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Sheehan N, Bannai D, Silverstein SM, Lizano P. Neuroretinal Alterations in Schizophrenia and Bipolar Disorder: An Updated Meta-analysis. Schizophr Bull 2024:sbae102. [PMID: 38954839 DOI: 10.1093/schbul/sbae102] [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: 07/04/2024]
Abstract
Schizophrenia (SZ) and bipolar disorder (BD) are characterized by major symptomatic, cognitive, and neuroanatomical changes. Recent studies have used optical coherence tomography (OCT) to investigate retinal changes in SZ and BD, but their unique and shared changes require further evaluation. Articles were identified using PubMed and Google Scholar. 39 studies met the inclusion criteria. Diagnostic groups were proband (SZ/BD combined), SZ, BD, and healthy control (HC) eyes. Meta-analyses utilized fixed and random effects models when appropriate, and publication bias was corrected using trim-and-fill analysis ("meta" package in R). Results are reported as standardized mean differences with 95% CIs. Data from 3145 patient eyes (1956 SZ, 1189 BD) and 3135 HC eyes were included. Studies identified thinning of the peripapillary retinal nerve fiber layer (pRNFL, overall and in 2 subregions), m-Retina (overall and all subregions), mGCL-IPL, mIPL, and mRPE in SZ patients. BD showed thinning of the pRNFL (overall and in each subregion), pGCC, and macular Retina (in 5 subregions), but no changes in thickness or volume for the total retina. Neither SZ nor BD patients demonstrated significant changes in the fovea, mRNFL, mGCL, mGCC, mINL, mOPL, mONL, or choroid thicknesses. Moderating effects of age, illness duration, and smoking on retinal structures were identified. This meta-analysis builds upon previous literature in this field by incorporating recent OCT studies and examining both peripapillary and macular retinal regions with respect to psychotic disorders. Overall, this meta-analysis demonstrated both peripapillary and macular structural retinal abnormalities in people with SZ or BD compared with HCs.
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Affiliation(s)
- Nora Sheehan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Deepthi Bannai
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
| | - Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Elmers J, Colzato LS, Ziemssen F, Ziemssen T, Beste C. Optical coherence tomography as a potential surrogate marker of dopaminergic modulation across the life span. Ageing Res Rev 2024; 96:102280. [PMID: 38518921 DOI: 10.1016/j.arr.2024.102280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/02/2024] [Accepted: 03/18/2024] [Indexed: 03/24/2024]
Abstract
The retina has been considered a "window to the brain" and shares similar innervation by the dopaminergic system with the cortex in terms of an unequal distribution of D1 and D2 receptors. Here, we provide a comprehensive overview that Optical Coherence Tomography (OCT), a non-invasive imaging technique, which provides an "in vivo" representation of the retina, shows promise to be used as a surrogate marker of dopaminergic neuromodulation in cognition. Overall, most evidence supports reduced retinal thickness in individuals with dopaminergic dysregulation (e.g., patients with Parkinson's Disease, non-demented older adults) and with poor cognitive functioning. By using the theoretical framework of metacontrol, we derive hypotheses that retinal thinning associated to decreased dopamine (DA) levels affecting D1 families, might lead to a decrease in the signal-to-noise ratio (SNR) affecting cognitive persistence (depending on D1-modulated DA activity) but not cognitive flexibility (depending on D2-modulated DA activity). We argue that the use of OCT parameters might not only be an insightful for cognitive neuroscience research, but also a potentially effective tool for individualized medicine with a focus on cognition. As our society progressively ages in the forthcoming years and decades, the preservation of cognitive abilities and promoting healthy aging will hold of crucial significance. OCT has the potential to function as a swift, non-invasive, and economical method for promptly recognizing individuals with a heightened vulnerability to cognitive deterioration throughout all stages of life.
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Affiliation(s)
- Julia Elmers
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany; Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Lorenza S Colzato
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Focke Ziemssen
- Ophthalmological Clinic, University Clinic Leipzig, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany; Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China.
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Komatsu H, Onoguchi G, Silverstein SM, Jerotic S, Sakuma A, Kanahara N, Kakuto Y, Ono T, Yabana T, Nakazawa T, Tomita H. Retina as a potential biomarker in schizophrenia spectrum disorders: a systematic review and meta-analysis of optical coherence tomography and electroretinography. Mol Psychiatry 2024; 29:464-482. [PMID: 38081943 PMCID: PMC11116118 DOI: 10.1038/s41380-023-02340-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Abnormal findings on optical coherence tomography (OCT) and electroretinography (ERG) have been reported in participants with schizophrenia spectrum disorders (SSDs). This study aims to reveal the pooled standard mean difference (SMD) in retinal parameters on OCT and ERG among participants with SSDs and healthy controls and their association with demographic characteristics, clinical symptoms, smoking, diabetes mellitus, and hypertension. METHODS Using PubMed, Scopus, Web of Science, and PSYNDEX, we searched the literature from inception to March 31, 2023, using specific search terms. This study was registered with PROSPERO (CRD4202235795) and conducted according to PRISMA 2020. RESULTS We included 65 studies in the systematic review and 44 in the meta-analysis. Participants with SSDs showed thinning of the peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell layer- inner plexiform cell layer, and retinal thickness in all other segments of the macula. A meta-analysis of studies that excluded SSD participants with diabetes and hypertension showed no change in results, except for pRNFL inferior and nasal thickness. Furthermore, a significant difference was found in the pooled SMD of pRNFL temporal thickness between the left and right eyes. Meta-regression analysis revealed an association between retinal thinning and duration of illness, positive and negative symptoms. In OCT angiography, no differences were found in the foveal avascular zone and superficial layer foveal vessel density between SSD participants and controls. In flash ERG, the meta-analysis showed reduced amplitude of both a- and b-waves under photopic and scotopic conditions in SSD participants. Furthermore, the latency of photopic a-wave was significantly shorter in SSD participants in comparison with HCs. DISCUSSION Considering the prior report of retinal thinning in unaffected first-degree relatives and the results of the meta-analysis, the findings suggest that retinal changes in SSDs have both trait and state aspects. Future longitudinal multimodal retinal imaging studies are needed to clarify the pathophysiological mechanisms of these changes and to clarify their utility in individual patient monitoring efforts.
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Affiliation(s)
- Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan.
- Miyagi Psychiatric Center, Natori, Japan.
| | - Goh Onoguchi
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Stefan Jerotic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Atsushi Sakuma
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuhisa Kanahara
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Yoshihisa Kakuto
- Miyagi Psychiatric Center, Natori, Japan
- Department of Community Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Takeshi Yabana
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Tomita
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
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Shew W, Zhang DJ, Menkes DB, Danesh-Meyer HV. Optical Coherence Tomography in Schizophrenia Spectrum Disorders: A Systematic Review and Meta-analysis. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:19-30. [PMID: 38021252 PMCID: PMC10654004 DOI: 10.1016/j.bpsgos.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 12/01/2023] Open
Abstract
Background Inner retinal atrophy has been demonstrated in schizophrenia spectrum disorder (SSD) using optical coherence tomography (OCT). This systematic review and meta-analysis investigated the role of contemporary Fourier domain OCT devices in SSD. Methods MEDLINE, PubMed, Scopus, Embase, PsycInfo, PYSNDEX, World Health Organization, and Cochrane databases were searched from inception until May 2022. All peer-reviewed adult SSD case-control studies using Fourier domain OCT were included. Ocular pathologies known to affect retinal OCT scans were excluded. Search, data appraisal, and summary data extraction were independently performed by 2 authors. Results The review criteria was met by k = 36 studies, with k = 24 studies (1074 cases, 854 controls) suitable for meta-analysis. The SSD group exhibited a thinner global peripapillary retinal nerve fiber layer (-3.26 μm, 95% CI, -5.07 to -1.45, I2 = 64%, k = 21), thinner average macular layer (-7.88 μm, 95% CI, -12.73 to -3.04, I2 = 65%, k = 11), and thinner macular ganglion cell-inner plexiform sublayer (-2.44 μm, 95% CI, -4.13 to -0.76, I2 = 30%, k = 8) compared with the control group. Retinal nerve fiber layer findings remained significant after exclusion of metabolic disease, low quality, outlier, and influential studies. Studies involving eye examinations to exclude eye disease were associated with greater atrophy in SSD. Except for cardiometabolic disease, most studies did not report clinically significant covariate data known to influence retinal thickness. Conclusions Individuals with SSD generally exhibited retinal atrophy, possibly paralleling reduced brain volumes documented in clinical imaging. Prospective longitudinal studies that collect clinical data, including various illness phases, and control for confounders will be necessary to evaluate retinal atrophy as a biomarker in SSD.
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Affiliation(s)
- William Shew
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Daniel J. Zhang
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - David B. Menkes
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Helen V. Danesh-Meyer
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
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Kiely C, Douglas KAA, Douglas VP, Miller JB, Lizano P. Overlap between ophthalmology and psychiatry - A narrative review focused on congenital and inherited conditions. Psychiatry Res 2024; 331:115629. [PMID: 38029629 PMCID: PMC10842794 DOI: 10.1016/j.psychres.2023.115629] [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: 10/13/2022] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023]
Abstract
A number of congenital and inherited diseases present with both ocular and psychiatric features. The genetic inheritance and phenotypic variants play a key role in disease severity. Early recognition of the signs and symptoms of those disorders is critical to earlier intervention and improved prognosis. Typically, the associations between these two medical subspecialties of ophthalmology and psychiatry are poorly understood by most practitioners so we hope to provide a narrative review to improve the identification and management of these disorders. We conducted a comprehensive review of the literature detailing the diseases with ophthalmic and psychiatric overlap that were more widely represented in the literature. Herein, we describe the clinical features, pathophysiology, molecular biology, diagnostic tests, and the most recent approaches for the treatment of these diseases. Recent studies have combined technologies for ocular and brain imaging such as optical coherence tomography (OCT) and functional imaging with genetic testing to identify the genetic basis for eye-brain connections. Additional work is needed to further explore these potential biomarkers. Overall, accurate, efficient, widely distributed and non-invasive tests that can help with early recognition of these diseases will improve the management of these patients using a multidisciplinary approach.
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Affiliation(s)
- Chelsea Kiely
- Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, 612, Boston, MA, United States
| | - Konstantinos A A Douglas
- Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, 612, Boston, MA, United States; Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, United States
| | | | - John B Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, United States; Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, 612, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, United States.
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6
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Kurt A, Zor KR, Yıldırım Biçer G, Küçük E, Erşan EE. Optical Coherence Tomography Findings in Bipolar Disorder Patients and the Related Factors. PSYCHIAT CLIN PSYCH 2023; 33:254-263. [PMID: 38765851 PMCID: PMC11037475 DOI: 10.5152/pcp.2023.23687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/18/2023] [Indexed: 05/22/2024] Open
Abstract
Background This study's purpose is to determine the effects of current episode and the mood stabilizers on chorioretinal layer thicknesses of bipolar disorder (BD) patients using spectral-domain optical coherence tomography (SD-OCT). Methods Sixty-seven patients were diagnosed with BD I and using lithium (Li) or valproic acid (VPA), of whom 20 were manic, 24 were depressive, and 23 were in remission, and 49 healthy individuals were included in the study. Peripapillary retinal nerve fiber layer (RNFL), ganglion cell layer, and macular thicknesses of the participants were measured automatically using SD-OCT, and their choroid layer thicknesses were measured manually using the depth imaging mode of SD-OCT. Statistical analysis of the data was performed using Statistical Package for the Social Sciences version 23.0. Results The patient group's mean age was 39.78 ± 11.78, and the control group's mean age was 42.06 ± 12.10. The mean disease duration was 13.22 ± 8.23 in the patient group, and 26 patients were using Li. While peripapillary RNFL thicknesses were lower in the patient group (P < .05), other layer measurements were similar between the groups. Moreover, the episodes experienced by BD patients did not affect chorioretinal SD-OCT measurements. The patients on VPA had significantly lower RNFL thicknesses compared to the control and the Li groups, and all chorioretinal measurements were similar between the Li and the control groups. Conclusion As a result of the study, it was established that neurodegenerative processes play a role in the pathophysiology of BD and the usage of Li is protective against the neurodegeneration of RNFL. Retinal changes measured with SD-OCT can be used for the diagnosis and prognosis of BD and for evaluating responses to mood stabilizers.
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Affiliation(s)
- Aydın Kurt
- Department of Psychiatry, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, Turkey
| | - Kürşad Ramazan Zor
- Department of Ophthalmology, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, Turkey
| | - Gamze Yıldırım Biçer
- Department of Ophthalmology, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, Turkey
| | - Erkut Küçük
- Department of Ophthalmology, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, Turkey
| | - Etem Erdal Erşan
- Department of Psychiatry, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, Turkey
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Kurtulmus A, Sahbaz C, Elbay A, Guler EM, Sonmez Avaroglu G, Kocyigit A, Ozdemir MH, Kirpinar I. Clinical and biological correlates of optical coherence tomography findings in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2023; 273:1837-1850. [PMID: 37022475 DOI: 10.1007/s00406-023-01587-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: 10/12/2022] [Accepted: 03/06/2023] [Indexed: 04/07/2023]
Abstract
There is a growing body of evidence indicating retinal layer thinning in schizophrenia. However, neuropathological processes underlying these retinal structural changes and its clinical correlates are yet to be known. Here, we aim to investigate the clinical and biological correlates of OCT findings in schizophrenia. 50 schizophrenia patients and 40 healthy controls were recruited. Retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and macular and choroidal thicknesses were recorded. A comprehensive battery of neuropsychological tests was applied. Fasting glucose, triglycerides and HDL-cholesterol levels, TNF-α, IL-1β and IL-6 levels were measured. Right IPL was significantly thinner in patients than the controls after controlling for various confounders (F = 5.42, p = .02). Higher IL-6, IL-1β, and TNF-α levels were associated with decreased left macular thickness (r = - 0.26, p = .027, r = - 0.30, p = 0.012, and r = - 0.24, p = .046, respectively) and higher IL-6 was associated with thinning of right IPL (r = - 0.27, p = 0.023) and left choroid (r = - 0.23, p = .044) in the overall sample. Thinning of right IPL and left macula were also associated with worse executive functioning (r = 0.37, p = 0.004 and r = 0.33, p = 0.009) and attention (r = 0.31, p = 0.018 and r = 0.30, p = 0.025). In patients with schizophrenia, IPL thinning was associated with increased BMI (r = - 0.44, p = 0.009) and decreased HDL levels (r = 0.43, p = 0.021). Decreased TNF-α level was related to IPL thinning, especially in the left eye (r = 0.40, p = 0.022). These findings support the hypothesis that OCT might provide the opportunity to establish an accessible and non-invasive probe of brain pathology in schizophrenia and related disorders. However, future studies investigating retinal structural changes as a biological marker for schizophrenia should also consider the metabolic state of the subjects.
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Affiliation(s)
- Ayse Kurtulmus
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey.
- Department od Psychiatry, Istanbul Medeniyet University Goztepe Research and Training Hospital, Istanbul, Turkey.
| | - Cigdem Sahbaz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ahmet Elbay
- Department of Ophthalmology, Bezmialem Vakif University, Istanbul, Turkey
| | - Eray Metin Guler
- Department of Medical Biochemistry, Hamidiye School of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Gamze Sonmez Avaroglu
- Fatih Community Mental Health Centre, Haseki Research and Training Hospital, Istanbul, Turkey
| | - Abdurrahim Kocyigit
- Department of Medical Biochemistry, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Ismet Kirpinar
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
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Prasannakumar A, Kumar V, Mailankody P, Appaji A, Battu R, Berendschot TTJM, Rao NP. A systematic review and meta-analysis of optical coherence tomography studies in schizophrenia, bipolar disorder and major depressive disorder. World J Biol Psychiatry 2023; 24:707-720. [PMID: 37070475 DOI: 10.1080/15622975.2023.2203231] [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: 01/04/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES Due to the common neurodevelopmental origin and easy accessibility, the retina serves as a surrogate marker for changes in the brain. Hence, Optical Coherence Tomography (OCT), a tool to examine the neuronal layers of retina has gained importance in investigating psychiatric disorders. Several studies in the last decade have reported retinal structural alterations in schizophrenia (SCZ), bipolar disorder (BD), and major depressive disorder (MDD). However, the findings are inconsistent. Hence, we conducted a meta-analysis to investigate alterations in OCT parameters in patients with SCZ, BD and MDD. METHODS We searched electronic databases for studies that examined OCT parameters in patients with SCZ, BD and MDD published up to January 2023. The primary outcome measures were thickness and volumes of the retinal Nerve Fibre Layer (RNFL). We conducted meta-analysis using a random effects model. RESULTS The searches yielded 2638 publications of which 43 studies were included in the final analysis across all disorders. Compared to controls, the RNFL was thinner in SCZ patients (SMD = -0.37, p = <0.001) and BD patients (SMD = -0.67, p = < 0.001), but not in MDD patients (SMD = -0.08, p = 0.54). On quadrant wise analysis, temporal quadrant RNFL was thinner in SCZ but not in BD, while all other quadrants were thinner in both SCZ and BD. CONCLUSION We found significant reductions in RNFL thickness in SCZ and BD, but not in MDD. The differential involvement in various quadrants and parameters across the disorders has potential implications for using retinal parameters as a diagnostic biomarker.
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Affiliation(s)
- Akash Prasannakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Vijay Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Pooja Mailankody
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Abhishek Appaji
- Department of Medical Electronics, BMS College of Engineering, Bangalore, Karnataka, India
- Department of Opthalmology, University Eye Clinic Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Rajani Battu
- Department of Opthalmology, Centre for Eye Genetics and Research, Bangalore, Karnataka, India
| | - Tos T J M Berendschot
- Department of Opthalmology, University Eye Clinic Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Blose BA, Lai A, Crosta C, Thompson JL, Silverstein SM. Retinal Neurodegeneration as a Potential Biomarker of Accelerated Aging in Schizophrenia Spectrum Disorders. Schizophr Bull 2023; 49:1316-1324. [PMID: 37459382 PMCID: PMC10483469 DOI: 10.1093/schbul/sbad102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND HYPOTHESES Several biological markers are believed to reflect accelerated aging in schizophrenia spectrum disorders; however, retinal neural changes have not yet been explored as potential CNS biomarkers of accelerated aging in this population. The aim of this study was to determine whether retinal neural layer thinning is more strongly related to age in schizophrenia and schizoaffective disorder patients (SZ) than in a psychiatrically healthy control group (CON). STUDY DESIGN Schizophrenia (n = 60) and CON participants (n = 69) underwent spectral domain optical coherence tomography (OCT) scans to examine the following variables in both eyes: retinal nerve fiber layer (RNFL) thickness, macula central subfield (CSF) thickness, macula volume, ganglion cell layer-inner plexiform layer (GCL-IPL) thickness, optic cup volume, and cup-to-disc ratio. Eleven participants in each group had diabetes or hypertension. STUDY RESULTS Significant negative relationships between age and RNFL thickness, macula volume, and GCL-IPL thickness were observed in the SZ group, while no significant relationships were observed in the CON group. However, many of the findings in the SZ group lost significance when participants with diabetes/hypertension were removed from analyses. A notable exception to this was that the age × SZ interaction accounted for a unique proportion of variance in GCL-IPL thinning over and above the effect of diabetes/hypertension. CONCLUSIONS The results suggest that retinal atrophy occurs at an increased rate in schizophrenia spectrum disorders, potentially reflecting accelerated aging inherent to these conditions, with considerable contributions from systemic medical diseases closely linked to this population.
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Affiliation(s)
- Brittany A Blose
- Department of Psychology, University of Rochester, Rochester, NY, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Adriann Lai
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- University Behavioral Health Care, Rutgers University, Piscataway, NJ, USA
| | - Christen Crosta
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, USA
| | - Judy L Thompson
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, NJ, USA
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- University Behavioral Health Care, Rutgers University, Piscataway, NJ, USA
- Department of Psychiatry, Rutgers University, Piscataway, NJ, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
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10
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Domagała A, Domagała L, Kopiś-Posiej N, Harciarek M, Krukow P. Differentiation of the retinal morphology aging trajectories in schizophrenia and their associations with cognitive dysfunctions. Front Psychiatry 2023; 14:1207608. [PMID: 37539329 PMCID: PMC10396397 DOI: 10.3389/fpsyt.2023.1207608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023] Open
Abstract
Previous studies evaluating the morphology of the selected retinal layers in schizophrenia showed abnormalities regarding macular thickness, retinal nerve fiber layer (RNLF), and ganglion cell complex (GCC). Concurrently, accumulating neuroimaging results suggest that structural alterations of the brain in this disease might be an effect of accelerated aging. Referring to these findings, we aimed to determine whether the thinning of the retinal layers assessed with the optic coherence tomography (OCT) in a group of schizophrenia patients (n = 60) presents a significant age-related decrease exceeding potential changes noted in the control group (n = 61). Samples of patients and controls were divided into three age subgroups, namely, younger, middle-aged, and older participants. OCT outcomes, such as macular thickness and volume, macular RNFL, peripapillary RNFL, and GCC, were analyzed concerning a diagnosis status (controls vs. patients) and age subgroups. Additionally, associations between retinal parameters, age, and selected cognitive functions were evaluated. post-hoc tests revealed that macular thickness and volume in patients undergo significant age-dependent thinning, which was not observed in the control group. Regression analyses confirmed the association between macular morphology and age. Selected speed-dependent cognitive functions in patients decreased significantly with age, and these features were also significantly associated with some OCT outcomes also after controlling for antipsychotic treatment. Our results suggest that reduced measures of retinal structure detected in schizophrenia may be an effect of accelerated aging; however, further research is needed using computational solutions derived from brain imaging studies based on large datasets covering representatives of all age groups.
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Affiliation(s)
- Adam Domagała
- Department of Clinical Neuropsychiatry, Medical University of Lublin, Lublin, Poland
| | - Lucyna Domagała
- Non-Public Health Facility “OKO-MED”, Sandomierz, Sandomierz County, Poland
| | - Natalia Kopiś-Posiej
- Department of Clinical Neuropsychiatry, Medical University of Lublin, Lublin, Poland
| | - Michał Harciarek
- Department of Neuropsychology, Institute of Psychology, University of Gdańsk, Gdansk, Poland
| | - Paweł Krukow
- Department of Clinical Neuropsychiatry, Medical University of Lublin, Lublin, Poland
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11
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Krčmář L, Jäger I, Boudriot E, Hanken K, Gabriel V, Melcher J, Klimas N, Dengl F, Schmoelz S, Pingen P, Campana M, Moussiopoulou J, Yakimov V, Ioannou G, Wichert S, DeJonge S, Zill P, Papazov B, de Almeida V, Galinski S, Gabellini N, Hasanaj G, Mortazavi M, Karali T, Hisch A, Kallweit MS, Meisinger VJ, Löhrs L, Neumeier K, Behrens S, Karch S, Schworm B, Kern C, Priglinger S, Malchow B, Steiner J, Hasan A, Padberg F, Pogarell O, Falkai P, Schmitt A, Wagner E, Keeser D, Raabe FJ. The multimodal Munich Clinical Deep Phenotyping study to bridge the translational gap in severe mental illness treatment research. Front Psychiatry 2023; 14:1179811. [PMID: 37215661 PMCID: PMC10196006 DOI: 10.3389/fpsyt.2023.1179811] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/14/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Treatment of severe mental illness (SMI) symptoms, especially negative symptoms and cognitive dysfunction in schizophrenia, remains a major unmet need. There is good evidence that SMIs have a strong genetic background and are characterized by multiple biological alterations, including disturbed brain circuits and connectivity, dysregulated neuronal excitation-inhibition, disturbed dopaminergic and glutamatergic pathways, and partially dysregulated inflammatory processes. The ways in which the dysregulated signaling pathways are interconnected remains largely unknown, in part because well-characterized clinical studies on comprehensive biomaterial are lacking. Furthermore, the development of drugs to treat SMIs such as schizophrenia is limited by the use of operationalized symptom-based clusters for diagnosis. Methods In line with the Research Domain Criteria initiative, the Clinical Deep Phenotyping (CDP) study is using a multimodal approach to reveal the neurobiological underpinnings of clinically relevant schizophrenia subgroups by performing broad transdiagnostic clinical characterization with standardized neurocognitive assessments, multimodal neuroimaging, electrophysiological assessments, retinal investigations, and omics-based analyzes of blood and cerebrospinal fluid. Moreover, to bridge the translational gap in biological psychiatry the study includes in vitro investigations on human-induced pluripotent stem cells, which are available from a subset of participants. Results Here, we report on the feasibility of this multimodal approach, which has been successfully initiated in the first participants in the CDP cohort; to date, the cohort comprises over 194 individuals with SMI and 187 age and gender matched healthy controls. In addition, we describe the applied research modalities and study objectives. Discussion The identification of cross-diagnostic and diagnosis-specific biotype-informed subgroups of patients and the translational dissection of those subgroups may help to pave the way toward precision medicine with artificial intelligence-supported tailored interventions and treatment. This aim is particularly important in psychiatry, a field where innovation is urgently needed because specific symptom domains, such as negative symptoms and cognitive dysfunction, and treatment-resistant symptoms in general are still difficult to treat.
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Affiliation(s)
- Lenka Krčmář
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Iris Jäger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Emanuel Boudriot
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Hanken
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Vanessa Gabriel
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Julian Melcher
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Nicole Klimas
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Fanny Dengl
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Schmoelz
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Pauline Pingen
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Mattia Campana
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Joanna Moussiopoulou
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Vladislav Yakimov
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Georgios Ioannou
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Sven Wichert
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Silvia DeJonge
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Peter Zill
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Boris Papazov
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Valéria de Almeida
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Sabrina Galinski
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Nadja Gabellini
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Genc Hasanaj
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Matin Mortazavi
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Temmuz Karali
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Alexandra Hisch
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Marcel S Kallweit
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Verena J. Meisinger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Lisa Löhrs
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Karin Neumeier
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Stephanie Behrens
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Karch
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Benedikt Schworm
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | - Christoph Kern
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | | | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Johann Steiner
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
- Center for Health and Medical Prevention, Magdeburg, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- NeuroImaging Core Unit Munich, University Hospital, LMU Munich, Munich, Germany
- Munich Center for Neurosciences, LMU Munich, Munich, Germany
| | - Florian J. Raabe
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
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12
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Wagner SK, Cortina-Borja M, Silverstein SM, Zhou Y, Romero-Bascones D, Struyven RR, Trucco E, Mookiah MRK, MacGillivray T, Hogg S, Liu T, Williamson DJ, Pontikos N, Patel PJ, Balaskas K, Alexander DC, Stuart KV, Khawaja AP, Denniston AK, Rahi JS, Petzold A, Keane PA. Association Between Retinal Features From Multimodal Imaging and Schizophrenia. JAMA Psychiatry 2023; 80:478-487. [PMID: 36947045 PMCID: PMC10034669 DOI: 10.1001/jamapsychiatry.2023.0171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/23/2023] [Indexed: 03/23/2023]
Abstract
Importance The potential association of schizophrenia with distinct retinal changes is of clinical interest but has been challenging to investigate because of a lack of sufficiently large and detailed cohorts. Objective To investigate the association between retinal biomarkers from multimodal imaging (oculomics) and schizophrenia in a large real-world population. Design, Setting, and Participants This cross-sectional analysis used data from a retrospective cohort of 154 830 patients 40 years and older from the AlzEye study, which linked ophthalmic data with hospital admission data across England. Patients attended Moorfields Eye Hospital, a secondary care ophthalmic hospital with a principal central site, 4 district hubs, and 5 satellite clinics in and around London, United Kingdom, and had retinal imaging during the study period (January 2008 and April 2018). Data were analyzed from January 2022 to July 2022. Main Outcomes and Measures Retinovascular and optic nerve indices were computed from color fundus photography. Macular retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (mGC-IPL) thicknesses were extracted from optical coherence tomography. Linear mixed-effects models were used to examine the association between schizophrenia and retinal biomarkers. Results A total of 485 individuals (747 eyes) with schizophrenia (mean [SD] age, 64.9 years [12.2]; 258 [53.2%] female) and 100 931 individuals (165 400 eyes) without schizophrenia (mean age, 65.9 years [13.7]; 53 253 [52.8%] female) were included after images underwent quality control and potentially confounding conditions were excluded. Individuals with schizophrenia were more likely to have hypertension (407 [83.9%] vs 49 971 [48.0%]) and diabetes (364 [75.1%] vs 28 762 [27.6%]). The schizophrenia group had thinner mGC-IPL (-4.05 μm, 95% CI, -5.40 to -2.69; P = 5.4 × 10-9), which persisted when investigating only patients without diabetes (-3.99 μm; 95% CI, -6.67 to -1.30; P = .004) or just those 55 years and younger (-2.90 μm; 95% CI, -5.55 to -0.24; P = .03). On adjusted analysis, retinal fractal dimension among vascular variables was reduced in individuals with schizophrenia (-0.14 units; 95% CI, -0.22 to -0.05; P = .001), although this was not present when excluding patients with diabetes. Conclusions and Relevance In this study, patients with schizophrenia had measurable differences in neural and vascular integrity of the retina. Differences in retinal vasculature were mostly secondary to the higher prevalence of diabetes and hypertension in patients with schizophrenia. The role of retinal features as adjunct outcomes in patients with schizophrenia warrants further investigation.
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Affiliation(s)
- Siegfried K. Wagner
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Mario Cortina-Borja
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Steven M. Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, New York
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York
- Center for Visual Science, University of Rochester, Rochester, New York
| | - Yukun Zhou
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - David Romero-Bascones
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Biomedical Engineering Department, Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Mondragón, Spain
| | - Robbert R. Struyven
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Emanuele Trucco
- VAMPIRE Project, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Muthu R. K. Mookiah
- VAMPIRE Project, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Tom MacGillivray
- VAMPIRE Project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Stephen Hogg
- VAMPIRE Project, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Timing Liu
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Dominic J. Williamson
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Nikolas Pontikos
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Praveen J. Patel
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Konstantinos Balaskas
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Daniel C. Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Kelsey V. Stuart
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Anthony P. Khawaja
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Alastair K. Denniston
- University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
| | - Jugnoo S. Rahi
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- Ulverscroft Vision Research Group, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
| | - Axel Petzold
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Pearse A. Keane
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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13
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Janti SS, Tikka SK. Retinal microvasculature in schizophrenia: A meta-analysis with trial sequential analysis of studies assessing vessel density using Optical Coherence Tomography Angiography. Asian J Psychiatr 2023; 84:103570. [PMID: 37030089 DOI: 10.1016/j.ajp.2023.103570] [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: 02/23/2023] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 04/10/2023]
Abstract
We performed a series of random-effects meta-analyses on cross-sectional studies assessing vessel density (VD) using Optical Coherence Tomography Angiography (OCTA) in schizophrenia. Five studies with a total sample size of 410 (schizophrenia-192;healthy-218) were analysed. Supplementary Trial Sequential Analyses (TSA) was also performed. Meta-analyses revealed significantly lower VD in schizophrenia patients compared to healthy controls in the peripapillary region of the optic disc, including both superior hemisphere and inferior hemisphere. TSA validated these significant effects. We conclude that reduced VD at the peripapillary region of the optic disc as measured by OCTA may have the potential to be a schizophrenia biomarker.
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Affiliation(s)
- Siddharam S Janti
- Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Sai Krishna Tikka
- Department of Psychiatry, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India.
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14
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Kennedy KG, Mio M, Goldstein BI, Brambilla P, Delvecchio G. Systematic review and meta-analysis of retinal microvascular caliber in bipolar disorder, major depressive disorder, and schizophrenia. J Affect Disord 2023; 331:342-351. [PMID: 36958491 DOI: 10.1016/j.jad.2023.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Individuals with a severe mental illness (SMI), such as bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia (SZ), have increased rates of cardiovascular and cerebrovascular disease. Interestingly, it has been reported that retinal microvessels, a proxy cerebrovascular measure, non-invasively assessed via retinal imaging, predict future cardiovascular disease, with some studies also showing anomalous retinal microvascular caliber in SMI. Therefore, this review and meta-analysis evaluated whether retinal microvascular caliber differs between individuals with SMI vs controls and summarized current findings. METHODS A systematic literature search for retinal microvascular caliber and SMI was conducted in Embase and MEDLINE. Studies needed to be published in English before 2022 December 1st and examine retinal microvascular caliber in individuals diagnosed with a SMI. Finally, a meta-analysis of arteriolar and venular caliber in SMI case-controlled studies was also conducted. RESULTS The search yielded 65 unique articles, 11 were included in the review and 6 in the meta-analysis. The meta-analysis found that the SMI group had significantly wider venules than controls (SMD = -0.53; 95 % CI = 0.24, 0.81; p = 0.0004) but not arterioles (SMD = 0.07; 95 % CI = -0.29, 0.44; p = 0.70). Additionally, the systematic review found that poorer retinal microvascular health is associated with greater illness severity. LIMITATIONS Large heterogeneity of findings and small sample size. CONCLUSION This systematic review and meta-analysis found that SMI, specifically SZ, is associated with wider retinal venules. Retinal imaging, a fast, cost-effective, and non-invasive assay of cerebrovascular health, may provide insight into the pathophysiological processes of SMI. However, future longitudinal studies investigating these findings are warranted.
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Affiliation(s)
- Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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15
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Torun IM, Tukenmez Dikmen N, Tellioglu Saka N, Sonmez M. Choroidal Structural Alterations and Choroidal Vascularity Index in Bipolar Disorder Patients. Photodiagnosis Photodyn Ther 2023; 42:103518. [PMID: 36948410 DOI: 10.1016/j.pdpdt.2023.103518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE The aim of this study was to compare bipolar disorder (BD) patients with age- and sex-matched healthy individuals in order to assess the choroidal structural alterations, retinal nerve fiber layer (RNFL) thickness, and retinal changes in BD patients using encanhed depth imaging optic coherence tomography (EDI-OCT). METHOD For this research, 39 eyes of BD patients and 36 eyes of age-matched healthy volunteers were used. Five locations were used to assess the choroidal thickness (CT): subfoveal, 500 µm nasal and 1500 µm nasal to the fovea, 500 µm temporal and 1500 µm temporal to the fovea. Image-J was used to determine the total choroidal area (TCA), luminal area (LA), and choroidal vascularity index (CVI). The Spectralis-OCT device was used to evaluate the central macular thickness (CMT), retinal nerve fiber layer (RNFL), and ganglion cell layer (GCL). The data were statistically compared. RESULTS BD patients had significantly decreased subfoveal, nasal, and temporal CTs than controls (for all three, p = 0.0001). The results of CMT and GCL were found to be thinner than controls. (for all p=0.0001) In comparison to the controls, the mean TCA and LA were decreased in the BD group. (p=0.0001, p=0.0001 respectively,). Between the RNFL and CVI values in the BD and control groups, there was no statistically significant difference (p>0.05). CONCLUSION The results of this investigation showed that the retina and choroid of patients with BD had considerable anatomical changes.
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Affiliation(s)
- Isil Merve Torun
- Department of Ophthalmology, Medical Health Sciences University, Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Turkey.
| | - Nejla Tukenmez Dikmen
- Department of Ophthalmology, Medical Health Sciences University, Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Turkey.
| | - Nergis Tellioglu Saka
- Department of Psychiatry, Medical Health Sciences University, Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Turkey.
| | - Murat Sonmez
- Department of Ophthalmology, Medical Health Sciences University, Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Turkey.
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16
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Choroidal structural analysis in ultra-high risk and first-episode psychosis. Eur Neuropsychopharmacol 2023; 70:72-80. [PMID: 36931136 DOI: 10.1016/j.euroneuro.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/02/2023] [Accepted: 02/22/2023] [Indexed: 03/19/2023]
Abstract
Both structural and functional alterations in the retina and the choroid of the eye, as parts of the central nervous system, have been shown in psychotic disorders, especially in schizophrenia. In addition, genetic and imaging studies indicate vascular and angiogenesis anomalies in the psychosis spectrum disorders. In this ocular imaging study, choroidal structure and vascularity were investigated using enhanced depth imaging (EDI) optical coherence tomography (OCT) in first-episode psychosis (FEP), ultra-high risk for psychosis (UHR-P), and age- and gender- matched healthy controls (HCs). There were no significant differences between groups in central choroidal thickness, stromal choroidal area (SCA), luminal choroidal area (LCA) and total subfoveal choroidal area. The LCA/SCA ratio (p<0.001) and the choroidal vascularity index (CVI) (p<0.001) were significantly different between FEP, UHR-P and HCs. CVI and LCA/SCA ratio were significantly higher in patients with FEP compared to help-seeking youth at UHR-P. CVI and LCA/SCA ratio were not different between UHR-P and HCs. However, CVI was higher in UHR-P compared to HCs after excluding the outliers for the sensitivity analysis (p = 0.002). Current findings suggest that choroidal thickness is normal, but there are abnormalities in choroidal microvasculature in prodromal and first-episode psychosis. Further longitudinal studies are needed to investigate oculomics, especially CVI, as a promising biomarker for the prediction of conversion to psychosis in individuals at clinical high-risk.
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17
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Taşdelen R, Ayık B, Kaya H, Sevimli N. Investigation of the Relationship Between Cognitive Functions and Retinal Findings From Spectral Optical Coherence Tomography in Patients With Schizophrenia and Their Healthy Siblings. Psychiatry Investig 2023; 20:236-244. [PMID: 36990667 PMCID: PMC10064210 DOI: 10.30773/pi.2022.0268] [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: 09/16/2022] [Accepted: 12/11/2022] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE Retinal structural changes which were investigated by optical coherence tomography (OCT) have been reported in schizophrenia. Since cognitive dysfunction is a core feature of schizophrenia, the correlations between retinal findings and cognitive functions of patients and their healthy siblings may provide insight into the pathophysiological processes of the disorder. We aimed to investigate the relationship between neuropsychiatric tests and retinal changes in schizophrenia patients and their healthy siblings. METHODS We measured OCT parameters and cognitive performance (via Trail Making Tests, verbal fluency tests, and The Digit Span Tests) of 72 participants (36 patients with schizophrenia and 36 healthy siblings) and disease severity (with Positive and Negative Syndrome Scale, Global Assessment of Functioning, and Clinical Global Impression scales) in patients with schizophrenia and evaluated the relationship between retinal findings and clinical parameters, especially neurocognitive tests. RESULTS We found decreased ganglion cell layer-inner plexiform layer thickness and macular volume in the patient group. There were strong correlations between neurocognitive tests and OCT findings in both groups. On the other hand, there was not any correlation between retinal findings and disease parameters. CONCLUSION The cognitive symptoms of schizophrenia may be more closely related to structural changes in the retina.
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Affiliation(s)
- Rümeysa Taşdelen
- Department of Psychiatry, Marmara University Istanbul Pendik Education and Research Hospital, Istanbul, Türkiye
| | - Batuhan Ayık
- Department of Psychiatry, Sancaktepe Community Mental Health Center, Istanbul Erenkoy Education and Research Hospital, Istanbul, Türkiye
| | - Hatice Kaya
- Department of Psychiatry, Sultanbeyli Community Mental Health Center, Istanbul Sultanbeyli State Hospital, Istanbul, Türkiye
| | - Neslihan Sevimli
- Department of Ophthalmology, Istanbul Sultanbeyli State Hospital, Istanbul, Türkiye
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18
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Gouravani M, Salehi MA, Mohammadi S, Arevalo JF. Choroidal thickness in eyes of migraine patients measured using spectral domain-optical coherence tomography: A meta-analysis. Surv Ophthalmol 2023; 68:67-77. [PMID: 35093402 DOI: 10.1016/j.survophthal.2022.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023]
Abstract
Recent developments in high-resolution optical coherence tomography allow evaluation of even the slightest changes of choroidal thickness in various disorders, including migraine. In this review, we analyze the choroidal thickness measurements reported in various studies that compare results between migraineurs and healthy individuals. We searched PubMed, Scopus, and EMBASE to identify relevant literature reporting choroidal thickness in the migraineurs' different macular regions compared with healthy controls. A fixed-effects or random-effects model was applied for the meta-analysis based on the heterogeneity level. Moreover, subgroup analyses, meta-regression, publication bias, and quality assessment were also performed. We identified ten studies involving 580 migraineurs (173 with aura, 128 without aura, and 279 without specification for the presence of aura) and 407 healthy controls to be included in this meta-analysis. Results indicated that average choroidal thickness was significantly decreased in the migraine cases (SMD, -1.28; 95% CI, -2.47 to -0.08; P = 0.04) compared to healthy individuals. Furthermore, both with aura (SMD, -1.16; 95% CI, -1.39 to -0.92; P < 0.0001) and without aura migraine patients (SMD, -0.81; 95% CI, -1.28 to -0.34; P < 0.001) had significantly thinner subfoveal choroid compared to healthy controls. Moreover, subfoveal choroidal thickness in the migraineurs with aura was significantly lower than those without aura (SMD, -0.45; 95% CI, -0.84 to -0.05; P = 0.03). The alterations in choroidal thickness, suggestive of migraine's neurovascular pathophysiology, were tentatively confirmed by this study's findings. Further longitudinal studies with more diverse settings are required to derive more definitive conclusions.
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Affiliation(s)
- Mahdi Gouravani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - J Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
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19
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Developing a clinical decision tool based on electroretinogram to monitor the risk of severe mental illness. BMC Psychiatry 2022; 22:718. [PMID: 36401192 PMCID: PMC9673390 DOI: 10.1186/s12888-022-04375-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We have shown that electroretinograms can discriminate between patients with severe mental illness (SMI) and healthy controls in previous studies. We now intend to enhance the development and clinical utility of ERG as a biological tool to monitor the risk of SMI. METHODOLOGY A sample of 301 SMI patients (bipolar disorder or schizophrenia) and 200 controls was first split into a training (N = 401) and testing dataset (N = 100). A logistic regression using ERG was modeled in the training data, while external validation and discriminative ability were assessed in the testing data. A decision curve analysis was used to test clinical usefulness. Moreover, the identification of thresholds of uncertainty based on the two-graph ROC and the interval of uncertainty was used to enhance prediction. RESULTS The discriminative assessment of the ERG showed very high sensitivity (91%) and specificity (89%) after considering uncertainty levels. Furthermore, for prediction probabilities ranging from 0.14 to 0.95 in the testing data, the net benefit of using our ERG model to decide whether to intervene or not exceeded that of never or always intervening. CONCLUSION The ERG predicted SMI risk with a high level of accuracy when uncertainty was accounted for. This study further supports the potential of ERG to become a useful clinical decision tool to decide the course of action for subjects at risk of SMI. However, further investigation is still needed in longitudinal studies to assess the external validity of the instrument.
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20
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Qian N, Lipkin RM, Kaszowska A, Silipo G, Dias EC, Butler PD, Javitt DC. Computational modeling of excitatory/inhibitory balance impairments in schizophrenia. Schizophr Res 2022; 249:47-55. [PMID: 32291128 PMCID: PMC8760932 DOI: 10.1016/j.schres.2020.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 12/14/2022]
Abstract
Deficits in glutamatergic function are well established in schizophrenia (SZ) as reflected in "input" dysfunction across sensory systems. By contrast, less is known about contributions of the GABAergic system to impairments in excitatory/inhibitory balance. We investigated this issue by measuring contrast thresholds for orientation detection, orientation discriminability, and orientation-tilt-aftereffect curves in schizophrenia subjects and matched controls. These measures depend on the amplitude and width of underlying orientation tuning curves, which, in turn, depend on excitatory and inhibitory interactions. By simulating a well-established V1 orientation selectivity model and its link to perception, we demonstrate that reduced cortical excitation and inhibition are both necessary to explain our psychophysical data. Reductions in GABAergic feedback may represent a compensatory response to impaired glutamatergic input in SZ, or a separate pathophysiological event. We also found evidence for the widely accepted, but rarely tested, inverse relationship between orientation discriminability and tuning width.
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Affiliation(s)
- Ning Qian
- Department of Neuroscience, Zuckerman Institute, Department of Physiology & Cellular Biophysics, Columbia University, New York, NY 10027, United States of America
| | - Richard M Lipkin
- Department of Neuroscience, Zuckerman Institute, Department of Physiology & Cellular Biophysics, Columbia University, New York, NY 10027, United States of America
| | - Aleksandra Kaszowska
- Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States of America; Department of Electronic Systems, Aalborg University, Denmark
| | - Gail Silipo
- Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States of America
| | - Elisa C Dias
- Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States of America
| | - Pamela D Butler
- Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States of America
| | - Daniel C Javitt
- Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States of America; Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, New York, NY 10032, United States of America.
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21
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Atagun MI, Sonugur G, Yusifova A, Celik I, Ugurlu N. Machine learning algorithms revealed distorted retinal vascular branching in individuals with bipolar disorder. J Affect Disord 2022; 315:35-41. [PMID: 35905794 DOI: 10.1016/j.jad.2022.07.060] [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: 03/15/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Converging evidence designate vascular vulnerability in bipolar disorder. The predisposition progresses into distortion in time, thus detection of the vascular susceptibility may help reducing morbidity and mortality. It was aimed to assess retinal fundus vasculature in cardiovascular risk-free patients with bipolar disorder. METHODS Total of 68 individuals (38 patients with bipolar disorder, 30 healthy controls) were enrolled. In order to avoid from degenerative processes, participants were between 18 and 45 years of age, vascular risk factors were eliminated. Microscopic retinal fundus images were processed with machine learning algorithms (multilayer perceptron and support vector machine) and artificial neural network approaches. RESULTS In comparison to the healthy control group, the bipolar disorder group had lower number of breaking points (P < 0.001), lower number of curved vessel segments (P < 0.001). Total length of smooth vessels was longer (P = 0.040), and total length of curved vessel segments was significantly shorter (P < 0.001) than the control group. Vascular endothelial growth factor levels and gender were the confounders. There were significant correlations between vascular measures and serum lipid levels. LIMITATIONS Sample size was small and patients were on various medications. CONCLUSIONS These results indicate distortion in retinal vascular branching in bipolar disorder. Disrupted branching may reflect disturbed prosperity of retinal vascular plexus in patients with bipolar disorder. Alterations in the retinal vessels might be indicators of disruption in cerebral vascular system efficiency and thus neurovascular unit dysfunction in bipolar disorder.
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Affiliation(s)
- Murat Ilhan Atagun
- Department of Psychiatry, Canakkale Onsekiz Mart University Faculty of Medicine, Canakkale, Turkey.
| | - Guray Sonugur
- Mechatronics Engineering, Faculty of Technology, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | | | - Ibrahim Celik
- Mechatronics Engineering, Faculty of Technology, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Nagihan Ugurlu
- Department of Ophtalmology, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
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22
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Komatsu H, Onoguchi G, Jerotic S, Kanahara N, Kakuto Y, Ono T, Funakoshi S, Yabana T, Nakazawa T, Tomita H. Retinal layers and associated clinical factors in schizophrenia spectrum disorders: a systematic review and meta-analysis. Mol Psychiatry 2022; 27:3592-3616. [PMID: 35501407 DOI: 10.1038/s41380-022-01591-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The retina shares structural and functional similarities with the brain. Furthermore, structural changes in the retina have been observed in patients with schizophrenia spectrum disorders (SSDs). This systematic review and meta-analysis investigated retinal abnormalities and their association with clinical factors for SSD. METHODS Studies related to retinal layers in SSD patients were retrieved from PubMed, Scopus, Web of Science, Cochrane Controlled Register of Trials, International Clinical Trials Registry Platform, and PSYNDEX databases from inception to March 31, 2021. We screened and assessed the eligibility of the identified studies. EZR ver.1.54 and the metafor package in R were used for the meta-analysis and a random-effects or fixed-effects model was used to report standardized mean differences (SMDs). RESULTS Twenty-three studies (2079 eyes of patients and 1571 eyes of controls) were included in the systematic review and meta-analysis. The average peripapillary retinal nerve fiber layer (pRNFL) thickness, average macular thickness (MT), and macular ganglion cell layer-inner plexiform layer (GCL-IPL) thickness were significantly lower in patients than in controls (n = 14, 6, and 3, respectively; SMD = -0.33, -0.49, and -0.43, respectively). Patients also had significantly reduced macular volume (MV) compared to controls (n = 7; SMD = -0.53). The optic cup volume (OCV) was significantly larger in patients than in controls (n = 3; SMD = 0.28). The meta-regression analysis indicated an association between several clinical factors, such as duration of illness and the effect size of the pRNFL, macular GCL-IPL, MT, and MV. CONCLUSION Thinning of the pRNFL, macular GCL-IPL, MT, and MV and enlargement of the OCV in SSD were observed. Retinal abnormalities may be applicable as state/trait markers in SSDs. The accumulated evidence was mainly cross-sectional and requires verification by longitudinal studies to characterize the relationship between OCT findings and clinical factors.
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Affiliation(s)
- Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan. .,Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan. .,Miyagi Psychiatric Center, Natori, Japan.
| | - Goh Onoguchi
- Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Stefan Jerotic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nobuhisa Kanahara
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan.,Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Yoshihisa Kakuto
- Miyagi Psychiatric Center, Natori, Japan.,Department of Community Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | | | - Shunichi Funakoshi
- Miyagi Psychiatric Center, Natori, Japan.,Department of Community Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takeshi Yabana
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Collaborative Program for Ophthalmic Drug Discovery, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Tomita
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan.,Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan.,Department of Disaster Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan.,Department of Disaster Psychiatry, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
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23
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Boudriot E, Schworm B, Slapakova L, Hanken K, Jäger I, Stephan M, Gabriel V, Ioannou G, Melcher J, Hasanaj G, Campana M, Moussiopoulou J, Löhrs L, Hasan A, Falkai P, Pogarell O, Priglinger S, Keeser D, Kern C, Wagner E, Raabe FJ. Optical coherence tomography reveals retinal thinning in schizophrenia spectrum disorders. Eur Arch Psychiatry Clin Neurosci 2022; 273:575-588. [PMID: 35930031 PMCID: PMC10085905 DOI: 10.1007/s00406-022-01455-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Schizophrenia spectrum disorders (SSDs) are presumed to be associated with retinal thinning. However, evidence is lacking as to whether these retinal alterations reflect a disease-specific process or are rather a consequence of comorbid diseases or concomitant microvascular impairment. METHODS The study included 126 eyes of 65 patients with SSDs and 143 eyes of 72 healthy controls. We examined macula and optic disc measures by optical coherence tomography (OCT) and OCT angiography (OCT-A). Additive mixed models were used to assess the impact of SSDs on retinal thickness and perfusion and to explore the association of retinal and clinical disease-related parameters by controlling for several ocular and systemic covariates (age, sex, spherical equivalent, intraocular pressure, body mass index, diabetes, hypertension, smoking status, and OCT signal strength). RESULTS OCT revealed significantly lower parafoveal macular, macular ganglion cell-inner plexiform layer (GCIPL), and macular retinal nerve fiber layer (RNFL) thickness and thinner mean and superior peripapillary RNFL in SSDs. In contrast, the applied OCT-A investigations, which included macular and peripapillary perfusion density, macular vessel density, and size of the foveal avascular zone, did not reveal any significant between-group differences. Finally, a longer duration of illness and higher chlorpromazine equivalent doses were associated with lower parafoveal macular and macular RNFL thickness. CONCLUSIONS This study strengthens the evidence for disease-related retinal thinning in SSDs.
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Affiliation(s)
- Emanuel Boudriot
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Benedikt Schworm
- Department of Ophthalmology, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Lenka Slapakova
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), 80804, Munich, Germany
| | - Katharina Hanken
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Iris Jäger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Marius Stephan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), 80804, Munich, Germany
| | - Vanessa Gabriel
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Georgios Ioannou
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Julian Melcher
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Genc Hasanaj
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Mattia Campana
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Joanna Moussiopoulou
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Lisa Löhrs
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, 86156, Augsburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany.,Max Planck Institute of Psychiatry, 80804, Munich, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany.,NeuroImaging Core Unit Munich (NICUM), University Hospital, LMU Munich, 80336, Munich, Germany.,Munich Center for Neurosciences (MCN), LMU Munich, 82152, Planegg-Martinsried, Germany
| | - Christoph Kern
- Department of Ophthalmology, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Florian J Raabe
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany. .,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), 80804, Munich, Germany.
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24
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Gonzalez-Diaz JM, Radua J, Sanchez-Dalmau B, Camos-Carreras A, Zamora DC, Bernardo M. Mapping Retinal Abnormalities in Psychosis: Meta-analytical Evidence for Focal Peripapillary and Macular Reductions. Schizophr Bull 2022; 48:1194-1205. [PMID: 35810337 PMCID: PMC9673251 DOI: 10.1093/schbul/sbac085] [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: 12/14/2022]
Abstract
BACKGROUND Several studies have suggested that the retina structure is affected in schizophrenia spectrum disorders (SSD). We aimed to investigate the location and size of the potential differences between patients and healthy controls (HC) in several thickness and volume measures across the retina. STUDY DESIGN We included cross-sectional studies comparing peripapillary retinal nerve fiber layer (pRNFL) thickness, macular volume, macular thickness (MT), foveal thickness, ganglion cell and inner plexiform layer thickness (GCL+IPL), cup volume, and cup/disc ratio (C/D) in the right and/or left eyes and/or the pRNFL and MT quadrants between patients with SSD and HC. Search databases were MEDLINE, Web of Science, PsycINFO, Cochrane Central, and medrxiv.org. Risk of bias was assessed with the Newcastle-Ottawa Scale. Standardized mean differences (SMD), subgroup analysis, and meta-regression with several variables were computed using the dmetar package in R. PROSPERO: CRD42021287873. STUDY RESULTS Data from 22 reports (942 patients, 742 HC) were included. We found a retinal thinning in pRNFL (-0.30; 95% CI: -0.46, -0.14), macula (-0.37; 95% CI: -0.61, -0.13), and GCL+IPL (-0.33; 95% CI: -0.57, -0.10). The retinal thinning was especially pronounced in the superior and inferior quadrants of the inner ring of the macula. We also observed a decrease of macular volume (-0.44; 95% CI: -0.68, -0.20) and an increase in C/D ratio (0.35; 95% CI: 0.03, 0.67). CONCLUSIONS Current evidence demonstrates retinal thinning in SSD, affecting both axonal and cellular structures, specially focused in the inner ring of the macula.
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Affiliation(s)
- Jairo M Gonzalez-Diaz
- Universitat de Barcelona, Barcelona, Spain,UR Center for Mental Health—CERSAME, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia,Clinica Nuestra Señora de la Paz, Bogota, Colombia
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain,Early Psychosis: Interventions and Clinical-detection Lab, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,Department of Clinical Neuroscience, Stockholm Health Care Services, Stockholm County Council, Karolinska Institutet, Stockholm, Sweden
| | - Bernardo Sanchez-Dalmau
- Institut Clínic d’Oftalmologia, Hospital Clínic, Barcelona, Spain,Visual Lab. Ocular Inflammation Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Anna Camos-Carreras
- Institut Clínic d’Oftalmologia, Hospital Clínic, Barcelona, Spain,Visual Lab. Ocular Inflammation Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Diana C Zamora
- UR Center for Mental Health—CERSAME, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Miquel Bernardo
- To whom correspondence should be addressed; Department of Psychiatry and Psychology, Clinical Institute of Neuroscience. Hospital Clinic of Barcelona, Villarroel, 170. 08036. Barcelona, Spain; tel: +34 93 227 54 00 Ext. 3142, e-mail:
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25
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Retinal changes in bipolar disorder as an endophenotype candidate: Comparison of OCT-detected retinal changes in patients, siblings, and healthy controls. Psychiatry Res 2022; 313:114606. [PMID: 35561535 DOI: 10.1016/j.psychres.2022.114606] [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: 03/05/2022] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 11/22/2022]
Abstract
Optical coherence tomography (OCT) is a non-invasive imaging technique that detects retinal changes reflecting neurodegeneration. In recent studies in patients with bipolar disorder (BD) abnormal OCT findings have shown. In this study, we aimed to investigate the retinal changes in BD patients and their healthy siblings (HS) by comparing them with the healthy control (HC) group and to explore these findings as potential endophenotype candidates. 31 patients with BD, 31 age-matched HSs and 46 HCs were included and peripapillary retinal nerve fiber layer (RNFL), ganglion cell layer (GCL)+inner plexiform layer (IPL) and macular volume (MV) thicknesses were measured by OCT. The relationship between disease severity parameters, functionality and OCT measurements in the patient group was also investigated. In results, the mean RNFL thicknesses did not differ between groups. All GCL+IPL thicknesses were found to be significantly lower in the patient and sibling groups compared to the HCs. GCL+IPL thicknesses were significantly correlated with functionality of patients and severity of the disorder. Our findings suggest that analysis of retinal layers with OCT may be a beneficial indicator to show neuronal changes in BD and GCL+IPL may be a suitable endophenotype candidate.
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26
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Li CY, Garg I, Bannai D, Kasetty M, Katz R, Adhan I, Douglas KAA, Wang JC, Kim LA, Keshavan M, Lizano P, Miller JB. Sex-Specific Changes in Choroid Vasculature Among Patients with Schizophrenia and Bipolar Disorder. Clin Ophthalmol 2022; 16:2363-2371. [PMID: 35924185 PMCID: PMC9343178 DOI: 10.2147/opth.s352731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/17/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose While structural changes within the retina of psychosis patients have been established, no detailed studies of choroidal microvasculature in these patients have been performed. Given evidence of microvascular disruption in psychosis patients, this study sought to determine whether there exists evidence of microvascular disruption in the choroids in these patients. Methods Fifty-six subjects (20 controls and 36 psychosis patients) were recruited from April 2018 to February 2020. Five were excluded due to imaging artifact or missing demographic information. Swept-source optical coherence tomography angiography (SS-OCTA) images were obtained. Choroid vascular enface images (12 mm × 9mm) were exported every 2.6 μm from Bruch’s membrane to the choroid–scleral interface from Topcon to ImageJ. The images were binarized using Otsu’s method, signal from the optic disk and retinal vasculature was removed, and average choroid vascular density (CVD) was calculated as the average of percent area occupied by choroidal vasculature across images in the stack. Choroid vascular volume (CVV) was calculated as the CVD multiplied by maximum CT and image area. During image analysis, study staff were blinded to the phenotype of the study subjects. Results Compared with same-sex controls, male psychiatric patients had significantly lower CVD. Compared with same-sex controls, female psychiatric patients had significantly lower maximum CT with correspondingly decreased CVV, after adjusting for age. When all psychiatric patients were compared with all healthy controls, no significant differences in CT, CVD, or CVV were noted. Conclusion These results suggest that the pathogenesis of psychotic illness affects choroidal microvasculature in a sex-specific manner.
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Affiliation(s)
- Chloe Y Li
- Harvard Retinal Imaging Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
| | - Itika Garg
- Harvard Retinal Imaging Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Deepthi Bannai
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Megan Kasetty
- Harvard Retinal Imaging Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
| | - Raviv Katz
- Harvard Retinal Imaging Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Iniya Adhan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Jay C Wang
- Harvard Retinal Imaging Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
| | - Leo A Kim
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Paulo Lizano, Harvard Medical School, Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Road, Room 612, Boston, MA, 02115, USA, Tel +1 617-754-1227, Email
| | - John B Miller
- Harvard Retinal Imaging Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
- Correspondence: John B Miller, Harvard Medical School, Department of Ophthalmology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA, Tel +1 617-573-3529, Email
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27
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Hsu CH, Hsu JL, Tsai SY. Retinal nerve fiber layer thickness associated with specific brain region volumes in bipolar disorder. Acta Psychiatr Scand 2022; 146:98-100. [PMID: 35383892 DOI: 10.1111/acps.13430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/09/2022] [Accepted: 03/20/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Chi-Hsin Hsu
- Department of Ophthalmology, Shuang- Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Jung-Lung Hsu
- Department of Neurology, New Taipei Municipal Tu-Cheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei City, Taiwan.,Graduate Institute of Humanities in Medicine and Research Center for Brain and Consciousness, College of Humanities And Social Sciences, Taipei Medical University, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
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28
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Ulugut H, Trieu C, Groot C, van 't Hooft JJ, Tijms BM, Scheltens P, Ossenkoppele R, Barkhof F, van den Heuvel OA, Pijnenburg YAL. Overlap of Neuroanatomical Involvement in Frontotemporal Dementia and Primary Psychiatric Disorders: A Meta-analysis. Biol Psychiatry 2022; 93:820-828. [PMID: 35965106 DOI: 10.1016/j.biopsych.2022.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/05/2022] [Accepted: 05/31/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite significant symptomatic overlap between behavioral variant frontotemporal dementia (bvFTD) and primary psychiatric disorders (PPDs), a potential overlap in their structural anatomical changes has not been studied systematically. METHODS In this magnetic resonance imaging-based meta-analysis, we included studies on bvFTD, schizophrenia, bipolar disorder, and autism spectrum disorder that 1) used voxel-based morphometry analysis to assess regional gray matter volumes (GMVs) and 2) reported the coordinates of the regional GMV. Separate analyses were performed comparing clusters of coordinate-based changes in the GMVs (n = 24,183) between patients and control subjects, and overlapping brain regions between bvFTD and each PPD were examined. RESULTS We found that GMV alterations in the prefrontal and anterior cingulate cortices, temporal lobe, amygdala, and insula comprise the transdiagnostic brain alterations in bvFTD and PPD. CONCLUSIONS Our meta-analysis revealed significant anatomical overlap that paves the way for future investigations of shared pathophysiological pathways, and our cross-disorder approach would provide new insights to better understand the relationship between bvFTD and PPD.
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Affiliation(s)
- Hulya Ulugut
- Departments of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Calvin Trieu
- Departments of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Colin Groot
- Departments of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jochum J van 't Hooft
- Departments of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Betty M Tijms
- Departments of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Philip Scheltens
- Departments of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rik Ossenkoppele
- Departments of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Clinical Memory Research Unit, Lunds Universitet, Lund, Sweden
| | - Frederik Barkhof
- Radiology and Nuclear Medicine, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; University College London, Institutes of Neurology and Healthcare Engineering, London, United Kingdom
| | - Odile A van den Heuvel
- Department of Psychiatry, Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Departments of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Kaya H, Ayık B, Tasdelen R, Sevimli N, Ertekin E. Comparing retinal changes measured by optical coherence tomography in patients with schizophrenia and their siblings with healthy controls: Are retinal findings potential endophenotype candidates? Asian J Psychiatr 2022; 72:103089. [PMID: 35397439 DOI: 10.1016/j.ajp.2022.103089] [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: 12/09/2021] [Revised: 02/01/2022] [Accepted: 03/22/2022] [Indexed: 11/02/2022]
Abstract
AIM The aim of our study is to examine whether differences in retinal structure may reflect endophenotypes for schizophrenia by comparing thicknesses of retinal layers between patients with schizophrenia, their unaffected siblings, and healthy control groups and investigating the relationship between OCT findings and disease parameters. MATERIAL AND METHODS 46 patients with schizophrenia, their 46 healthy siblings, and 46 age and gender-matched healthy controls were enrolled in the study and underwent spectral domain OCT (examinations to assess differences in peripapillary retinal nerve fiber layer (RNFL) thickness, ganglion cell layer (GCL)+ inner plexiform layer (IPL) thicknesses and macular volumes (MV) in both eyes). Clinical variables were also recorded in the patient group. RESULTS There was no difference between the groups in terms of RNFL thicknesses. The GCL+IPL thicknesses of the siblings are between the patients and controls but according to post hoc comparisons the GCL+IPLs of the patients were only thinner than controls. Additionally, MVs were significantly lower in the patient group compared to the sibling group. There was no correlation between any clinical parameters and the GCL+IPLs of all groups, however there were some correlations between RNFL and clinical features especially in the patients group. CONCLUSION GCL+IPL values do not seem to be affected by the disease parameters or the factors like body mass index or nicotine use. On the other hand, further studies are needed to determine whether GCL+IPL could be an endophenotype candidate.
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Affiliation(s)
- Hatice Kaya
- Department of Psychiatry, Istanbul Sultanbeyli State Hospital, Sultanbeyli Community Mental Health Center, Sultanbeyli, Istanbul, Turkey.
| | - Batuhan Ayık
- Department of Psychiatry, Istanbul Erenkoy Education and Research Hospital, Sancaktepe Community Mental Health Center, Erenkoy, Istanbul, Turkey
| | - Rumeysa Tasdelen
- Department of Psychiatry, Marmara University Istanbul Pendik Education and Research Hospital, Pendik, Istanbul, Turkey
| | - Neslihan Sevimli
- Department of Ophthalmology, Istanbul Sultanbeyli State Hospital, Sultanbeyli, Istanbul, Turkey
| | - Erhan Ertekin
- Department of Psychiatry, Istanbul University, Istanbul Faculty of Medicine, Fatih, Istanbul, Turkey
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30
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Silverstein SM, Choi JJ, Green KM, Bowles-Johnson KE, Ramchandran RS. Schizophrenia in Translation: Why the Eye? Schizophr Bull 2022; 48:728-737. [PMID: 35640030 PMCID: PMC9212100 DOI: 10.1093/schbul/sbac050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Schizophrenia is increasingly recognized as a systemic disease, characterized by dysregulation in multiple physiological systems (eg, neural, cardiovascular, endocrine). Many of these changes are observed as early as the first psychotic episode, and in people at high risk for the disorder. Expanding the search for biomarkers of schizophrenia beyond genes, blood, and brain may allow for inexpensive, noninvasive, and objective markers of diagnosis, phenotype, treatment response, and prognosis. Several anatomic and physiologic aspects of the eye have shown promise as biomarkers of brain health in a range of neurological disorders, and of heart, kidney, endocrine, and other impairments in other medical conditions. In schizophrenia, thinning and volume loss in retinal neural layers have been observed, and are associated with illness progression, brain volume loss, and cognitive impairment. Retinal microvascular changes have also been observed. Abnormal pupil responses and corneal nerve disintegration are related to aspects of brain function and structure in schizophrenia. In addition, studying the eye can inform about emerging cardiovascular, neuroinflammatory, and metabolic diseases in people with early psychosis, and about the causes of several of the visual changes observed in the disorder. Application of the methods of oculomics, or eye-based biomarkers of non-ophthalmological pathology, to the treatment and study of schizophrenia has the potential to provide tools for patient monitoring and data-driven prediction, as well as for clarifying pathophysiology and course of illness. Given their demonstrated utility in neuropsychiatry, we recommend greater adoption of these tools for schizophrenia research and patient care.
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Affiliation(s)
- Steven M Silverstein
- To whom correspondence should be addressed; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA; tel: +1 585-275-6742, e-mail:
| | - Joy J Choi
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Kyle M Green
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Rajeev S Ramchandran
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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31
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Hsu TW, Bai YM, Tsai SJ, Chen TJ, Liang CS, Chen MH. Risk of retinal disease in patients with bipolar disorder: A nationwide cohort study. Psychiatry Clin Neurosci 2022; 76:106-113. [PMID: 34994991 DOI: 10.1111/pcn.13326] [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: 07/26/2021] [Revised: 12/06/2021] [Accepted: 12/21/2021] [Indexed: 12/13/2022]
Abstract
AIMS Patients with brain diseases have been associated with several retinal abnormalities. This study aimed to assess the risk of retinal diseases in patients with bipolar disorder (BD). METHODS This nationwide cohort of 73,271 patients with BD was enrolled between 2001 and 2009. To identify newly diagnosed retinal diseases, the patients were followed to the end of 2011. The control group included 293,084 patients, matched for demographic characteristics and medical and ophthalmological comorbidities. The Kaplan-Meier method was used to estimate incidence rates of retinal diseases. Cox regression was applied to calculate the hazard ratios (HRs) with 95% confidence intervals (CIs) after adjusting for confounders. RESULTS Patients with BD had higher incidence rates of any retinal disease than the controls (1.27% vs 0.48%, P < 0.001), and retinal diseases were diagnosed at a young age (54.23 years [±12.68 years] vs 57.01 years [±13.12 years], P < 0.001). After adjusting for demographic characteristics, physical and ophthalmological comorbidities, and medications, the HR was 3.24 (95% CI, 2.18-4.82) for retinal detachment, 2.35 (95% CI, 1.83-3.03) for primary retinopathy, 2.26 (95% CI, 1.91-2.68) for diabetes retinopathy, 2.39 (95% CI, 1.49-3.82) for hypertensive retinopathy, and 3.46 (95% CI, 2.45-4.89) for retinal vascular complications in patients with BD vs controls. The cumulative daily dose of bipolar medications was not associated with the incidence of any retinal disease. CONCLUSION Patients with BD were associated with a higher risk of retinal detachment, primary retinopathy, diabetes retinopathy, hypertensive retinopathy, and retinal vascular complications than the controls. Further studies are needed to examine the mechanisms mediating these retinal diseases in patients with BD.
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Affiliation(s)
- Tien-Wei Hsu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Sung Liang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
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32
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Bozali E, Yalinbas D. Analysis of the Thickness of the Outer Retinal Layer Using Optical Coherence Tomography - A Predictor of Visual Acuity in Schizophrenia. Klin Monbl Augenheilkd 2022; 239:1232-1238. [PMID: 35320864 DOI: 10.1055/a-1741-7988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the thickness of the outer retinal layer (ORL) together with macular thickness and changes in the retinal nerve fiber layer (RNFL) in patients with schizophrenia in comparison with healthy controls. METHODS This study included 114 eyes of 57 patients diagnosed with schizophrenia and 114 eyes of 57 healthy controls. Central foveal thickness (CFT), central macular thickness (CMT), and ORL thickness were measured in both groups via the images obtained by spectral-domain optical coherence tomography (SD-OCT). RNFL was also assessed in four quadrants (inferior, superior, temporal, nasal). CMT measurements were presented as the average thickness of the macula in the central 1 mm area on the Early Treatment Diabetic Retinopathy Study (ETDRS) grid. The ORL thickness was defined as the distance between the external limiting membrane and retinal pigment epithelium at the center of the foveal pit. RESULTS The mean age of 57 patients was 37 ± 10 years, of whom 34 (60%) were male and 23 (40%) female. No statistically significant difference was found between groups in terms of age and gender (p = 0.8 for age, p = 0.9 for gender). There was no statistically significant difference in the mean CMT between the two groups (p = 0.1). The mean ORL thickness in the two groups was 99.8 ± 8.3 and 103.7 ± 6.2, respectively, and was significantly decreased in the schizophrenia group (p = 0.005). RNFL analysis demonstrated significant thinning in the inferior and superior quadrants compared to healthy controls (p < 0.001 and p = 0.017, respectively). CONCLUSIONS SD-OCT findings - especially ORL and RNFL thickness - may be related to the neurodegenerational changes in schizophrenia.
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Affiliation(s)
- Erman Bozali
- Sivas Cumhuriyet University Faculty of Medicine, Department of Ophthalmology, Sivas, Turkey
| | - Duygu Yalinbas
- Sivas Cumhuriyet University Faculty of Medicine, Department of Ophthalmology, Sivas, Turkey
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33
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Combined influence of medication and symptom severity on visual processing in bipolar disorder. J Psychiatr Res 2022; 147:135-141. [PMID: 35032946 DOI: 10.1016/j.jpsychires.2022.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/18/2021] [Accepted: 01/03/2022] [Indexed: 12/16/2022]
Abstract
Previous studies have reported visual impairments in patients with bipolar disorder (BPD), but unclear were whether clinical variables would be associated with those disturbances. Here, we investigate the relationship between visual functioning, in terms of color discrimination, and the impact of BPD duration, mood state, and the patients' medication. Forty-five participants (25-45 years old) were recruited for this study. Color discrimination was performed using the Cambridge Colour Test. Serial multiple mediations were run to investigate the assumption of association between color discrimination and the clinical variables. Our findings showed that, compared with healthy controls, BPD patients' performance was worse for the Protan, Deutan, and Tritan vectors, revealing deterioration of color discrimination. In addition, the mediation analyses revealed a strong direct (p < .001) and moderate-to-high indirect effects (p < .01) of medication and symptom severity on color discrimination. Overall, both longer the duration of the disease and greater the symptom severity of BPD patients resulted in worse performance. It highlights the importance of examining the wider clinical context of an affective disorder to understand how it affects visual processing in this population.
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Bannai D, Adhan I, Katz R, Kim LA, Keshavan M, Miller JB, Lizano P. Quantifying Retinal Microvascular Morphology in Schizophrenia Using Swept-Source Optical Coherence Tomography Angiography. Schizophr Bull 2022; 48:80-89. [PMID: 34554256 PMCID: PMC8781445 DOI: 10.1093/schbul/sbab111] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Retinovascular changes are reported on fundus imaging in schizophrenia (SZ). This is the first study to use swept-source optical coherence tomography angiography (OCT-A) to comprehensively examine retinal microvascular changes in SZ. METHODS This study included 30 patients with SZ/schizoaffective disorder (8 early and 15 chronic) and 22 healthy controls (HCs). All assessments were performed at Beth Israel Deaconess Medical Center and Massachusetts Eye and Ear. All participants underwent swept-source OCT-A of right (oculus dextrus [OD]) and left (oculus sinister [OS]) eye, clinical, and cognitive assessments. Macular OCT-A images (6 × 6 mm) were collected with the DRI Topcon Triton for superficial, deep, and choriocapillaris vascular regions. Microvasculature was quantified using vessel density (VD), skeletonized vessel density (SVD), fractal dimension (FD), and vessel diameter index (VDI). RESULTS Twenty-one HCs and 26 SZ subjects were included. Compared to HCs, SZ patients demonstrated higher overall OD superficial SVD, OD choriocapillaris VD, and OD choriocapillaris SVD, which were primarily observed in the central, central and outer superior, and central and outer inferior/superior, respectively. Early-course SZ subjects had significantly higher OD superficial VD, OD choriocapillaris SVD, and OD choriocapillaris FD compared to matched HCs. Higher bilateral (OU) superficial VD correlated with lower Positive and Negative Syndrome Scale (PANSS) positive scores, and higher OU deep VDI was associated with higher PANSS negative scores. CONCLUSIONS AND RELEVANCE These results suggest the presence of microvascular dysfunction associated with early-stage SZ. Clinical associations with microvascular alterations further implicate this hypothesis, with higher measures being associated with worse symptom severity and functioning in early stages and with lower symptom severity and better functioning in later stages.
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Affiliation(s)
- Deepthi Bannai
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Iniya Adhan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Raviv Katz
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
| | - Leo A Kim
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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35
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An Integrated Neuroimaging Approach to Inform Transcranial Electrical Stimulation Targeting in Visual Hallucinations. Harv Rev Psychiatry 2022; 30:181-190. [PMID: 35576449 PMCID: PMC9179829 DOI: 10.1097/hrp.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
For decades, noninvasive brain stimulation (NIBS), such as transcranial electrical stimulation (tES), has been used to directly modulate human brain mechanisms of visual perception, setting the groundwork for the development of novel circuit-based therapies. While the field of NIBS has grown considerably over recent years, few studies have used these technologies to treat visual hallucinations (VH). Here, we review the NIBS-VH literature and find mixed results due to shortcomings that may potentially be addressed with a unique multimodal neuroimaging-NIBS approach. We highlight methodological advances in NIBS research that have provided researchers with more precise anatomical measurements that may improve our ability to influence brain activity. Specifically, we propose a methodology that combines neuroimaging advances, clinical neuroscience developments such as the identification of brain regions causally involved in VH, and personalized NIBS approaches that improve anatomical targeting. This methodology may enable us to reconcile existing discrepancies in tES-VH research and pave the way for more effective, VH-specific protocols for treating a number of neuropsychiatric disorders with VH as a core symptom.
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36
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Tian C, Duan L, Fu C, He J, Dai J, Zhu G. Study on the Correlation Between Iris Characteristics and Schizophrenia. Neuropsychiatr Dis Treat 2022; 18:811-820. [PMID: 35431547 PMCID: PMC9005354 DOI: 10.2147/ndt.s361614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/01/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recently, researchers have conducted many studies on the potential contribution of the retina and other eye structures on schizophrenia. This study aimed to evaluate differences in iris characteristics between patients with schizophrenia and healthy individuals so as to find more easily accessible and easily measurable biomarkers with a view to improving clinical assessments and furthering our understanding of the disease. METHODS Overall, 80 patients with schizophrenia and 52 healthy individuals were included in the case group and the control group, respectively. Iris images were collected from all subjects to compare differences in the structure and color of the iris. The Positive and Negative Symptom Scale (PANSS) and the Modified Overt Aggression Scale (MOAS) were used to evaluate the clinical symptoms and characteristics of 45 first-episode untreated schizophrenics, and analyzed correlations between iris characteristics and schizophrenia symptoms. RESULTS There were significant differences in iris crypts (P<0.05) and pigment spots (P<0.01) between the case and control group, but no significant difference was found in iris wrinkles (P<0.05). The logistic regression analysis demonstrated that the total iris crypts [odds ratio (OR) 1.166, 95% confidence interval (CI) 1.022-1.330] and total iris pigment spots (OR 1.815, 95% CI 1.186-2.775) increased the risk of suffering from schizophrenia. Furthermore, it was demonstrated that the number of iris crypts was positively associated with the MOAS score (r=0.474, P<0.01). Moreover, the number of the iris pigment spots (r=0.395, P<0.01) and wrinkles (r=0.309, P<0.05) were positively correlated with the subjects' negative symptom scores, respectively. CONCLUSION Iris crypts and pigment spots were identified as potential biomarkers for detecting schizophrenia. In patients with first-episode untreated schizophrenia, iris characteristics may help psychiatrists to identify the illness and its severity, and to detect characteristic clinical symptoms.
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Affiliation(s)
- Chunsheng Tian
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China.,Shenyang Mental Health Center, Shenyang, 110168, People's Republic of China
| | - Li Duan
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China.,School of Nursing, Chengde Medical University, Chengde, 067000, People's Republic of China
| | - Chunfeng Fu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Juan He
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Jiali Dai
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Gang Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China
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Liu X, Lai S, Ma S, Yang H, Liu L, Yu G, Zhong S, Jia Y, Zhong J. Development of a Novel Retina-Based Diagnostic Score for Early Detection of Major Depressive Disorder: An Interdisciplinary View. Front Psychiatry 2022; 13:897759. [PMID: 35664496 PMCID: PMC9162334 DOI: 10.3389/fpsyt.2022.897759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/28/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Clinically effective markers for the diagnosis of major depressive disorder (MDD) are lacking. Alterations in retinal features are closely related to the pathophysiological progression of MDD. However, the reliable retina-related diagnostic model for MDD remains to be developed. Thus, our study aimed to quantitatively evaluate retinal vascular and structural changes in MDD patients and to develop a reliable diagnostic model of MDD based on retinal parameters. METHODS Seventy-eight patients with MDD and 47 healthy controls (HCs) underwent retinal vessel density and structure examination using optical coherence tomography angiography and visual field examination using perimetry. Independent-sample t test was used to assess the differences in retinal parameters between the groups. Meanwhile, we constructed the corresponding retina-based diagnostic model by LASSO logistic regression. Finally, the diagnostic ability of the model was evaluated by area under the curve (AUC) of receiver operating characteristic curves and calibration plot of nomogram. RESULTS MDD patients showed lower retinal vessel density (including radial peripapillary capillary vessel density, superficial and deep capillary plexus vessel density), thinner subfoveal choroidal thickness, and poorer visual fields compared to HCs (all p < 0.05). Furthermore, a retina-based diagnostic model was constructed and shows a strong diagnostic capability for MDD (AUC = 0.9015, p < 0.001). CONCLUSION Patients with MDD showed distinct retinal features compared to HCs. The retina-based diagnostic model is expected to be a necessary complement to the diagnosis of MDD.
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Affiliation(s)
- Xiao Liu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shunkai Lai
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shisi Ma
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hong Yang
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lian Liu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Guocheng Yu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shuming Zhong
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yanbin Jia
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jingxiang Zhong
- Department of Ophthalmology, The Sixth Affiliated Hospital of Jinan University, Dongguan, China.,Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Gross G, Tursini K, Albuisson E, Angioi-Duprez K, Conart JB, Louis Dorr V, Schwan R, Schwitzer T. Bipolar disorders and retinal electrophysiological markers (BiMAR): Study protocol for a comparison of electroretinogram measurements between subjects with bipolar disorder and a healthy control group. Front Psychiatry 2022; 13:960512. [PMID: 36159928 PMCID: PMC9492949 DOI: 10.3389/fpsyt.2022.960512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/11/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Bipolar disorders (BD) is a common, chronic and disabling psychiatric condition. In addition to being characterized by significant clinical heterogeneity, notable disturbances of sleep and cognitive function are frequently observed in all phases of the disease. Currently, there is no readily available biomarker in current clinical practice to help diagnose or predict the disease course. Thus, identification of biomarkers in BD is today a major challenge. In this context, the study of electrophysiological biomarkers based on electroretinogram (ERG) measurements in BD seems highly promising. The BiMAR study aims to compare electrophysiological data measured with ERG between a group of euthymic patients with BD and a group of healthy control subjects. Secondarily, we will also describe the existing potential relationship between clinical, sleep and neuropsychological phenotypes of patients and electrophysiological data. METHODS The BiMAR study is a comparative and monocentric study carried out at the Expert Center for BD in Nancy, France. In total, 70 euthymic adult patients with BD and 70 healthy control subjects will be recruited. Electrophysiological recordings with ERG and electroencephalogram (EEG) will be performed with a virtual reality headset after a standardized clinical evaluation to all participants. Then, an actigraphic monitoring of 21 consecutive days will be carried out. At the end of this period a neuropsychological evaluation will be performed during a second visit. The primary outcome will be electrophysiological measurements with ERG flash and pattern. Secondary outcomes will be EEG data, sleep settings, clinical and neuropsychological assessments. For patients only, a complementary ancillary study, carried out at the University Hospital of Nancy, will be proposed to assess the retinal structure and microvascularization using Optical Coherence Tomography. Recruitment started in January 2022 and will continue until the end of July 2023. DISCUSSION The BiMAR study will contribute to identifying candidate ERG electrophysiological markers for helping the diagnosis of BD and identify subgroups of patients with different clinical profiles. Eventually, this would allow earlier diagnosis and personalized therapeutic interventions. CLINICAL TRIAL REGISTRATION The study is registered at Clinicaltrials.gov, NCT05161546, on 17 December 2021 (https://clinicaltrials.gov/ct2/show/NCT05161546).
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Affiliation(s)
- Grégory Gross
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.,INSERM U1254, Unité d'Imagerie Adaptative Diagnostique et Interventionnelle, Nancy, France.,Faculté de Médecine, Université de Lorraine, Nancy, France.,Fondation FondaMental, Créteil, France
| | - Katelyne Tursini
- INSERM U1254, Unité d'Imagerie Adaptative Diagnostique et Interventionnelle, Nancy, France
| | - Eliane Albuisson
- DRCI, Unité de Méthodologie, Data Management et Statistique UMDS, CHRU de Nancy, Nancy, France
| | | | | | | | - Raymund Schwan
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.,INSERM U1254, Unité d'Imagerie Adaptative Diagnostique et Interventionnelle, Nancy, France.,Faculté de Médecine, Université de Lorraine, Nancy, France.,Fondation FondaMental, Créteil, France
| | - Thomas Schwitzer
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.,INSERM U1254, Unité d'Imagerie Adaptative Diagnostique et Interventionnelle, Nancy, France.,Faculté de Médecine, Université de Lorraine, Nancy, France.,Fondation FondaMental, Créteil, France
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Năstase MG, Vlaicu I, Trifu SC, Trifu SC. Genetic polymorphism and neuroanatomical changes in schizophrenia. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2022; 63:307-322. [PMID: 36374137 PMCID: PMC9801677 DOI: 10.47162/rjme.63.2.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The article is a review of the latest meta-analyses regarding the genetic spectrum in schizophrenia, discussing the risks given by the disrupted-in-schizophrenia 1 (DISC1), catechol-O-methyltransferase (COMT), monoamine oxidases-A∕B (MAO-A∕B), glutamic acid decarboxylase 67 (GAD67) and neuregulin 1 (NRG1) genes, and dysbindin-1 protein. The DISC1 polymorphism significantly increases the risk of schizophrenia, as well injuries from the prefrontal cortex that affect connectivity. NRG1 is one of the most important proteins involved. Its polymorphism is associated with the reduction of areas in the corpus callosum, right uncinate, inferior lateral fronto-occipital fascicle, right external capsule, fornix, right optic tract, gyrus. NRG1 and the ErbB4 receptor (tyrosine kinase receptor) are closely related to the N-methyl-D-aspartate receptor (NMDAR) (glutamate receptor). COMT is located on chromosome 22 and together with interleukin-10 (IL-10) have an anti-inflammatory and immunosuppressive function that influences the dopaminergic system. MAO gene methylation has been associated with mental disorders. MAO-A is a risk gene in the onset of schizophrenia, more precisely a certain type of single-nucleotide polymorphism (SNP), at the gene level, is associated with schizophrenia. In schizophrenia, we find deficits of the γ-aminobutyric acid (GABA)ergic neurotransmitter, the dysfunctions being found predominantly at the level of the substantia nigra. In schizophrenia, missing an allele at GAD67, caused by a SNP, has been correlated with decreases in parvalbumin (PV), somatostatin receptor (SSR), and GAD ribonucleic acid (RNA). Resulting in the inability to mature PV and SSR neurons, which has been associated with hyperactivity.
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Affiliation(s)
- Mihai Gabriel Năstase
- Department of Neurosciences, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania;
| | - Ilinca Vlaicu
- Department of Psychiatry, Hospital for Psychiatry, Săpunari, Călăraşi County, Romania
| | - Simona Corina Trifu
- Department of Neurosciences, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Gandu S, Bannai D, Adhan I, Kasetty M, Katz R, Zang R, Lutz O, Kim LA, Keshavan M, Miller JB, Lizano P. Inter-device reliability of swept source and spectral domain optical coherence tomography and retinal layer differences in schizophrenia. Biomark Neuropsychiatry 2021. [DOI: 10.1016/j.bionps.2021.100036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Bernardin F, Schwitzer T, Angioi-Duprez K, Giersch A, Ligier F, Bourion-Bedes S, Jansen C, Schwan R, Laprevote V. Retinal dysfunctions in a patient with a clinical high risk for psychosis and severe visual disturbances: A single case report. Early Interv Psychiatry 2021; 15:1784-1788. [PMID: 33350103 DOI: 10.1111/eip.13103] [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: 04/08/2020] [Revised: 11/30/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022]
Abstract
AIM Psychosis can be preceded by a clinical high risk for psychosis (CHR) and visual anomalies are predictors of transition to psychosis. Visual retinal processing is altered in psychosis, but no study has explored the links between visual symptoms and retinal functions in CHR patients. We report here the case of NR, an antipsychotic-naive young adult with CHR and severe visual symptoms in whom we explored the retinal function. METHODS A flash electroretinogram (fERG) and a pattern electroretinogram (pERG) protocol were conducted and we compared NR results to a group of patients with schizophrenia and a group of healthy controls. RESULTS Despites an overlap between the measures of NR and the two groups, visual analyses revealed that NR showed increased b-wave implicit time (rod response) compared to the control group and NR's response was at an intermediate level between two subgroups of schizophrenia patients regarding presence or absence of visual hallucinations. DISCUSSION The relevance of retinal dysfunctions as a marker of vulnerability for psychosis is discussed.
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Affiliation(s)
- Florent Bernardin
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.,INSERM U1114, Université de Strasbourg, Pôle de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Thomas Schwitzer
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.,INSERM U1114, Université de Strasbourg, Pôle de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France.,Université de Lorraine, Vandœuvre-lès-Nancy, France
| | | | - Anne Giersch
- INSERM U1114, Université de Strasbourg, Pôle de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Fabienne Ligier
- Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, Laxou, France.,Université de Lorraine, EA 4360 APEMAC, équipe MICS, Vandœuvre-lès-Nancy, France
| | - Stéphanie Bourion-Bedes
- Université de Lorraine, EA 4360 APEMAC, équipe MICS, Vandœuvre-lès-Nancy, France.,Service Médico Psychologique Régional, Metz, France
| | - Claire Jansen
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
| | - Raymund Schwan
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.,INSERM U1114, Université de Strasbourg, Pôle de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France.,Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Vincent Laprevote
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.,INSERM U1114, Université de Strasbourg, Pôle de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France.,Université de Lorraine, Vandœuvre-lès-Nancy, France
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Koman-Wierdak E, Róg J, Brzozowska A, Toro MD, Bonfiglio V, Załuska-Ogryzek K, Karakuła-Juchnowicz H, Rejdak R, Nowomiejska K. Analysis of the Peripapillary and Macular Regions Using OCT Angiography in Patients with Schizophrenia and Bipolar Disorder. J Clin Med 2021; 10:4131. [PMID: 34575242 PMCID: PMC8472507 DOI: 10.3390/jcm10184131] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To measure RNFL and vasculature around the optic disc and in the macula in patients with schizophrenia (SZ) and bipolar disorder (BD) using optical coherence tomography angiography (OCTA). METHODS 24 eyes of patients with SZ and 16 eyes of patients with BD as well as 30 eyes of healthy subjects were examined with OCTA. The radiant peripapillary capillary (RPC) density and RNFL thickness were measured in the peripapillary area. Moreover, macular thickness and vessel density were measured in both superficial and deep layers. RESULTS Significantly decreased values of vessel density in the macular deep vascular complex were found in the eyes of patients with SZ, compared to BD and the control group. The macular thickness in the whole vascular complex and in the fovea was significantly lower in SZ and BD group than in the control group. The radiant peripapillary vascular density and RNFL thickness were similar across groups. CONCLUSIONS The retinal microvascular dysfunction occurs in the macula in patients with SZ and BD, but not around optic disc. OCTA can become an essential additional diagnostic tool in detection of psychiatric disorders.
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Affiliation(s)
- Edyta Koman-Wierdak
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (M.D.T.); (R.R.); (K.N.)
| | - Joanna Róg
- Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, 20-079 Lublin, Poland; (J.R.); (H.K.-J.)
| | - Agnieszka Brzozowska
- Department of Mathematics and Medical Biostatistics, Medical University of Lublin, 20-079 Lublin, Poland;
| | - Mario Damiano Toro
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (M.D.T.); (R.R.); (K.N.)
- Department of Ophthalmology, University of Zurich, 8091 Zurich, Switzerland
| | - Vincenza Bonfiglio
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy;
| | | | - Hanna Karakuła-Juchnowicz
- Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, 20-079 Lublin, Poland; (J.R.); (H.K.-J.)
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (M.D.T.); (R.R.); (K.N.)
| | - Katarzyna Nowomiejska
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (M.D.T.); (R.R.); (K.N.)
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Jerotic S, Lalovic N, Pejovic S, Mihaljevic M, Pavlovic Z, Britvic D, Risimic D, Soldatovic I, Silverstein SM, Maric NP. Sex differences in macular thickness of the retina in patients with psychosis spectrum disorders. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110280. [PMID: 33567332 DOI: 10.1016/j.pnpbp.2021.110280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Imaging of retinal structure in psychosis spectrum disorders (PSD) is a novel approach to studying effect of this illness class on CNS structure. Studies of optical coherence tomography (OCT) have revealed significant reductions in regarding: retinal nerve fiber layer (RNFL), macular thickness (MT), ganglion cell-inner plexiform layer (GC-IPL) and macular volume (MV). Sex differences in retinal structure in PSD have not been previously explored. METHODS This cross-sectional pilot study included 81 participant of age matched patients and controls. There were no differences between genders regarding illness duration and antipsychotic daily dose in the patient group. SD-OCT assessed RNFL, GC-IPL, MT, MV, and optic nerve cup-to-disc (C/D) ratio. In order to assess the main effects of illness, sex, and illness × sex interaction on the retinal parameters, general linear model was performed. RESULTS Patients demonstrated abnormalities on all OCT indices. Effects of sex were observed for central subfield MT and C/D ratio, which were lower in females. An illness × sex interaction effect was observed for the left MT, indicating greater thinning in female patients. CONCLUSION Sex differences in OCT findings in PSD appear to be most prominent considering macular parameters. These preliminary data may have important implications for the valid interpretation of OCT findings as potential biomarkers for PSD.
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Affiliation(s)
- Stefan Jerotic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia.
| | - Nikola Lalovic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Slobodanka Pejovic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marina Mihaljevic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zorana Pavlovic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dubravka Britvic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Dijana Risimic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Ophthalmology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ivan Soldatovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Nadja P Maric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Mental Health, Belgrade, Serbia
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Automatic Diagnosis of Bipolar Disorder Using Optical Coherence Tomography Data and Artificial Intelligence. J Pers Med 2021; 11:jpm11080803. [PMID: 34442447 PMCID: PMC8402059 DOI: 10.3390/jpm11080803] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/16/2021] [Indexed: 01/01/2023] Open
Abstract
Background: The aim of this study is to explore an objective approach that aids the diagnosis of bipolar disorder (BD), based on optical coherence tomography (OCT) data which are analyzed using artificial intelligence. Methods: Structural analyses of nine layers of the retina were analyzed in 17 type I BD patients and 42 controls, according to the areas defined by the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. The most discriminating variables made up the feature vector of several automatic classifiers: Gaussian Naive Bayes, K-nearest neighbors and support vector machines. Results: BD patients presented retinal thinning affecting most layers, compared to controls. The retinal thickness of the parafoveolar area showed a high capacity to discriminate BD subjects from healthy individuals, specifically for the ganglion cell (area under the curve (AUC) = 0.82) and internal plexiform (AUC = 0.83) layers. The best classifier showed an accuracy of 0.95 for classifying BD versus controls, using as variables of the feature vector the IPL (inner nasal region) and the INL (outer nasal and inner inferior regions) thickness. Conclusions: Our patients with BD present structural alterations in the retina, and artificial intelligence seem to be a useful tool in BD diagnosis, but larger studies are needed to confirm our findings.
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Silverstein SM, Lai A, Green KM, Crosta C, Fradkin SI, Ramchandran RS. Retinal Microvasculature in Schizophrenia. Eye Brain 2021; 13:205-217. [PMID: 34335068 PMCID: PMC8318708 DOI: 10.2147/eb.s317186] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/15/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Schizophrenia is associated with alterations in neural structure and function of the retina that are similar to changes seen in the retina and brain in multiple neurodegenerative disorders. Preliminary evidence suggests that retinal microvasculature may also be compromised in schizophrenia. The goal of this study was to determine, using optical coherence tomography angiography (OCTA), whether 1) schizophrenia is associated with alterations in retinal microvasculature density; and 2) microvasculature reductions are associated with retinal neural layer thinning and performance on a measure of verbal IQ. PATIENTS AND METHODS Twenty-eight outpatients with schizophrenia or schizoaffective disorder and 37 psychiatrically healthy control subjects completed OCT and OCTA exams, and the Wechsler Test of Adult Reading. RESULTS Schizophrenia patients were characterized by retinal microvasculature density reductions, and enlarged foveal avascular zones, in both eyes. These microvascular abnormalities were generally associated with thinning of retinal neural (macular and peripapillary nerve fiber layer) tissue (but the data were stronger for the left than the right eye) and lower scores on a proxy measure of verbal IQ. First- and later-episode patients did not differ significantly on OCTA findings. CONCLUSION The retinal microvasculature impairments seen in schizophrenia appear to be a biomarker of overall brain health, as is the case for multiple neurological conditions. Additional research is needed, however, to clarify contributions of social disadvantage and medical comorbidities to the findings.
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Affiliation(s)
- Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
- Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Adriann Lai
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Kyle M Green
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
| | - Christen Crosta
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, USA
| | | | - Rajeev S Ramchandran
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Korann V, Appaji A, Jacob A, Devi P, Nagendra B, Chako DM, Padmanabha A, Thonse U, Bharath RD, Kumar V, Varambally S, Venkatasubramanian G, Rao SV, Webers CAB, Berendschot TTJM, Rao NP. Association between retinal vascular caliber and brain structure in schizophrenia. Asian J Psychiatr 2021; 61:102707. [PMID: 34052670 DOI: 10.1016/j.ajp.2021.102707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/11/2021] [Accepted: 05/21/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Several lines of research in the last decade have indicated the potential utility of retina as a window to the brain. Emerging evidence suggests abnormalities in retinal vascular caliber in schizophrenia. However, the relationship between retinal vascular measures and brain structure has not been examined in schizophrenia to date. Hence, we examined the relationship between retinal vasculature measured using fundus photography and brain structure measured using magnetic resonance imaging. METHOD We recruited 17 healthy volunteers and 20 patients with schizophrenia. Using a non-mydriatic camera, we captured the images for left and right eyes separately and retinal vascular calibers were calculated using a semi-automated software package. Whole-brain anatomical T1 MPRAGE images were acquired using a 3-Tesla MRI scanner. Whole-brain and regional volume and cortical thickness were calculated using the Freesurfer software package. We used FreeSurfer's QDEC interface to compute vertex-by-vertex for analysis of the volume and cortical thickness. The relation between brain volume, cortical thickness, and retinal vascular caliber was examined using partial correlation and regression analysis. RESULTS There was a significant negative correlation between average CRVE and global cortical mean thickness in schizophrenia but not in healthy. In schizophrenia patients, there was a significant negative correlation between average CRVE and cortical thickness in frontal regions - left rostral middle frontal, left superior frontal, and right caudal middle frontal gyri and posterior brain regions - left lateral occipital gyrus and left posterior cingulate cortex. DISCUSSION The findings of the study suggest potential utility of retinal venular diameter as a proxy marker to abnormal neurodevelopment in schizophrenia.
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Affiliation(s)
- Vittal Korann
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Abhishek Appaji
- Department of Medical Electronics, BMS College of Engineering, Bangalore, India
| | - Arpitha Jacob
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Priyanka Devi
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Bhargavi Nagendra
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dona Maria Chako
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ananth Padmanabha
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Umesh Thonse
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Rose Dawn Bharath
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vijay Kumar
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | | | - Shyam Vasudeva Rao
- Department of Medical Electronics, BMS College of Engineering, Bangalore, India
| | - Carroll A B Webers
- University Eye Clinic Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Tos T J M Berendschot
- University Eye Clinic Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Naren P Rao
- National Institute of Mental Health and Neurosciences, Bangalore, India.
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Retinal structural changes in mood disorders: The optical coherence tomography to better understand physiopathology? Prog Neuropsychopharmacol Biol Psychiatry 2021; 108:110080. [PMID: 32827610 DOI: 10.1016/j.pnpbp.2020.110080] [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: 05/01/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Mood disorders are particularly common, disabling conditions. Diagnosis can be difficult as it may involve different pathophysiological assumptions. This could explain why such disorders are resistant to treatment. The retina is part of the central nervous system and shares a common embryonic origin with the brain. Optical coherence tomography (OCT) is an imaging technique for analysing the different layers of the retina. We reviewed studies that examined the retina with OCT in mood disorders. METHODS We conducted Pubmed search and additional manual research based on the bibliography in each of selected articles. We found and analysed 11 articles relevant to our subject. RESULTS This literature review confirms that it is possible to use OCT to detect neurodegeneration and neuroinflammation in mood disorders. Their impact is thought to depend on the duration and severity of the disease, and whether it is in acute or chronic stage. The differences seen in studies dealing with depression and those looking at bipolar disorder may reflect the particular characteristics of each disorder. A number of OCT parameters can be proposed as biomarkers of active or chronic inflammation and neurodegeneration. Markers of predisposition to an at-risk mental state are also suggested. LIMITATIONS The main limitation is selection bias, studies including more varied population would help to confirm and precise these results. CONCLUSION OCT is thus a particularly promising tool for evaluating some of the etiopathogenetic mechanisms involved in mood disorders. The combination with other approaches could help to find more specific biomarkers.
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Radonjić NV, Hess JL, Rovira P, Andreassen O, Buitelaar JK, Ching CRK, Franke B, Hoogman M, Jahanshad N, McDonald C, Schmaal L, Sisodiya SM, Stein DJ, van den Heuvel OA, van Erp TGM, van Rooij D, Veltman DJ, Thompson P, Faraone SV. Structural brain imaging studies offer clues about the effects of the shared genetic etiology among neuropsychiatric disorders. Mol Psychiatry 2021; 26:2101-2110. [PMID: 33456050 PMCID: PMC8440178 DOI: 10.1038/s41380-020-01002-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 02/06/2023]
Abstract
Genomewide association studies have found significant genetic correlations among many neuropsychiatric disorders. In contrast, we know much less about the degree to which structural brain alterations are similar among disorders and, if so, the degree to which such similarities have a genetic etiology. From the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) consortium, we acquired standardized mean differences (SMDs) in regional brain volume and cortical thickness between cases and controls. We had data on 41 brain regions for: attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder (BD), epilepsy, major depressive disorder (MDD), obsessive compulsive disorder (OCD), and schizophrenia (SCZ). These data had been derived from 24,360 patients and 37,425 controls. The SMDs were significantly correlated between SCZ and BD, OCD, MDD, and ASD. MDD was positively correlated with BD and OCD. BD was positively correlated with OCD and negatively correlated with ADHD. These pairwise correlations among disorders were correlated with the corresponding pairwise correlations among disorders derived from genomewide association studies (r = 0.494). Our results show substantial similarities in sMRI phenotypes among neuropsychiatric disorders and suggest that these similarities are accounted for, in part, by corresponding similarities in common genetic variant architectures.
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Affiliation(s)
- Nevena V Radonjić
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jonathan L Hess
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Paula Rovira
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ole Andreassen
- NORMENT-Institute of Clinical Medicine, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Jan K Buitelaar
- Radboudumc, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christopher R K Ching
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Marina Del Rey, CA, USA
| | - Barbara Franke
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martine Hoogman
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Neda Jahanshad
- Imaging Genetics Center, Department of Neurology and Biomedical Engineering, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Marina Del Rey, CA, USA
| | - Carrie McDonald
- Department of Psychiatry, Center for Multimodal Imaging and Genetics (CMIG), University of California, San Diego, CA, USA
| | - Lianne Schmaal
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The National Centre of Excellence for Youth Mental Health, Parkville, VIC, Australia
| | - Sanjay M Sisodiya
- UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, London, UK
- Chalfont Centre for Epilepsy, Epilepsy Society, Bucks, UK
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Odile A van den Heuvel
- Department of Psychiatry and Department of Anatomy & Neurosciences, Amsterdam UMC/VUmc, Amsterdam, The Netherlands
| | - Theo G M van Erp
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine, CA, USA
| | - Daan van Rooij
- Donders Centre for Cognitive Neuroimaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry and Department of Anatomy & Neurosciences, Amsterdam UMC/VUmc, Amsterdam, The Netherlands
| | - Paul Thompson
- Neuro Imaging Institute for Neuroimaging and Informatics, Keck School of Medicine of the University of Southern California, Marina Del Rey, CA, USA
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.
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Gokcinar NB, Buturak SV, Ozkal F, Ozcicek G, Yumusak ME, Turgal E. Optical coherence tomography neurodegenerative findings in patients with bipolar disorder. Asia Pac Psychiatry 2020; 12:e12394. [PMID: 32452640 DOI: 10.1111/appy.12394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/31/2020] [Accepted: 04/23/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Neuroimaging studies of patients with bipolar disorder (BD) have recently revealed neurodegenerative changes in the central nervous system. Optical coherence tomography (OCT) imaging of the retina, as an extension of brain, may be a biomarker in understanding the neurobiology of the disease. To assess OCT as a tool to detect neurodegeneration in BD we compared the retinal changes between patients with BD and healthy individuals. METHODS We performed complete ophthalmological examinations and took OCT images for 70 eyes of 70 patients with BD, and for age and sex-matched individual controls. We compared retinal nerve fiber layers (RNFLs) and total retinal (TR) thickness in the peripapillary areas; and ganglion cell complexes (GCCs) and TR thickness in the maculas between the groups. RESULTS The mean age of the patients was 40.41 ± 13.22 years and that of the controls 40.20 ± 13.03 years. The men/women ratios were 37/33 in both groups. BD was significantly associated with a decrease in the average peripapillary RNFL, with the average peripapillary TR, and with the average GCC thickness (P = .033, P = .008, and P = .009, respectively). The peripapillary RNFL and TR thinnings were prominent in the superior (P = .039, P = .033, respectively) and inferior quadrants (P = .031, P = .018, respectively). The BD effects on GCC thinning was prominent in the superior half (P = .001) and in the nasal sectors (except in the inner superonasal sector; all P < .05). BD was associated with a decrease in macular TR thickness only at the inner superior sector (P = .014). Disease duration was inversely correlated with the peripapillary RNFL, TR, and macular GCC thicknesses (P < .05). DISCUSSION Our findings support the neurodegeneration hypothesis in the etiopathogenesis of BD. OCT, a non-invasive neuro-imaging method, may be useful for BD diagnosis and follow-ups.
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Affiliation(s)
| | - Sadiye Visal Buturak
- Department of Psychiatry, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Fatma Ozkal
- Department of Ophthalmology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Gamze Ozcicek
- Department of Psychiatry, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Mehmet Erhan Yumusak
- Department of Ophthalmology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Ebru Turgal
- Department of Biostatistics, Faculty of Medicine, Hitit University, Çorum, Turkey
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50
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Liu CH, Kang EYC, Lin YH, Wu WC, Liu ZH, Kuo CF, Lai CC, Hwang YS. Association of ocular diseases with schizophrenia, bipolar disorder, and major depressive disorder: a retrospective case-control, population-based study. BMC Psychiatry 2020; 20:486. [PMID: 33008365 PMCID: PMC7532110 DOI: 10.1186/s12888-020-02881-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/19/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Psychiatric disorders and ocular neurovascular diseases may share a similar pathophysiological route of vascular structures or neurological changes. The aim of this study is to investigate the association between ocular neurovascular diseases and the risk of major psychiatric disorders. METHODS This was a retrospective case-control, population-based study including patients aged ≥20 and were diagnosed between 1997 and 2013. Ocular neurovascular diseases diagnosed between 1997 and 2006 and newly diagnosed psychiatric disorders including bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia between 2007 and 2013 were registered. Patients were propensity-score matched with control groups without psychiatric disorders in each cohort based on selected covariates. RESULTS A total of one million sampled patients in the database were categorized based on their diagnoses; 2243 (37.4% men) were categorized into the BD group, 10,110 (35.2% men) into the MDD group, and 1623 (43.1% men) into the schizophrenia group. In the BD group, all glaucoma (OR 1.49, [1.18-1.89]), open-angle glaucoma (OR 2.08, [1.34-3.24]), and closed-angle glaucoma (OR 2.12, [1.36-3.33]) showed statistical significance of risk. In the MDD group, age-related macular degeneration (OR 1.33, [1.13-1.57]), all glaucoma (OR 1.24, [1.11-1.37]), open-angle glaucoma (OR 1.47, [1.21-1.80]), and dry eye syndrome (OR 1.22, [1.13-1.31]) were associated with a significantly higher risk. In the schizophrenia group, only all glaucoma (OR 1.47, [1.02-2.11]), glaucoma suspect (OR 1.88, [1.01-3.49]), and open-angle glaucoma (OR 2.19, [1.13-4.26]) showed statistical significance. CONCLUSIONS In this population-based study, ocular neurovascular diseases, especially glaucoma, were associated with increased risks of BD, MDD, and schizophrenia.
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Affiliation(s)
- Chun-Hao Liu
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan ,Department of Psychiatry, New Taipei Municipal Tu-Cheng Hospital, New Taipei, Taiwan ,grid.145695.aCollege of Medicine, Chang Gung University, Taoyuan, Taiwan ,grid.260567.00000 0000 8964 3950Department of Sinophone Literatures, National Dong Hwa University, Hualien, Taiwan
| | - Eugene Yu-Chuan Kang
- grid.145695.aCollege of Medicine, Chang Gung University, Taoyuan, Taiwan ,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yu-Hsiang Lin
- grid.145695.aCollege of Medicine, Chang Gung University, Taoyuan, Taiwan ,Department of Urology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan ,grid.145695.aGraduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- grid.145695.aCollege of Medicine, Chang Gung University, Taoyuan, Taiwan ,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Zhuo-Hao Liu
- grid.145695.aCollege of Medicine, Chang Gung University, Taoyuan, Taiwan ,Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- grid.145695.aCollege of Medicine, Chang Gung University, Taoyuan, Taiwan ,Department of Rheumatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chi-Chun Lai
- grid.145695.aCollege of Medicine, Chang Gung University, Taoyuan, Taiwan ,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
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