOI: 10.1177/07067437211055413] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The objective of this study was to analyze the real-world prevalence of long-acting injectable (LAI) antipsychotic use and determine when LAIs are being used in sequencing of antipsychotic medications among Canadian patients with schizophrenia. Methods: This was a retrospective, longitudinal cohort study using Canadian pharmacy prescription data between August 2005 and June 2017. Patients with inferred schizophrenia spectrum disorder were indexed on the date of their first antipsychotic prescription and analyzed for minimum 12 months to track lines of antipsychotic therapy and LAI utilization. Results: A total of 16,300 patients were identified for analysis. 48.2% and 46.0% of index antipsychotic prescriptions were prescribed by a general practitioner/family medicine doctor and psychiatrist, respectively. 1,062 (6.5%) patients used an LAI during the study period. Of those patients, 789 used an LAI within two years of index (74.3% of LAI users; 4.8% of all patients). The majority of LAI use (62.0%) occurred in the third line of therapy or later. 65.0% of patients had tried at least two therapy lines, and most patients reported gaps of six months to one year between treatment lines. Conclusion: Despite their potential to reduce relapse in schizophrenia by improving treatment adherence, this study shows LAIs continue to be under-utilized in Canada. When used, LAIs are positioned late in sequencing of antipsychotic medications, often not initiated until years after diagnosis. Continued preference for oral APs with poor adherence may be negatively impacting prognosis and exacerbating burden of schizophrenia. Efforts should be invested to understand barriers to LAI uptake and advocate for earlier, widespread use of LAIs.
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Affiliation(s)
- Ofer Agid
- Clinician Scientist and Psychiatrist, Centre for Addiction and Mental Health
| | - Gary Remington
- Clinician Scientist and Psychiatrist, Centre for Addiction and Mental Health
| | - Carmen Fung
- Manager of Data & Analytics Centre, 41697Janssen Inc
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Andreou D, Jørgensen KN, Nerland S, Smelror RE, Wedervang-Resell K, Johannessen CH, Myhre AM, Andreassen OA, Blennow K, Zetterberg H, Agartz I. Lower plasma total tau in adolescent psychosis: Involvement of the orbitofrontal cortex. J Psychiatr Res 2021; 144:255-261. [PMID: 34700214 DOI: 10.1016/j.jpsychires.2021.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
Schizophrenia is thought to be a neurodevelopmental disorder with neuronal migration, differentiation and maturation disturbances. Tau is a microtubule-associated protein with a crucial role in these processes. Lower circulating tau levels have been reported in adults with schizophrenia, but this association has not been investigated in adolescent psychosis. We aimed to test the hypotheses that a) adolescents with early-onset psychosis (EOP; age of onset <18 years) display lower plasma tau concentrations compared to healthy controls, and b) among patients with psychosis, tau levels are linked to structural brain measures associated with the microtubule-associated tau (MAPT) gene and psychosis. We included 37 adolescent patients with EOP (mean age 16.4 years) and 59 adolescent healthy controls (mean age 16.2 years). We investigated putative patient-control differences in plasma total tau concentrations measured by a Single molecule array (Simoa) immunoassay. We explored the correlations between tau and selected structural brain measures based on T1-weighted MRI scans processed in FreeSurfer v6.0. We found significantly lower plasma tau concentrations in patients compared to healthy controls (p = 0.017, partial eta-squared = 0.061). Tau was not associated with antipsychotic use or the antipsychotic dosage. Among patients but not healthy controls, tau levels were positively correlated with the cortical orbitofrontal surface area (p = 0.013, R-squared = 0.24). The results are suggestive of a tau-related neurodevelopmental disturbance in adolescent psychosis.
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Affiliation(s)
- Dimitrios Andreou
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
| | - Kjetil Nordbø Jørgensen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Stener Nerland
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Runar Elle Smelror
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Kirsten Wedervang-Resell
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Child and Adolescent Mental Health Research Unit, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Cecilie Haggag Johannessen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Margrethe Myhre
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK; UK Dementia Research Institute at UCL, London, UK
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Katschnig H, Sint P. Late 'Early Intervention in Psychosis': A Family School for Learning How to Live with Schizophrenia. CONSORTIUM PSYCHIATRICUM 2021; 2:3-16. [PMID: 39044750 PMCID: PMC11262250 DOI: 10.17816/cp99] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/08/2021] [Indexed: 11/08/2022] Open
Abstract
The paper describes a family school for learning how to live with schizophrenia, which was founded in 1986 in Vienna, Austria, and is still running today. It was established in cooperation between professionals and the Austrian self-help association HPE of the relatives of persons with mental disorders. It addresses the needs of 10 families at a time, in cases where a son or a daughter was diagnosed with schizophrenia and had already experienced one or several episodes of the illness. The course lasts one and a half years and is organized according to the model of a weekly boarding school, where 10 children, the "residents", stay in the school overnight from Sunday evening to Friday and take part in a structured program on cognitive, social and practical life skills. Ambulatory psychiatric treatment is taking place concurrently outside the school through local routine services. On weekends residents stay with their parents since the school is closed. Parents visit the school regularly to take part in joint activities with the residents. They also undertake night shifts in the school and attend a weekly parents' group. In the regular encounters during everyday activities in the school, "learning by doing" occurs - parents get to know the daughters and sons of other families and can learn to distinguish between disease-related and personality-related behavior. Residents can have similar learning experiences in relation to the parents of other residents. The main aim of the school is that parents learn to provide "protected autonomy" for the daughters or sons in question, in order to assist them after the end of the course in leading a life characterized by as much autonomy as possible after the end of the school.
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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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38
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Ajnakina O, Rodriguez V, Quattrone D, di Forti M, Vassos E, Arango C, Berardi D, Bernardo M, Bobes J, de Haan L, Del-Ben CM, Gayer-Anderson C, Jongsma HE, Lasalvia A, Tosato S, Llorca PM, Menezes PR, Rutten BP, Santos JL, Sanjuán J, Selten JP, Szöke A, Tarricone I, D’Andrea G, Richards A, Tortelli A, Velthorst E, Jones PB, Arrojo Romero M, La Cascia C, Kirkbride JB, van Os J, O’Donovan M, Murray RM. Duration of Untreated Psychosis in First-Episode Psychosis is not Associated With Common Genetic Variants for Major Psychiatric Conditions: Results From the Multi-Center EU-GEI Study. Schizophr Bull 2021; 47:1653-1662. [PMID: 33963865 PMCID: PMC8562562 DOI: 10.1093/schbul/sbab055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Duration of untreated psychosis (DUP) is associated with clinical outcomes in people with a diagnosis of first-episode psychosis (FEP), but factors associated with length of DUP are still poorly understood. Aiming to obtain insights into the possible biological impact on DUP, we report genetic analyses of a large multi-center phenotypically well-defined sample encompassing individuals with a diagnosis of FEP recruited from 6 countries spanning 17 research sites, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. Genetic propensity was measured using polygenic scores for schizophrenia (SZ-PGS), bipolar disorder (BD-PGS), major depressive disorder (MDD-PGS), and intelligence (IQ-PGS), which were calculated based on the results from the most recent genome-wide association meta-analyses. Following imputation for missing data and log transformation of DUP to handle skewedness, the association between DUP and polygenic scores (PGS), adjusting for important confounders, was investigated with multivariable linear regression models. The sample comprised 619 individuals with a diagnosis of FEP disorders with a median age at first contact of 29.0 years (interquartile range [IQR] = 22.0-38.0). The median length of DUP in the sample was 10.1 weeks (IQR = 3.8-30.8). One SD increases in SZ-PGS, BD-PGS, MDD-PGS or IQ-PGS were not significantly associated with the length of DUP. Our results suggest that genetic variation does not contribute to the DUP in patients with a diagnosis of FEP disorders.
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Affiliation(s)
- Olesya Ajnakina
- Department of Biostatistics & Health Informatics,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, University of London, London,
UK
- Department of Behavioural Science and Health, Institute of
Epidemiology and Health Care, University College London,
London, UK
- Department of Clinical Medicine, Aarhus
University, Aarhus, Denmark
| | - Victoria Rodriguez
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London,
London, UK
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, London, UK
| | - Marta di Forti
- Social, Genetic and Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, London, UK
| | - Evangelos Vassos
- Social, Genetic and Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, London, UK
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Institute of
Psychiatry and Mental Health, Hospital General Universitario Gregorio
Marañón, School of Medicine, Universidad Complutense,
Madrid, Spain
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences,
Psychiatry Unit, Alma Mater Studiorum Università di Bologna,
Bologna, Italy
| | - Miguel Bernardo
- Department of Psychiatry, Barcelona Clinic Schizophrenia
Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of
Barcelona, IDIBAPS, CIBERSAM, Barcelona,
Spain
| | - Julio Bobes
- Faculty of Medicine and Health Sciences –
Psychiatry, Universidad de Oviedo, ISPA, INEUROPA, CIBERSAM,
Oviedo, Spain
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section,
Amsterdam UMC, University of Amsterdam,
Amsterdam, The
Netherlands
| | - Cristina Marta Del-Ben
- Neuroscience and Behavior Department, Ribeirão Preto
Medical School, University of São Paulo, São
Paulo, Brazil
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, De Crespigny Park, Denmark Hill, London,
UK
| | - Hannah E Jongsma
- Centre for Longitudinal Studies, University College
London, London, UK
- Centre for Transcultural Psychiatry
Veldzicht, Balkbrug, The Netherlands
- University Centre for Psychiatry, University Medical
Centre Groningen, Groningen, The Netherlands
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona,
Verona,Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona,
Verona,Italy
| | - Pierre-Michel Llorca
- Université Clermont Auvergne, CMP-B CHU, CNRS,
Clermont Auvergne INP, Institut Pascal,
Clermont-Ferrand, France
| | - Paulo Rossi Menezes
- Department of Preventative Medicine, Faculdade de Medicina
FMUSP, University of São Paulo, São
Paulo, Brazil
| | - Bart P Rutten
- Department of Psychiatry and Neuropsychology, School for
Mental Health and Neuroscience, South Limburg Mental Health Research and
Teaching Network, Maastricht University Medical Centre,
Maastricht, The
Netherlands
| | - Jose Luis Santos
- Department of Psychiatry, Servicio de Psiquiatría
Hospital “Virgen de la Luz,”Cuenca, Spain
| | - Julio Sanjuán
- Department of Psychiatry, Hospital Clínico
Universitario de Valencia, INCLIVA, CIBERSAM, School of Medicine, Universidad de
Valencia, Valencia, Spain
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Health
Care, Sandifortdreef 19, 2333 ZZ Leiden,
The Netherlands
| | - Andrei Szöke
- Univ Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux
Universitaires “ H. Mondor ,” DMU IMPACT, Fondation
FondaMental, Creteil, France
| | - Ilaria Tarricone
- Division of Psychological Medicine and Clinical
Neurosciences, Cardiff, UK
| | - Giuseppe D’Andrea
- Department of Biomedical and Neuromotor Sciences,
Psychiatry Unit, Alma Mater Studiorum Università di Bologna,
Bologna, Italy
| | - Alexander Richards
- Division of Psychological Medicine and Clinical
Neurosciences, Cardiff, UK
| | | | - Eva Velthorst
- Department of Psychiatry, Early Psychosis Section,
Academic Medical Centre, University of Amsterdam,
Amsterdam, The
Netherlands
- Department of Psychiatry, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Herchel
Smith Building for Brain & Mind Sciences,
Cambridge, UK
- CAMEO Early Intervention Service, Cambridgeshire &
Peterborough NHS Foundation Trust,
Cambridge, UK
| | - Manuel Arrojo Romero
- Department of Psychiatry, Psychiatric Genetic Group,
Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo
Hospitalario Universitario de Santiago de Compostela,
Santiago de Compostela, Spain
| | - Caterina La Cascia
- Department of Experimental Biomedicine and Clinical
Neuroscience, University of Palermo,
Palermo, Italy
| | - James B Kirkbride
- Psylife Group, Division of Psychiatry, University College
London, London, UK
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London,
London, UK
- Department of Psychiatry and Neuropsychology, School for
Mental Health and Neuroscience, South Limburg Mental Health Research and
Teaching Network, Maastricht University Medical Centre,
Maastricht, The
Netherland
- UMC Utrecht Brain Centre, Utrecht University Medical
Centre, Utrecht, The
Netherlands
| | - Mick O’Donovan
- Division of Psychological Medicine and Clinical
Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff
University, Cardiff, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London,
London, UK
- Department of Psychiatry, Experimental Biomedicine and
Clinical Neuroscience, University of Palermo,
Palermo, Italy
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Abstract
This viewpoint is a continuation of the debate on the early intervention movement in psychiatry. The criticisms of Malhi and colleagues have generated some fundamental questions about the priorities of the early intervention movement and the need for further work. In particular, the summons sent to neuroscience need to be more specific in the near future. We may be doing well with what we have, but more directed efforts are needed to purposefully seek what we do not.
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Affiliation(s)
- Lena Palaniyappan
- Robarts Research Institute, London, ON, Canada,Department of Psychiatry, Western University, London, ON, Canada,The Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, ON, Canada,Department of Medical Biophysics, Western University, London, ON, Canada,Lena Palaniyappan, Robarts Research Institute, Room 1232D, 1151 Richmond Street N, London, ON N6A 5B7, Canada.
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40
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Erazo-Chavez LJ, La-Rotta EIG, Onocko-Campos RT. Cross-cultural adaptation of the Recovery Self-Assessment RSA-R Family/Brazil: Validity evidence based on test content. CIENCIA & SAUDE COLETIVA 2021; 26:3693-3704. [PMID: 34468663 DOI: 10.1590/1413-81232021269.2.32692019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/27/2020] [Indexed: 11/21/2022] Open
Abstract
In the cross-cultural adaptation of instruments, the qualitative component of adaptation is generally poorly reported, sometimes being superficially addressed. In this study we aimed to describe the qualitative component of the cross-cultural adaptation process and to demonstrate validity evidence based on test content of the Recovery Self-Assessment-RSA-R Family/Brazil. We conducted a qualitative study that included the steps of preparation, translation, back-translation, expert's assessment, workshop with a researcher from Yale University, and two pilot studies involving family members of patients attended at mental health services. Among the results, we found considerable validity evidence based on test content with a percentage of agreement above 80%. Pilot studies contributed to accentuating this evidence, assisting in the cultural adequacy of the statements and in the operational equivalence of the instrument. The adaptation process of the RSA-R Family/Brazil proved to be complex. From this experience, we concluded that presenting validity evidence based on test content is important to ensure the applicability tools to the target culture. The instrument will still be evaluated as for psychometric characteristics through statistical techniques.
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Affiliation(s)
- Leidy Janeth Erazo-Chavez
- Universidade Estadual de Campinas. Cidade Universitária Zeferino Vaz s/n, Barão Geraldo. 13083-970 Campinas SP Brasil.
| | | | - Rosana Teresa Onocko-Campos
- Universidade Estadual de Campinas. Cidade Universitária Zeferino Vaz s/n, Barão Geraldo. 13083-970 Campinas SP Brasil.
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41
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Koike S, Uematsu A, Sasabayashi D, Maikusa N, Takahashi T, Ohi K, Nakajima S, Noda Y, Hirano Y. Recent Advances and Future Directions in Brain MR Imaging Studies in Schizophrenia: Toward Elucidating Brain Pathology and Developing Clinical Tools. Magn Reson Med Sci 2021; 21:539-552. [PMID: 34408115 DOI: 10.2463/mrms.rev.2021-0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Schizophrenia is a common severe psychiatric disorder that affects approximately 1% of general population through the life course. Historically, in Kraepelin's time, schizophrenia was a disease unit conceptualized as dementia praecox; however, since then, the disease concept has changed. Recent MRI studies had shown that the neuropathology of the brain in this disorder was characterized by mild progression before and after the onset of the disease, and that the brain alterations were relatively smaller than assumed. Although genetic factors contribute to the brain alterations in schizophrenia, which are thought to be trait differences, other changes include factors that are common in psychiatric diseases. Furthermore, it has been shown that the brain differences specific to schizophrenia were relatively small compared to other changes, such as those caused by brain development, aging, and gender. In addition, compared to the disease and participant factors, machine and imaging protocol differences could affect MRI signals, which should be addressed in multi-site studies. Recent advances in MRI modalities, such as multi-shell diffusion-weighted imaging, magnetic resonance spectroscopy, and multimodal brain imaging analysis, may be candidates to sharpen the characterization of schizophrenia-specific factors and provide new insights. The Brain/MINDS Beyond Human Brain MRI (BMB-HBM) project has been launched considering the differences and noises irrespective of the disease pathologies and includes the future perspectives of MRI studies for various psychiatric and neurological disorders. The sites use restricted MRI machines and harmonized multi-modal protocols, standardized image preprocessing, and traveling subject harmonization. Data sharing to the public will be planned in FY 2024. In the future, we believe that combining a high-quality human MRI dataset with genetic data, randomized controlled trials, and MRI for non-human primates and animal models will enable us to understand schizophrenia, elucidate its neural bases and therapeutic targets, and provide tools for clinical application at bedside.
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Affiliation(s)
- Shinsuke Koike
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo.,University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM).,University of Tokyo Center for Integrative Science of Human Behavior (CiSHuB).,The International Research Center for Neurointelligence (WPI-IRCN), Institutes for Advanced Study (UTIAS), The University of Tokyo
| | - Akiko Uematsu
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences.,Research Center for Idling Brain Science (RCIBS), University of Toyama
| | - Norihide Maikusa
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo
| | - Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences.,Research Center for Idling Brain Science (RCIBS), University of Toyama
| | - Kazutaka Ohi
- Department of Psychiatry and Psychotherapy, Gifu University Graduate School of Medicine
| | | | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine
| | - Yoji Hirano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University.,Institute of Industrial Science, The University of Tokyo
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42
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Bavato F, Cathomas F, Klaus F, Gütter K, Barro C, Maceski A, Seifritz E, Kuhle J, Kaiser S, Quednow BB. Altered neuroaxonal integrity in schizophrenia and major depressive disorder assessed with neurofilament light chain in serum. J Psychiatr Res 2021; 140:141-148. [PMID: 34116440 DOI: 10.1016/j.jpsychires.2021.05.072] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/11/2021] [Accepted: 05/29/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Schizophrenia (SZ) and major depressive disorders (MDD) have been frequently linked to anatomical brain alterations. However, the relationship between brain pathology, inflammation and clinical symptoms in these disorders is still unclear. Thus, by applying novel blood markers of neuroaxonal integrity such as neurofilament light chain (NfL), we can now address main issues in psychiatric research and potentially offer innovative diagnostic tools toward better clinical characterizations and monitoring in both SZ and MDD. METHODS NfL levels were measured in serum of 44 patients with SZ and in 41 patients with MDD applying single molecule array technology and compared to a healthy norm population. Main inflammatory markers (C- reactive protein, interleukins IL-6 and IL-10) were measured to define patients with inflammatory phenotype. The Digit Symbol Substitution Task (DSST) and the Letter-Number-Sequencing Task were performed to estimate cognitive function in both groups. RESULTS NfL levels in MDD group (but not in SZ group) were significantly higher than reference values of healthy norm population. A higher than expected proportion of patients with NfL levels above age-specific cut-off values was observed in both SZ and MDD groups. No correlation was observed between NfL and inflammatory markers. A negative correlation between DSST and NfL-values was observed in patients with MDD. CONCLUSIONS Both SZ and MDD showed elevated serum levels of NfL, which were independent from inflammatory markers but associated with cognitive performance.
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Affiliation(s)
- Francesco Bavato
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zürich, University of Zurich, Switzerland.
| | - Flurin Cathomas
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zürich, University of Zurich, Switzerland
| | - Federica Klaus
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zürich, University of Zurich, Switzerland
| | - Karoline Gütter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zürich, University of Zurich, Switzerland
| | - Christian Barro
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland
| | - Aleksandra Maceski
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zürich, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland
| | - Stefan Kaiser
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zürich, University of Zurich, Switzerland; Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Chemin du Petit-Bel-Air, 1225, Chêne-Bourg, Switzerland
| | - Boris B Quednow
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zürich, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
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43
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Measuring the effectiveness of psychoeducation on adherence, depression, anxiety and stress among patients with diagnosis of schizophrenia. a control trial. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-00255-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AbstractDespite evidence of the impact of depression and stress on attitudes towards medication in general medical pathology regimens, little is known of the effects of depression and stress on attitudes towards medication in schizophrenia. This study explores the effects of a hope-based psychoeducation on attitudes towards medication, depression, anxiety and stress, and predictors of attitudes towards medication. The participants in the study (n = 29) were randomly allocated to either the psychoeducation group or the control group. Results from the psychoeducation group revealed that attitudes towards medication were significantly improved and anxiety was significantly reduced. Given the small sample, which was recruited from among patients of a day mental health centre, findings should be interpreted tentatively. Being longer in pharmacotherapy, having experienced fewer occurrences of hospitalisation, and being less depressed predicted positivity towards medication. Patients in the control group did not exhibit significant change in any of the studied variables. Findings were interpreted in the light of research on stigma and insight into illness, and add modestly to literature arguing for the importance of patients’ retention of hope, empowerment and sense of control over illness. This study proposed that psychoeducation is an appropriate intervention to address a wide range of factors that compound adherence to medication and patients’ symptoms, such as patients’ interpretations of causal models, their sense of hope and control over the illness, and their insight into illness and self-stigma.
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44
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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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45
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Chopra S, Fornito A, Francey SM, O'Donoghue B, Cropley V, Nelson B, Graham J, Baldwin L, Tahtalian S, Yuen HP, Allott K, Alvarez-Jimenez M, Harrigan S, Sabaroedin K, Pantelis C, Wood SJ, McGorry P. Differentiating the effect of antipsychotic medication and illness on brain volume reductions in first-episode psychosis: A Longitudinal, Randomised, Triple-blind, Placebo-controlled MRI Study. Neuropsychopharmacology 2021; 46:1494-1501. [PMID: 33637835 PMCID: PMC8209146 DOI: 10.1038/s41386-021-00980-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 01/31/2023]
Abstract
Changes in brain volume are a common finding in Magnetic Resonance Imaging (MRI) studies of people with psychosis and numerous longitudinal studies suggest that volume deficits progress with illness duration. However, a major unresolved question concerns whether these changes are driven by the underlying illness or represent iatrogenic effects of antipsychotic medication. In this study, 62 antipsychotic-naïve patients with first-episode psychosis (FEP) received either a second-generation antipsychotic (risperidone or paliperidone) or a placebo pill over a treatment period of 6 months. Both FEP groups received intensive psychosocial therapy. A healthy control group (n = 27) was also recruited. Structural MRI scans were obtained at baseline, 3 months and 12 months. Our primary aim was to differentiate illness-related brain volume changes from medication-related changes within the first 3 months of treatment. We secondarily investigated long-term effects at the 12-month timepoint. From baseline to 3 months, we observed a significant group x time interaction in the pallidum (p < 0.05 FWE-corrected), such that patients receiving antipsychotic medication showed increased volume, patients on placebo showed decreased volume, and healthy controls showed no change. Across the entire patient sample, a greater increase in pallidal grey matter volume over 3 months was associated with a greater reduction in symptom severity. Our findings indicate that psychotic illness and antipsychotic exposure exert distinct and spatially distributed effects on brain volume. Our results align with prior work in suggesting that the therapeutic efficacy of antipsychotic medications may be primarily mediated through their effects on the basal ganglia.
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Affiliation(s)
- Sidhant Chopra
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia.
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia.
| | - Alex Fornito
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Shona M Francey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Brian O'Donoghue
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Melbourne, VIC, Australia
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jessica Graham
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Lara Baldwin
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Steven Tahtalian
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Melbourne, VIC, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kelly Allott
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Susy Harrigan
- Department of Social Work, Monash University, Clayton, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Kristina Sabaroedin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Melbourne, VIC, Australia
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen J Wood
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- School of Psychology, University Birmingham, Edgbaston, UK
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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46
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Svancer P, Spaniel F. Brain ventricular volume changes in schizophrenia. A narrative review. Neurosci Lett 2021; 759:136065. [PMID: 34146640 DOI: 10.1016/j.neulet.2021.136065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/15/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022]
Abstract
Brain ventricles are among the most studied structures in psychotic illness. In our mini-review we present available evidence on brain ventricle changes during the course of schizophrenia, from high-risk subjects and the first episode of schizophrenia to patients with chronic schizophrenia. We present current findings on the relationship between ventricle changes and level of psychopathology. The potential pathophysiological background of ventricle changes is also discussed. Understanding the dynamics of brain ventricle changes could resolve long-standing questions on the proportion of neurodegenerative and neurodevelopmental processes in the pathophysiology of schizophrenia.
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Affiliation(s)
- Patrik Svancer
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Filip Spaniel
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
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47
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The progression of disorder-specific brain pattern expression in schizophrenia over 9 years. NPJ SCHIZOPHRENIA 2021; 7:32. [PMID: 34127678 PMCID: PMC8203625 DOI: 10.1038/s41537-021-00157-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022]
Abstract
Age plays a crucial role in the performance of schizophrenia vs. controls (SZ-HC) neuroimaging-based machine learning (ML) models as the accuracy of identifying first-episode psychosis from controls is poor compared to chronic patients. Resolving whether this finding reflects longitudinal progression in a disorder-specific brain pattern or a systematic but non-disorder-specific deviation from a normal brain aging (BA) trajectory in schizophrenia would help the clinical translation of diagnostic ML models. We trained two ML models on structural MRI data: an SZ-HC model based on 70 schizophrenia patients and 74 controls and a BA model (based on 561 healthy individuals, age range = 66 years). We then investigated the two models’ predictions in the naturalistic longitudinal Northern Finland Birth Cohort 1966 (NFBC1966) following 29 schizophrenia and 61 controls for nine years. The SZ-HC model’s schizophrenia-specificity was further assessed by utilizing independent validation (62 schizophrenia, 95 controls) and depression samples (203 depression, 203 controls). We found better performance at the NFBC1966 follow-up (sensitivity = 75.9%, specificity = 83.6%) compared to the baseline (sensitivity = 58.6%, specificity = 86.9%). This finding resulted from progression in disorder-specific pattern expression in schizophrenia and was not explained by concomitant acceleration of brain aging. The disorder-specific pattern’s progression reflected longitudinal changes in cognition, outcomes, and local brain changes, while BA captured treatment-related and global brain alterations. The SZ-HC model was also generalizable to independent schizophrenia validation samples but classified depression as control subjects. Our research underlines the importance of taking account of longitudinal progression in a disorder-specific pattern in schizophrenia when developing ML classifiers for different age groups.
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48
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McWhinney S, Kolenic M, Franke K, Fialova M, Knytl P, Matejka M, Spaniel F, Hajek T. Obesity as a Risk Factor for Accelerated Brain Ageing in First-Episode Psychosis-A Longitudinal Study. Schizophr Bull 2021; 47:1772-1781. [PMID: 34080013 PMCID: PMC8530396 DOI: 10.1093/schbul/sbab064] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Obesity is highly prevalent in schizophrenia, with implications for psychiatric prognosis, possibly through links between obesity and brain structure. In this longitudinal study in first episode of psychosis (FEP), we used machine learning and structural magnetic resonance imaging (MRI) to study the impact of psychotic illness and obesity on brain ageing/neuroprogression shortly after illness onset. METHODS We acquired 2 prospective MRI scans on average 1.61 years apart in 183 FEP and 155 control individuals. We used a machine learning model trained on an independent sample of 504 controls to estimate the individual brain ages of study participants and calculated BrainAGE by subtracting chronological from the estimated brain age. RESULTS Individuals with FEP had a higher initial BrainAGE than controls (3.39 ± 6.36 vs 1.72 ± 5.56 years; β = 1.68, t(336) = 2.59, P = .01), but similar annual rates of brain ageing over time (1.28 ± 2.40 vs 1.07±1.74 estimated years/actual year; t(333) = 0.93, P = .18). Across both cohorts, greater baseline body mass index (BMI) predicted faster brain ageing (β = 0.08, t(333) = 2.59, P = .01). For each additional BMI point, the brain aged by an additional month per year. Worsening of functioning over time (Global Assessment of Functioning; β = -0.04, t(164) = -2.48, P = .01) and increases especially in negative symptoms on the Positive and Negative Syndrome Scale (β = 0.11, t(175) = 3.11, P = .002) were associated with faster brain ageing in FEP. CONCLUSIONS Brain alterations in psychosis are manifest already during the first episode and over time get worse in those with worsening clinical outcomes or higher baseline BMI. As baseline BMI predicted faster brain ageing, obesity may represent a modifiable risk factor in FEP that is linked with psychiatric outcomes via effects on brain structure.
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Affiliation(s)
- Sean McWhinney
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marian Kolenic
- National Institute of Mental Health, Klecany, Czech Republic,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katja Franke
- Structural Brain Mapping Group, Department of Neurology, Jena University Hospital, Jena, Germany
| | - Marketa Fialova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Pavel Knytl
- National Institute of Mental Health, Klecany, Czech Republic
| | - Martin Matejka
- National Institute of Mental Health, Klecany, Czech Republic,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Filip Spaniel
- National Institute of Mental Health, Klecany, Czech Republic,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada,National Institute of Mental Health, Klecany, Czech Republic,To whom correspondence should be addressed; Department of Psychiatry, Dalhousie University, QEII HSC, A. J. Lane Building, Room 3093, 5909 Veteran’s Memorial Lane, Halifax, Nova Scotia B3H 2E2, Canada; tel: (902) 473-8299, fax: (902) 473-1583, e-mail:
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49
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Cooper RE, Mason JP, Calton T, Richardson J, Moncrieff J. Opinion Piece: The case for establishing a minimal medication alternative for psychosis and schizophrenia. PSYCHOSIS 2021. [DOI: 10.1080/17522439.2021.1930119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Ruth E. Cooper
- Newham Centre for Mental Health, Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, Newham Centre for Mental Health, London, UK
- Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
| | - John P. Mason
- Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, UK
- The International Society for Psychological and Social Approaches to Psychosis (ISPS), UK
| | - Tim Calton
- Louth Crisis Resolution and Home Treatment Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - John Richardson
- The International Society for Psychological and Social Approaches to Psychosis (ISPS), UK
| | - Joanna Moncrieff
- Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, UK
- Division of Psychiatry, University College London, London, UK
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50
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Du J, Palaniyappan L, Liu Z, Cheng W, Gong W, Zhu M, Wang J, Zhang J, Feng J. The genetic determinants of language network dysconnectivity in drug-naïve early stage schizophrenia. NPJ SCHIZOPHRENIA 2021; 7:18. [PMID: 33658499 PMCID: PMC7930279 DOI: 10.1038/s41537-021-00141-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 01/12/2021] [Indexed: 01/31/2023]
Abstract
Schizophrenia is a neurocognitive illness of synaptic and brain network-level dysconnectivity that often reaches a persistent chronic stage in many patients. Subtle language deficits are a core feature even in the early stages of schizophrenia. However, the primacy of language network dysconnectivity and language-related genetic variants in the observed phenotype in early stages of illness remains unclear. This study used two independent schizophrenia dataset consisting of 138 and 53 drug-naïve first-episode schizophrenia (FES) patients, and 112 and 56 healthy controls, respectively. A brain-wide voxel-level functional connectivity analysis was conducted to investigate functional dysconnectivity and its relationship with illness duration. We also explored the association between critical language-related genetic (such as FOXP2) mutations and the altered functional connectivity in patients. We found elevated functional connectivity involving Broca's area, thalamus and temporal cortex that were replicated in two FES datasets. In particular, Broca's area - anterior cingulate cortex dysconnectivity was more pronounced for patients with shorter illness duration, while thalamic dysconnectivity was predominant in those with longer illness duration. Polygenic risk scores obtained from FOXP2-related genes were strongly associated with functional dysconnectivity identified in patients with shorter illness duration. Our results highlight the criticality of language network dysconnectivity, involving the Broca's area in early stages of schizophrenia, and the role of language-related genes in this aberration, providing both imaging and genetic evidence for the association between schizophrenia and the determinants of language.
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Affiliation(s)
- Jingnan Du
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
| | - Lena Palaniyappan
- Department of Psychiatry and Robarts Research Institute, University of Western Ontario, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Zhaowen Liu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Wei Cheng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
| | - Weikang Gong
- Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Mengmeng Zhu
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China.
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China.
- Department of Computer Science, University of Warwick, Coventry, UK.
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