1
|
Andreou D, Steen NE, Jørgensen KN, Smelror RE, Wedervang-Resell K, Nerland S, Westlye LT, Nærland T, Myhre AM, Joa I, Reitan SMK, Vaaler A, Morken G, Bøen E, Elvsåshagen T, Boye B, Malt UF, Aukrust P, Skrede S, Kroken RA, Johnsen E, Djurovic S, Andreassen OA, Ueland T, Agartz I. Lower circulating neuron-specific enolase concentrations in adults and adolescents with severe mental illness. Psychol Med 2023; 53:1479-1488. [PMID: 35387700 PMCID: PMC10009386 DOI: 10.1017/s0033291721003056] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/05/2021] [Accepted: 07/13/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Both neurodegenerative and neurodevelopmental abnormalities have been suggested to be part of the etiopathology of severe mental illness (SMI). Neuron-specific enolase (NSE), mainly located in the neuronal cytoplasm, may indicate the process as it is upregulated after neuronal injury while a switch from non-neuronal enolase to NSE occurs during neuronal maturation. METHODS We included 1132 adult patients with SMI [schizophrenia (SZ) or bipolar spectrum disorders], 903 adult healthy controls (HC), 32 adolescent patients with SMI and 67 adolescent HC. Plasma NSE concentrations were measured by enzyme immunoassay. For 842 adults and 85 adolescents, we used total grey matter volume (TGMV) based on T1-weighted magnetic resonance images processed in FreeSurfer v6.0. We explored NSE case-control differences in adults and adolescents separately. To investigate whether putative case-control differences in NSE were TGMV-dependent we controlled for TGMV. RESULTS We found significantly lower NSE concentrations in both adult (p < 0.001) and adolescent patients with SMI (p = 0.007) compared to HC. The results remained significant after controlling for TGMV. Among adults, both patients with SZ spectrum (p < 0.001) and bipolar spectrum disorders (p = 0.005) had lower NSE than HC. In both patient subgroups, lower NSE levels were associated with increased symptom severity. Among adults (p < 0.001) and adolescents (p = 0.040), females had lower NSE concentrations than males. CONCLUSION We found lower NSE concentrations in adult and adolescent patients with SMI compared to HC. The results suggest the lack of progressive neuronal injury, and may reflect abnormal neuronal maturation. This provides further support of a neurodevelopmental rather than a neurodegenerative mechanism in SMI.
Collapse
Affiliation(s)
- Dimitrios Andreou
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Nils Eiel Steen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
| | - Kjetil Nordbø Jørgensen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Runar Elle Smelror
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Kirsten Wedervang-Resell
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Child and Adolescent Mental Health Research Unit, Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Stener Nerland
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Lars T. Westlye
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Terje Nærland
- K.G. Jebsen Center for Neurodevelopmental Disorders, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - Anne Margrethe Myhre
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Inge Joa
- TIPS – Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Solveig Merete Klæbo Reitan
- Faculty of Medicine and Health Sciences, Department of Mental Health, NTNU, Trondheim, Norway
- St Olavs Hospital, Department of Mental Health, Trondheim, Norway
| | - Arne Vaaler
- Faculty of Medicine and Health Sciences, Department of Mental Health, NTNU, Trondheim, Norway
- St Olavs Hospital, Department of Mental Health, Trondheim, Norway
| | - Gunnar Morken
- Faculty of Medicine and Health Sciences, Department of Mental Health, NTNU, Trondheim, Norway
- St Olavs Hospital, Department of Mental Health, Trondheim, Norway
| | - Erlend Bøen
- Psychosomatic and C-L Psychiatry, Adult, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Elvsåshagen
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Birgitte Boye
- Psychosomatic and C-L Psychiatry, Adult, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Behavioural Medicine, University of Oslo, Oslo, Norway
| | - Ulrik Fredrik Malt
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Aukrust
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Silje Skrede
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Rune Andreas Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Bergen, Norway
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- Department of Clinical Science, Norwegian Centre for Mental Disorders Research (NORMENT), University of Bergen, Bergen, Norway
| | - Ole A. Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
| | - Thor Ueland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| |
Collapse
|
2
|
Holttinen T, Pirkola S, Kaltiala R. Schizophrenia among young people first admitted to psychiatric inpatient care during early and middle adolescence. Schizophr Res 2023; 252:103-109. [PMID: 36640743 DOI: 10.1016/j.schres.2023.01.006] [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: 06/07/2021] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study explored the incidence and stability of schizophrenia in a large national register data of all adolescents first admitted to psychiatric inpatient care at ages 13-17 in Finland 1980-2010. METHODS The study population (N 17,112) comprised all Finnish citizens aged 13-17 receiving their first ever psychiatric inpatient treatment between 1980 and 2010 in Finland. To explore incidence and stability of schizophrenia, the diagnostic information on inpatient care or disability pension was obtained from the appropriate registers. RESULTS The incidence of schizophrenia disorders (F20 + F25) during adolescence was higher in the study population for those admitted to psychiatric inpatient care 1980-1989 than in other decades examined. Overall, psychiatric inpatient care during adolescence was a risk factor for subsequent schizophrenia, especially if a diagnosis of F20-29 was set although a considerable share of those with psychotic disorders other than schizophrenia diagnosis did not subsequently convert to schizophrenia. The stability of adolescent onset schizophrenia diagnosis was high. CONCLUSION Adolescents requiring psychiatric inpatient care have a higher later rate of schizophrenia diagnosis than prevalence at community level. Whereas adolescent onset schizophrenia diagnosis is a fairly stable diagnosis, there are other adolescent psychotic disorders which are more transient in nature.
Collapse
Affiliation(s)
- Timo Holttinen
- Tampere University Hospital, Department of Adolescent Psychiatry and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Sami Pirkola
- Tampere University, Faculty of Social Sciences, Tampere, Finland
| | - Riittakerttu Kaltiala
- Tampere University Hospital, Department of Adolescent Psychiatry and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Vanha Vaasa Hospital, Vaasa, Finland
| |
Collapse
|
3
|
Patel RS, Hobart K, Wadhawan A, Chalia A, Youssef NA. Electroconvulsive Treatment Utilization for Inpatient Management of Catatonia in Adolescents With Schizophrenia Spectrum Disorders. J ECT 2022; 38:244-248. [PMID: 35623014 DOI: 10.1097/yct.0000000000000858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine rates of electroconvulsive therapy (ECT) use for catatonia in schizophrenia spectrum disorders, stratified by patient demographics and hospital characteristics, and its impact on inpatient length of stay and cost. METHODS We found 155 adolescents (aged 12-18 years) with principal discharge diagnosis of schizophrenia spectrum disorders with catatonia from the National Inpatient Sample. They were subgrouped into ECT (n = 20) and non-ECT (n = 135) groups. We used descriptive statistics to evaluate the utilization of ECT for catatonia and independent-sample t test for continuous variables with statistical significance at P ≤ 0.05. RESULTS The overall utilization rate of ECT in adolescents for catatonia was 12.9%. A high rate of ECT use was evident for Whites (30.8%) compared with the other race/ethnicities and also was seen in private health insurance beneficiaries (20%). The rate of ECT use varied by the region, with highest for the Northeast (20%), followed by the South (18.2%), and the West (14.3%). Adolescent inpatients with catatonia in public and teaching type, and large bed-size hospitals were more likely to receive ECT than their counterparts. The mean number of ECT sessions required during the inpatient stay was 5.2 (range, 1-15), and the mean number of days from admission to initial ECT was 2.5 (range, 0-6). CONCLUSIONS Electroconvulsive therapy is used for approximately only 13% of adolescents with catatonia when comorbid schizophrenia spectrum disorders are present, suggesting that many patients may not get evidence-based treatment. Future studies in this area are needed.
Collapse
Affiliation(s)
- Rikinkumar S Patel
- From the Department of Psychiatry, Oklahoma State University, Norman, OK
| | - Kelsey Hobart
- Department of Psychiatry, Saint Elizabeths Hospital, Washington, DC
| | | | - Ankit Chalia
- Department of Psychiatry, West Virginia University, Martinsburg, WV
| | - Nagy A Youssef
- Department of Psychiatry, The Ohio State University College of Medicine, Columbus, OH
| |
Collapse
|
4
|
Lundberg M, Bohman H, Curbo S, Mansouri S, Agartz I, Areström I, Ahlborg N. Development of an ELISA displaying similar reactivity with reduced and oxidized human Thioredoxin-1 (Trx1): The plasma level of Trx1 in early onset psychosis disorders. J Immunol Methods 2022; 510:113347. [PMID: 36058259 DOI: 10.1016/j.jim.2022.113347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 06/29/2022] [Accepted: 08/29/2022] [Indexed: 12/31/2022]
Abstract
The plasma level of human thioredoxin-1 (Trx1) has been shown to be increased in various somatic diseases and psychiatric disorders. However, when comparing the reported plasma levels of Trx1, a great inter-study variability, as well as variability in study outcomes of differences between patients and control subjects has been observed, ultimately limiting the possibility to make comparative analyses. Trx1 is a highly redox active protein prone to form various redox forms, e.g. dimers, oligomers or Trx1-protein complexes. We have recently shown that ELISA systems may vary in reactivity to various Trx1 redox forms. The primary aim of the present study was to develop an ELISA system with similar reactivity to various Trx1 redox forms. By evaluating a panel of novel monoclonal antibodies (mAbs), in various paired combinations, three ELISA systems were generated, with observed large variability in reactivity to various Trx1 redox forms. Importantly, an ELISA system (capture mAb MT17R6 and detection mAb MT13X3-biotin), was identified that displayed similar reactivity to oxidized and DTT reduced Trx1. The ELISA system (MT17R6/MT13X3-biotin), was subsequently used to analyze the level of Trx1 in plasma from patients (<18 years) with early onset psychosis disorders (EOP). However, no significant (p > 0.7) difference in plasma Trx1 levels between patients with EOP (n = 23) and healthy age matched controls (HC) (n = 20) were observed. Furthermore, reliable measurement was shown to be dependent on the establishment of platelet poor plasma samples, enabled by rigorous blood sample centrifugation and by efficient blocking of potentially interfering heterophilic antibodies. In conclusion, we report the design and characterization of a Trx1 ELISA system with similar reactivity to various Trx1 redox forms. Importantly, data indicated that generated ELISA systems show large variability in reactivity to various redox forms with ultimate impact on measured levels of Trx1. Overall, results from this study suggests that future studies may be strongly improved by the use of Trx1 ELISA systems with characterized specificity to various redox forms.
Collapse
Affiliation(s)
- Mathias Lundberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Neuroscience, Child and Adolescent Psychiatry and Psychiatry Unit, Uppsala University, Uppsala, Sweden.
| | - Hannes Bohman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Neuroscience, Child and Adolescent Psychiatry and Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - Sophie Curbo
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden
| | - Shiva Mansouri
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Agartz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Niklas Ahlborg
- Mabtech, Nacka Strand, Sweden; Department of Molecular Biosciences, The Wennergren Institute, Stockholm University, Stockholm, Sweden
| |
Collapse
|
5
|
Perkes IE, Eggleston M, Jacobs B, McEvoy P, Fung D, Robertson PG. The making of child and adolescent psychiatrists in Australia and New Zealand. Aust N Z J Psychiatry 2022; 56:899-904. [PMID: 34772296 DOI: 10.1177/00048674211055654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Child and adolescent psychiatry has an opportunity to adapt alongside the advancements in medical knowledge, post-graduate training, epidemiological realities and clinical service models. Here, we are guided by the mental health needs of our community's young and their families in our review of child and adolescent psychiatry training in Australia and New Zealand. We recognise that training must respond to clinical demand and service reform while ensuring a range of clinical and educational experiences to deliver expectable competencies in order to produce child and adolescent psychiatrists that meet the communities' needs now and in the future. We argue that training programmes be subject to rigorous evaluation by embedding continuing cycles of improvement including regular review and international bench marking.
Collapse
Affiliation(s)
- Iain E Perkes
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
- Department of Psychological Medicine, Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Matthew Eggleston
- Child, Adolescent and Family Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Brian Jacobs
- The Department of Child and Adolescent Psychiatry, South London and Maudsley National Health Service Foundation Trust, London, UK
- The Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Prue McEvoy
- Department of Child Protection, Government of South Australia, Adelaide, SA, Australia
- Department of Child Protection, Adelaide, SA, Australia
| | - Daniel Fung
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- DUKE NUS Medical School, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Paul G Robertson
- Mindful, Department of Psychiatry, The University of Melbourne, Travancore, VIC, Australia
- Eastern Health Child and Youth Mental Health Service, Eastern Health, Melbourne, VIC, Australia
| |
Collapse
|
6
|
A retrospective cohort study of the change in inflammatory parameters in childhood schizophrenia and bipolar disorder from childhood to adulthood. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1109124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background/Aim: The etiologies of childhood schizophrenia and bipolar disorder have not yet been clarified. In cases in which the symptoms of mood are not dominant and psychotic symptoms are more dominant, it may be difficult to distinguish between childhood schizophrenia and bipolar disorder diagnoses. Follow-up studies concerning this subject have indicated that approximately half of the adolescents diagnosed with bipolar disorder were first (and incorrectly) diagnosed with schizophrenia. Therefore, strong markers are still needed to be used in the differential diagnosis at the time of the first application. An increase in the number of studies on the neuroinflammatory process in pediatric schizophrenia and bipolar illness have started to appear in the literature. The neutrophil–lymphocyte, thrombocyte–lymphocyte, and thrombocyte–neutrophil ratio (NLR, TLR, and TNR, respectively) levels in patients with childhood schizophrenia and childhood bipolar disorder at the time of admission and five years later were evaluated to determine whether inflammatory markers changed over time.
Methods: Twelve patients diagnosed with childhood schizophrenia and 14 patients diagnosed with childhood bipolar disorder were included in the study. Active infections, medical, neurological, endocrine, and metabolic illnesses, mental retardation, further concomitant psychiatric diagnoses, and intoxication were all exclusion factors. Hemograms from the same patients who satisfied the inclusion criteria when they originally applied and again at the fifth year follow-up were evaluated. Age, gender, neutrophil, lymphocyte, leukocyte, and thrombocyte values were recorded. NLR was calculated by dividing the neutrophil count by lymphocyte count. TLR value was calculated by dividing the thrombocyte count by lymphocyte count. TNR value was calculated by dividing the thrombocyte count by neutrophil count. Bipolar disorder and schizophrenia status were compared using NLR, TLR, and TNR parameters both at the time of initial diagnosis and at the fifth year of follow-up.
Results: When the initial admission hemograms of patients with childhood schizophrenia or childhood bipolar disorder were examined, no statistically significant differences between the two groups in terms of NLR (P = 0.150) and TLR (P = 0.440) were found. TNR was significantly higher in childhood bipolar disorder patients than in childhood schizophrenia (P = 0.015). At the fifth year follow-up, the hemograms of individuals diagnosed with either childhood schizophrenia or childhood bipolar disorder were compared, and no statistically significant differences between the two groups in NLR, (P = 0.572),TLR (P = 0.758), and TNR (P = 0.328) were found.
Conclusion: It was concluded that NLR and TLR levels did not change significantly over time in either disease and could not be used for the differential diagnosis of either disease. TNR may be considered for differential diagnoses in childhood schizophrenia and bipolar disease, particularly at the time of the first episode after confirmation of this study's findings with future studies.
Collapse
|
7
|
Andreou D, Jørgensen KN, Nerland S, Smelror RE, Wedervang-Resell K, Johannessen CH, Myhre AM, Andreassen OA, Blennow K, Zetterberg H, Agartz I. Lower plasma total tau in adolescent psychosis: Involvement of the orbitofrontal cortex. J Psychiatr Res 2021; 144:255-261. [PMID: 34700214 DOI: 10.1016/j.jpsychires.2021.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
Schizophrenia is thought to be a neurodevelopmental disorder with neuronal migration, differentiation and maturation disturbances. Tau is a microtubule-associated protein with a crucial role in these processes. Lower circulating tau levels have been reported in adults with schizophrenia, but this association has not been investigated in adolescent psychosis. We aimed to test the hypotheses that a) adolescents with early-onset psychosis (EOP; age of onset <18 years) display lower plasma tau concentrations compared to healthy controls, and b) among patients with psychosis, tau levels are linked to structural brain measures associated with the microtubule-associated tau (MAPT) gene and psychosis. We included 37 adolescent patients with EOP (mean age 16.4 years) and 59 adolescent healthy controls (mean age 16.2 years). We investigated putative patient-control differences in plasma total tau concentrations measured by a Single molecule array (Simoa) immunoassay. We explored the correlations between tau and selected structural brain measures based on T1-weighted MRI scans processed in FreeSurfer v6.0. We found significantly lower plasma tau concentrations in patients compared to healthy controls (p = 0.017, partial eta-squared = 0.061). Tau was not associated with antipsychotic use or the antipsychotic dosage. Among patients but not healthy controls, tau levels were positively correlated with the cortical orbitofrontal surface area (p = 0.013, R-squared = 0.24). The results are suggestive of a tau-related neurodevelopmental disturbance in adolescent psychosis.
Collapse
Affiliation(s)
- Dimitrios Andreou
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
| | - Kjetil Nordbø Jørgensen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Stener Nerland
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Runar Elle Smelror
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Kirsten Wedervang-Resell
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Child and Adolescent Mental Health Research Unit, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Cecilie Haggag Johannessen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Margrethe Myhre
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK; UK Dementia Research Institute at UCL, London, UK
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| |
Collapse
|
8
|
Mørch-Johnsen L, Smelror RE, Andreou D, Barth C, Johannessen C, Wedervang-Resell K, Wortinger LA, Díaz R, Victoria G, Ueland T, Andreassen OA, Myhre AM, Rund BR, Ulloa RE, Agartz I. Negative Symptom Domains Are Associated With Verbal Learning in Adolescents With Early Onset Psychosis. Front Psychiatry 2021; 12:825681. [PMID: 35069300 PMCID: PMC8777217 DOI: 10.3389/fpsyt.2021.825681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/16/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Early-onset psychosis (EOP) is among the leading causes of disease burden in adolescents. Negative symptoms and cognitive deficits predicts poorer functional outcome. A better understanding of the association between negative symptoms and cognitive impairment may inform theories on underlying mechanisms and elucidate targets for development of new treatments. Two domains of negative symptoms have been described in adult patients with schizophrenia: apathy and diminished expression, however, the factorial structure of negative symptoms has not been investigated in EOP. We aimed to explore the factorial structure of negative symptoms and investigate associations between cognitive performance and negative symptom domains in adolescents with EOP. We hypothesized that (1) two negative symptom factors would be identifiable, and that (2) diminished expression would be more strongly associated with cognitive performance, similar to adult psychosis patients. Methods: Adolescent patients with non-affective EOP (n = 169) were included from three cohorts: Youth-TOP, Norway (n = 45), Early-Onset Study, Norway (n = 27) and Adolescent Schizophrenia Study, Mexico (n = 97). An exploratory factor analysis was performed to investigate the underlying structure of negative symptoms (measured with the Positive and Negative Syndrome Scale (PANSS)). Factor-models were further assessed using confirmatory factor analyses. Associations between negative symptom domains and six cognitive domains were assessed using multiple linear regression models controlling for age, sex and cohort. The neurocognitive domains from the MATRICS Consensus Cognitive Battery included: speed of processing, attention, working memory, verbal learning, visual learning, and reasoning and problem solving. Results: The exploratory factor analysis of PANSS negative symptoms suggested retaining only a single factor, but a forced two factor solution corroborated previously described factors of apathy and diminished expression in adult-onset schizophrenia. Results from confirmatory factor analysis indicated a better fit for the two-factor model than for the one-factor model. For both negative symptom domains, negative symptom scores were inversely associated with verbal learning scores. Conclusion: The results support the presence of two domains of negative symptoms in EOP; apathy and diminished expression. Future studies on negative symptoms in EOP should examine putative differential effects of these symptom domains. For both domains, negative symptom scores were significantly inversely associated with verbal learning.
Collapse
Affiliation(s)
- Lynn Mørch-Johnsen
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry and Department of Clinical Research, Østfold Hospital, Grålum, Norway
| | - Runar Elle Smelror
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Dimitrios Andreou
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Claudia Barth
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Cecilie Johannessen
- Department of Neurohabilitation, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kirsten Wedervang-Resell
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laura A Wortinger
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ricardo Díaz
- Research Department, Arete Proyectos y Administración, Mexico City, Mexico
| | - Gamaliel Victoria
- Planning of Prevention Programs in the Directorate of Integral Attention to Girls, Boys and Adolescents, System for the Integral Development of the Family, Mexico City, Mexico
| | - Torill Ueland
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway
| | - Anne M Myhre
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway.,Research Department, Vestre Viken Hospital Trust, Drammen, Norway
| | - Rosa Elena Ulloa
- Developmental Psychopharmacology at the Research Division, Child Psychiatric Hospital, Mexico City, Mexico
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Institute of Clinical Medicine, K.G. Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| |
Collapse
|
9
|
Kottaram A, Johnston LA, Tian Y, Ganella EP, Laskaris L, Cocchi L, McGorry P, Pantelis C, Kotagiri R, Cropley V, Zalesky A. Predicting individual improvement in schizophrenia symptom severity at 1-year follow-up: Comparison of connectomic, structural, and clinical predictors. Hum Brain Mapp 2020; 41:3342-3357. [PMID: 32469448 PMCID: PMC7375115 DOI: 10.1002/hbm.25020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 01/13/2020] [Accepted: 04/13/2020] [Indexed: 12/25/2022] Open
Abstract
In a machine learning setting, this study aims to compare the prognostic utility of connectomic, brain structural, and clinical/demographic predictors of individual change in symptom severity in individuals with schizophrenia. Symptom severity at baseline and 1-year follow-up was assessed in 30 individuals with a schizophrenia-spectrum disorder using the Brief Psychiatric Rating Scale. Structural and functional neuroimaging was acquired in all individuals at baseline. Machine learning classifiers were trained to predict whether individuals improved or worsened with respect to positive, negative, and overall symptom severity. Classifiers were trained using various combinations of predictors, including regional cortical thickness and gray matter volume, static and dynamic resting-state connectivity, and/or baseline clinical and demographic variables. Relative change in overall symptom severity between baseline and 1-year follow-up varied markedly among individuals (interquartile range: 55%). Dynamic resting-state connectivity measured within the default-mode network was the most accurate single predictor of change in positive (accuracy: 87%), negative (83%), and overall symptom severity (77%) at follow-up. Incorporating predictors based on regional cortical thickness, gray matter volume, and baseline clinical variables did not markedly improve prediction accuracy and the prognostic utility of these predictors in isolation was moderate (<70%). Worsening negative symptoms at 1-year follow-up were predicted by hyper-connectivity and hypo-dynamism within the default-mode network at baseline assessment, while hypo-connectivity and hyper-dynamism predicted worsening positive symptoms. Given the modest sample size investigated, we recommend giving precedence to the relative ranking of the predictors investigated in this study, rather than the prediction accuracy estimates.
Collapse
Affiliation(s)
- Akhil Kottaram
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leigh A Johnston
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Brain Centre Imaging Unit, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ye Tian
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Eleni P Ganella
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Cooperative Research Centre for Mental Health, Carlton, Victoria, Australia
| | - Liliana Laskaris
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Neural Engineering, Department of Electrical and Electronic Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Luca Cocchi
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Patrick McGorry
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Cooperative Research Centre for Mental Health, Carlton, Victoria, Australia.,Centre for Neural Engineering, Department of Electrical and Electronic Engineering, The University of Melbourne, Melbourne, Victoria, Australia.,North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia.,Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia
| | - Ramamohanarao Kotagiri
- Department of Computing and Information Systems, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Hawthorn, Victoria, Australia
| | - Andrew Zalesky
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Engen K, Wortinger LA, Jørgensen KN, Lundberg M, Bohman H, Smelror RE, Myhre AM, Jacobson L, Vincent A, Agartz I. Autoantibodies to the N-Methyl-D-Aspartate Receptor in Adolescents With Early Onset Psychosis and Healthy Controls. Front Psychiatry 2020; 11:666. [PMID: 32765314 PMCID: PMC7381144 DOI: 10.3389/fpsyt.2020.00666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Autoantibodies to the N-methyl-D-aspartate receptor (NMDAR-Abs) in autoimmune encephalitis have been associated with prominent psychiatric symptoms. The aims of the present study are to identify the prevalence of NMDAR-Abs in adolescents with early onset psychosis disorders (EOP) and healthy controls (HC) and examine its clinical significance. METHOD Plasma samples were acquired from 46 adolescent EOP patients and 69 age- and sex matched HC, and assessed for the presence of immunoglobulin G NMDAR-Abs. All participants underwent psychiatric evaluation, neurological examination and head magnetic resonance imaging. RESULTS NMDAR-Abs were detected in three of 46 (6.5%) EOP patients and in two of 69 (2.9%) HC. One NMDAR-Abs EOP patient presented with unusual psychopathology and minor T1 weighted lesions of vasculopathological origin located bi-frontally and in the basal ganglia, and had a recent diagnosis of a separate autoimmune disease. One NMDAR-Ab HC displayed a T2 weighted FLAIR hyperintensity lesion in the left frontal lobe. The remaining three NMDAR-Ab participants were two EOP patients without neurological or radiological findings, and one HC without any clinical findings. CONCLUSIONS We report that a small number of EOP patients and HC have NMDAR-Abs with a similar frequency in both groups. The presence of the antibodies was not associated with any distinctive clinical or radiological features. Detection of the antibodies had no diagnostic implication, and a positive NMDAR antibody test must be carefully interpreted and reviewed within the individual clinical context.
Collapse
Affiliation(s)
- Kristine Engen
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laura Anne Wortinger
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjetil Nordbø Jørgensen
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mathias Lundberg
- Department of Neuroscience, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Hannes Bohman
- Department of Neuroscience, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Runar Elle Smelror
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Margrethe Myhre
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Leslie Jacobson
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Ingrid Agartz
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
11
|
Abstract
BACKGROUND Psychosis is an illness characterised by alterations in thoughts and perceptions resulting in delusions and hallucinations. Psychosis is rare in adolescents but can have serious consequences. Antipsychotic medications are the mainstay treatment, and have been shown to be effective. However, there is emerging evidence on psychological interventions such as cognitive remediation therapy, psycho-education, family therapy and group psychotherapy that may be useful for adolescents with psychosis. OBJECTIVES To assess the effects of various psychological interventions for adolescents with psychosis. SEARCH METHODS We searched the Cochrane Schizophrenia Group's study-based Register of Trials including clinical trials registries (latest, 8 March 2019). SELECTION CRITERIA All randomised controlled trials comparing various psychological interventions with treatment-as-usual or other psychological treatments for adolescents with psychosis. For analyses, we included trials meeting our inclusion criteria and reporting useable data. DATA COLLECTION AND ANALYSIS We independently and reliably screened studies and we assessed risk of bias of the included studies. For dichotomous data, we calculated risk ratios (RRs) and 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous data, we used mean differences (MDs) and the 95% CIs. We used a random-effects model for analyses. We created a 'Summary of findings' table using GRADE. MAIN RESULTS The current review includes 7 studies (n = 319) assessing a heterogenous group of psychological interventions with variable risk of bias. Adverse events were not reported by any of the studies. None of the studies was sponsored by industry. Below, we summarise the main results from four of six comparisons, and the certainty of these results (based on GRADE). All scale scores are average endpoint scores. Cognitive Remediation Therapy (CRT) + Treatment-as-Usual (TAU) versus TAU Two studies compared adding CRT to participants' TAU with TAU alone. Global state (CGAS, high = good) was reported by one study. There was no clear difference between treatment groups (MD -4.90, 95% CI -11.05 to 1.25; participants = 50; studies = 1, very low-certainty). Mental state (PANSS, high = poor) was reported by one study. Scores were clearly lower in the TAU group (MD 8.30, 95% CI 0.46 to 16.14; participants = 50; studies = 1; very low-certainty). Clearly more participants in the CRT group showed improvement in cognitive functioning (Memory digit span test) compared to numbers showing improvement in the TAU group (1 study, n = 31, RR 0.58, 95% CI 0.37 to 0.89; very low-certainty). For global functioning (VABS, high = good), our analysis of reported scores showed no clear difference between treatment groups (MD 5.90, 95% CI -3.03 to 14.83; participants = 50; studies = 1; very low-certainty). The number of participants leaving the study early from each group was similar (RR 0.93, 95% CI 0.32 to 2.71; participants = 91; studies = 2; low-certainty). Group Psychosocial Therapy (GPT) + TAU versus TAU One study assessed the effects of adding GPT to participants' usual medication. Global state scores (CGAS, high = good) were clearly higher in the GPT group (MD 5.10, 95% CI 1.35 to 8.85; participants = 56; studies = 1; very low-certainty) but there was little or no clear difference between groups for mental state scores (PANSS, high = poor, MD -4.10, 95% CI -8.28 to 0.08; participants = 56; studies = 1, very low-certainty) and no clear difference between groups for numbers of participants leaving the study early (RR 0.43, 95% CI 0.15 to 1.28; participants = 56; studies = 1; very low-certainty). Cognitive Remediation Programme (CRP) + Psychoeducational Treatment Programme (PTP) versus PTP One study assessed the effects of combining two types psychological interventions (CRP + PTP) with PTP alone. Global state scores (GAS, high = good) were not clearly different (MD 1.60, 95% CI -6.48 to 9.68; participants = 25; studies = 1; very low-certainty), as were mental state scores (BPRS total, high = poor, MD -5.40, 95% CI -16.42 to 5.62; participants = 24; studies = 1; very low-certainty), and cognitive functioning scores (SPAN-12, high = good, MD 2.40, 95% CI -2.67 to 7.47; participants = 25; studies = 1; very low-certainty). Psychoeducational (PE) + Multifamily Treatment (MFT) Versus Nonstructured Group Therapy (NSGT, all long-term) One study compared (PE + MFT) with NSGT. Analysis of reported global state scores (CGAS, high = good, MD 3.38, 95% CI -4.87 to 11.63; participants = 49; studies = 1; very low-certainty) and mental state scores (PANSS total, high = poor, MD -8.23, 95% CI -17.51 to 1.05; participants = 49; studies = 1; very low-certainty) showed no clear differences. The number of participants needing hospital admission (RR 0.84, 95% CI 0.36 to 1.96; participants = 49; studies = 1) and the number of participants leaving the study early from each group were also similar (RR 0.52, 95% CI 0.10 to 2.60; participants = 55; studies = 1; low-certainty). AUTHORS' CONCLUSIONS Most of our estimates of effect for our main outcomes are equivocal. An effect is suggested for only four outcomes in the SOF tables presented. Compared to TAU, CRT may have a positive effect on cognitive functioning, however the same study reports data suggesting TAU may have positive effect on mental state. Another study comparing GPT with TAU reports data suggesting GPT may have a positive effect on global state. However, the estimate of effects for all the main outcomes in our review should be viewed with considerable caution as they are based on data from a small number of studies with variable risk of bias. Further data could change these results and larger and better quality studies are needed before any firm conclusions regarding the effects of psychological interventions for adolescents with psychosis can be made.
Collapse
Affiliation(s)
- Soumitra S Datta
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, India
| | - Rhea Daruvala
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, India
| | - Ajit Kumar
- Latrobe Regional Hospital, Victoria, Australia
| |
Collapse
|
12
|
Kafali HY, Bildik T, Bora E, Yuncu Z, Erermis HS. Distinguishing prodromal stage of bipolar disorder and early onset schizophrenia spectrum disorders during adolescence. Psychiatry Res 2019; 275:315-325. [PMID: 30953877 DOI: 10.1016/j.psychres.2019.03.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 12/14/2022]
Abstract
Prodromal symptoms of bipolar disorder (BD) and early onset schizophrenia spectrum disorder (EOSSD) overlap. To date, there has been no study directly comparing the prodromal stage of both disorders. Thus, the current study is aimed at determining which prodromal symptom clusters differentiate BD and EOSSD. One hundred twenty one adolescents (33 BD-1, 30 EOSSD, 58 healthy controls) were evaluated for the presence of 79 prodromal symptoms, divided into 7 prodromal symptom clusters. Great than 2 subsyndromal manic symptoms and ADHD comorbidity were significantly more specific for BD than schizophrenia; brief limited intermittent psychotic symptoms (BLIPS) were more likely to be part of EOSSD. In contrast, attenuated psychotic symptoms, and negative symptoms were not specifically related to the diagnosis of EOSSD. In conclusion, subsyndromal manic symptoms, BLIPS, and ADHD might be useful for predicting the trajectory of an emerging affective disorder versus schizophrenia and thus valuable for early detection, and intervention strategies.
Collapse
Affiliation(s)
- Helin Yilmaz Kafali
- Ankara Children's Hematology Oncology Training and Research Hospital, Department of Child and Adolescent Psychiatry, Sehit Omer Halisdemir Cad, Kurtdereli, 06110 Ankara, Turkey.
| | - Tezan Bildik
- Ege University School of Medicine, Department of Child and Adolescent Psychiatry, Izmir, Turkey
| | - Emre Bora
- Dokuz Eylül University School of Medicine, Department of Psychiatry, Izmir, Turkey; The Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, VIC, Australia
| | - Zeki Yuncu
- Ege University School of Medicine, Department of Child and Adolescent Psychiatry, Izmir, Turkey
| | - H Serpil Erermis
- Ege University School of Medicine, Department of Child and Adolescent Psychiatry, Izmir, Turkey
| |
Collapse
|
13
|
Kikuchi M, Miura K, Morita K, Yamamori H, Fujimoto M, Ikeda M, Yasuda Y, Nakaya A, Hashimoto R. Genome-wide Association Analysis of Eye Movement Dysfunction in Schizophrenia. Sci Rep 2018; 8:12347. [PMID: 30120336 PMCID: PMC6098030 DOI: 10.1038/s41598-018-30646-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 08/03/2018] [Indexed: 01/07/2023] Open
Abstract
Eye movements are considered endophenotypes of schizophrenia. However, the genetic factors underlying eye movement are largely unknown. In this study, we explored the susceptibility loci for four eye movement scores: the scanpath length during the free viewing test (SPL), the horizontal position gain during the fast Lissajous paradigm of the smooth pursuit test (HPG), the duration of fixations during the far distractor paradigm of the fixation stability test (DF) and the integrated eye movement score of those three scores (EMS). We found 16 SNPs relevant to the HPG that were located in 3 genomic regions (1q21.3, 7p12.1 and 20q13.12) in the patient group; however, these SNPs were intronic or intergenic SNPs. To determine whether these SNPs occur in functional non-coding regions (i.e., enhancer or promoter regions), we examined the chromatin status on the basis of publicly available epigenomic data from 127 tissues or cell lines. This analysis suggested that the SNPs on 1q21.3 and 20q13.12 are in enhancer or promoter regions. Moreover, we performed an analysis of expression quantitative trait loci (eQTL) in human brain tissues using a public database. Finally, we identified significant eQTL effects for all of the SNPs at 1q21.3 and 20q13.12 in particular brain regions.
Collapse
Affiliation(s)
- Masataka Kikuchi
- Department of Genome Informatics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kenichiro Miura
- Department of Integrative Brain Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kentaro Morita
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidenaga Yamamori
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Michiko Fujimoto
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masashi Ikeda
- Department of Psychiatry, Fujita Health University School of Medicine, Aichi, Japan
| | - Yuka Yasuda
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Akihiro Nakaya
- Department of Genome Informatics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ryota Hashimoto
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Osaka, Japan.
- Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, Osaka, Japan.
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
| |
Collapse
|
14
|
Gearing RE, Brewer KB, Mian I, Moore K, Fisher P, Hamilton J, Mandiberg J. First-episode psychosis: Ongoing mental health service utilization during the stable period for adolescents. Early Interv Psychiatry 2018; 12:677-685. [PMID: 27726284 DOI: 10.1111/eip.12366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/07/2016] [Accepted: 07/14/2016] [Indexed: 11/28/2022]
Abstract
AIM The timely identification and treatment of psychosis are increasingly the focus of early interventions, with research targeting the initial high-risk period in the months following first-episode hospitalization. Ongoing treatment after stabilization is also essential in the years following a first-episode psychosis (FEP), but has received less research attention. In this study, variables that could impact continued psychiatric service utilization by adolescents following their FEP and temporal patterns in service utilization are examined. METHODS Families of 52 adolescents (aged 14.4 ± 2.5 years) discharged following a hospitalization for FEP were contacted two or more years following the adolescents' discharge. A chart review (Time 1) of hospital records provided clinical data on each adolescent's psychiatric diagnosis, symptoms, illness course, medications and family history. Follow-up (Time 2) data were collected from parents/caregivers using a questionnaire enquiring about post-discharge treatment history and service utilization. RESULTS Bivariate analyses were conducted to identify Time 1 variables associated with psychiatric service utilization at Time 2. Significant variables were included in a logistic regression model and three variables were independently associated with continued service utilization: having a primary diagnosis of schizophrenia (odds ratio (OR) = 24.0; P = 0.02), not having a first-degree relative with depression (OR = 0.12; P = 0.05) and fewer months since the last inpatient discharge (OR = 0.92; P = 0.02). CONCLUSIONS Findings suggest: (1) the importance of early diagnosis, (2) that a relative with depression may negatively influence the adolescent's ongoing service utilization, and (3) that 18 months post-discharge may be a critical time to review treatment strategies and collaborate with youth and families to ensure appropriateness of services.
Collapse
Affiliation(s)
- Robin E Gearing
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
| | - Kathryne B Brewer
- Department of Social Work, University of New Hampshire, Durham, New Hampshire, USA
| | - Irfan Mian
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kiara Moore
- School of Social Work, Columbia University, New York, New York, USA
| | - Prudence Fisher
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, USA
| | - Jane Hamilton
- Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, Texas, USA
| | - James Mandiberg
- Silberman School of Social Work, Hunter College, New York, New York, USA
| |
Collapse
|
15
|
Vernal DL, Stenstrøm AD, Staal N, Christensen AMR, Ebbesen C, Pagsberg AK, Correll CU, Nielsen RE, Lauritsen MB. Validation study of the early onset schizophrenia diagnosis in the Danish Psychiatric Central Research Register. Eur Child Adolesc Psychiatry 2018; 27:965-975. [PMID: 29299680 DOI: 10.1007/s00787-017-1102-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/21/2017] [Indexed: 12/23/2022]
Abstract
The objective of this study is to assess (1) the concordance and validity of schizophrenia register diagnoses among children and adolescents (early onset schizophrenia = EOS) in the Danish Psychiatric Central Research Register (DPCRR), and (2) the validity of clinical record schizophrenia diagnoses. Psychiatric records from 200 patients with a first-time diagnosis of schizophrenia (F20.x) at age < 18 years between 1994 and 2009 in the DPCRR were rated by experienced clinicians according to ICD-10 criteria, using a predefined checklist. We retrieved 178 records, representing 19.6% of all patients diagnosed with EOS from 1994 to 2009. Mean age was 15.2 years and 56.2% were males. The register-based and clinical diagnoses matched in 158 cases (88.8%). Raters' diagnoses confirmed the DPCRR schizophrenia diagnoses in 134 cases, rendering a diagnostic validity of 75.3% of DPCRR schizophrenia, while 149 cases were confirmed as being in the schizophrenia spectrum (83.7%). When removing records with registration errors, 83.5% of cases were confirmed as schizophrenia and 91.8% as being in the schizophrenia spectrum. Interrater reliability was substantial with Cohen's kappa > 0.78-0.83 depending on classification. Compared to diagnoses made in outpatient settings, EOS diagnoses during hospitalizations were more likely to be valid and had fewer registration errors. Diagnosed in inpatient settings, EOS diagnoses are reliable and valid for register-based research. Schizophrenia diagnosed in children and adolescents in outpatient settings were found to have a high number of false-positives, both due to registration errors and diagnostic practice. Utilizing this knowledge, it is possible to reduce the number of false-positives in register-based research of EOS.
Collapse
Affiliation(s)
- Ditte Lammers Vernal
- Research Unit for Child and Adolescent Psychiatry, Aalborg University Hospital, Moelleparkvej 10, 9000, Aalborg, North Denmark Region, Denmark.
| | - Anne Dorte Stenstrøm
- Department of Child and Adolescent Psychiatry, University Clinic Odense, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Psychiatry Research Unit, University Clinic Odense, University of Southern Denmark, Odense, Denmark
- Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Nina Staal
- Child and Adolescent Mental Health Center, Mental Health Services, Glostrup, Capital Region of Denmark, Denmark
| | | | - Christine Ebbesen
- Center for Child Adolescent Psychiatry, Aarhus University Hospital, Risskov, Central Denmark Region, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Mental Health Services, Glostrup, Capital Region of Denmark, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- The Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - René Ernst Nielsen
- Unit for Psychiatric Research, Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marlene Briciet Lauritsen
- Research Unit for Child and Adolescent Psychiatry, Aalborg University Hospital, Moelleparkvej 10, 9000, Aalborg, North Denmark Region, Denmark
- Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
16
|
Risk factors for increased duration of untreated psychosis. Results from the FACE-SZ dataset. Schizophr Res 2018; 195:529-533. [PMID: 28888362 DOI: 10.1016/j.schres.2017.08.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Reducing the duration of untreated psychosis (DUP) may improve the prognosis of schizophrenia. This study investigated the prevalence, and associated risk factors, of long DUP in a large, non-selected sample of community-dwelling schizophrenia patients (SZ). METHOD 478 community-dwelling stable SZ participants (122 women and 356 men; mean age 32.37±9.86years) were recruited between 2010 and 2016. The mean retrospective DUP was evaluated from both patient and family reports, as well as hospital/psychiatrists records. Long DUP was defined as >2years. RESULTS The mean DUP was 1.5years. 80 participants (16.7%) had a DUP>2years. In multivariate analyses, after adjustment for sex, education level, history of childhood trauma and history of maternal schizophrenia or bipolar disorder, long DUP was associated with a younger age of illness onset (19.3±6.67years vs. 22.0±6.51years, adjusted odd ratio aOR=0.91, 95%CI [0.86; 0.97], p=0.003) and cannabis use disorder (20.0% vs. 10.3%, aOR=2.41, 95%CI [1.14-5.09], p=0.02). CONCLUSION A high proportion of SZ patients still have a long DUP. The present results suggest that illness onset before age 19years and cannabis use are associated with long DUP in schizophrenia patients. Early psychosis detection programs should prioritize the targeting of these populations.
Collapse
|
17
|
Salamon S, Santelmann H, Franklin J, Baethge C. Test-retest reliability of the diagnosis of schizoaffective disorder in childhood and adolescence - A systematic review and meta-analysis. J Affect Disord 2018; 230:28-33. [PMID: 29360577 DOI: 10.1016/j.jad.2017.12.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 12/05/2017] [Accepted: 12/31/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Reliability of schizoaffective disorder (SAD) diagnoses is low in adults but unclear in children and adolescents (CAD). We estimate the test-retest reliability of SAD and its key differential diagnoses (schizophrenia, bipolar disorder, and unipolar depression). METHODS Systematic literature search of Medline, Embase, and PsycInfo for studies on test-retest reliability of SAD, in CAD. Cohen's kappa was extracted from studies. We performed meta-analysis for kappa, including subgroup and sensitivity analysis (PROSPERO protocol: CRD42013006713). RESULTS Out of > 4000 records screened, seven studies were included. We estimated kappa values of 0.27 [95%-CI: 0.07 0.47] for SAD, 0.56 [0.29; 0.83] for schizophrenia, 0.64 [0.55; 0.74] for bipolar disorder, and 0.66 [0.52; 0.81] for unipolar depression. In 5/7 studies kappa of SAD was lower than that of schizophrenia; similar trends emerged for bipolar disorder (4/5) and unipolar depression (2/3). Estimates of positive agreement of SAD diagnoses supported these results. LIMITATIONS The number of studies and patients included is low. CONCLUSIONS The point-estimate of the test-retest reliability of schizoaffective disorder is only fair, and lower than that of its main differential diagnoses. All kappa values under study were lower in children and adolescents samples than those reported for adults. Clinically, schizoaffective disorder should be diagnosed in strict adherence to the operationalized criteria and ought to be re-evaluated regularly. Should larger studies confirm the insufficient reliability of schizoaffective disorder in children and adolescents, the clinical value of the diagnosis is highly doubtful.
Collapse
Affiliation(s)
- Sarah Salamon
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany; Clinical and Experimental Neurosciences, University of Cologne, Cologne, Germany
| | - Hanno Santelmann
- Department of Obstetrics and Gynecology, University Medical Centre Freiburg, Freiburg, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne Medical School, Cologne, Germany
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany.
| |
Collapse
|
18
|
Lowe K, Smith H, Clark A. Neuroleptic prescribing in an adolescent psychiatric in-patient unit. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.20.9.538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Royal College of Psychiatrists' consensus statement suggests that prescribing high dose antipsychotic medication in children and adolescents should rarely be necessary. Our objective was to study the prescribing of antipsychotic medication in a regional adolescent unit during a three-year period. We found that antipsychotic prescribing on this unit is common in psychotic disorders and often high closes are required. This is not in keeping with the recommendations of the consensus statement. Review of clinical practice on other adolescent units is needed, together with a more comprehensive evaluation of the outcome of psychotic disorders in this age group.
Collapse
|
19
|
Abstract
Schizophrenia is a devastating chronic disorder that typically presents in early adult life and impacts on a broad swathe of social and psychological functioning. It is not surprising that psychiatrists have tended to be circumspect about making this ominous diagnosis in children and adolescents. Genuine concerns about the validity of applying ‘adult’ psychotic diagnoses in this young age group, together with the lack of diagnosis-specific interventions, have suggested a cautious approach to diagnosis. Furthermore, the relative rarity of schizophrenia in this age group has meant that most psychiatrists have relatively little experience with ‘atypical’ early presentation of the disorder.
Collapse
|
20
|
Choi S, Cho HK, Lee MK. Demographic Characteristics, Medication Profile and Treatment Outcome of Patients with Very Early-Onset Schizophrenia in One Hospital. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.2.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- SungKu Choi
- Division of Medical Services, National Center for Mental Health, Seoul, Korea
| | - Hye-Kyung Cho
- Division of Medical Services, National Center for Mental Health, Seoul, Korea
| | - Min-Koo Lee
- Department of Information and Statistics, Chungnam National University, Daejeon, Korea
| |
Collapse
|
21
|
Merten EC, Cwik JC, Margraf J, Schneider S. Overdiagnosis of mental disorders in children and adolescents (in developed countries). Child Adolesc Psychiatry Ment Health 2017; 11:5. [PMID: 28105068 PMCID: PMC5240230 DOI: 10.1186/s13034-016-0140-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/11/2016] [Indexed: 11/22/2022] Open
Abstract
During the past 50 years, health insurance providers and national registers of mental health regularly report significant increases in the number of mental disorder diagnoses in children and adolescents. However, epidemiological studies show mixed effects of time trends of prevalence of mental disorders. Overdiagnosis in clinical practice rather than an actual increase is assumed to be the cause for this situation. We conducted a systematic literature search on the topic of overdiagnosis of mental disorders in children and adolescents. Most reviewed studies suggest that misdiagnosis does occur; however, only one study was able to examine overdiagnosis in child and adolescent mental disorders from a methodological point-of-view. This study found significant evidence of overdiagnosis of attention-deficit/hyperactivity disorder. In the second part of this paper, we summarize findings concerning diagnostician, informant and child/adolescent characteristics, as well as factors concerning diagnostic criteria and the health care system that can lead to mistakes in the routine diagnostic process resulting in misdiagnoses. These include the use of heuristics instead of data-based decisions by diagnosticians, misleading information by caregivers, ambiguity in symptom description relating to classification systems, as well as constraints in most health systems to assign a diagnosis in order to approve and reimburse treatment. To avoid misdiagnosis, standardized procedures as well as continued education of diagnosticians working with children and adolescents suffering from a mental disorder are needed.
Collapse
Affiliation(s)
- Eva Charlotte Merten
- Department of Clinical Child and Adolescent Psychology of the Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Jan Christopher Cwik
- Department of Clinical Psychology and Psychotherapy of the Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Jürgen Margraf
- Department of Clinical Psychology and Psychotherapy of the Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Silvia Schneider
- Department of Clinical Child and Adolescent Psychology of the Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| |
Collapse
|
22
|
Ceylan MF, Akca OF, Yuce M, Bodur S. Comparison of Symptoms of Pediatric Bipolar Disorder in the Manic Phase and Attention Deficit and Hyperactivity Disorder. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20120412022554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Mehmet Fatih Ceylan
- Dr. Sami Ulus Çocuk Hastanesi Eğitim ve Araştırma Hastanesi Çocuk ve Ergen Psikiyatrisi Kliniği, Ankara - Turkey
| | - Omer Faruk Akca
- Samsun Ruh Sağlığı ve Hastalıkları Hastanesi Çocuk ve Ergen Psikiyatrisi Kliniği, Samsun - Turkey
| | - Murat Yuce
- Ondokuz Mayıs Üniversitesi Çocuk ve Ergen Psikiyatrisi AD., Samsun - Turkey
| | - Sahin Bodur
- Dr. Sami Ulus Çocuk Hastanesi Eğitim ve Araştırma Hastanesi Çocuk ve Ergen Psikiyatrisi Kliniği, Ankara - Turkey
| |
Collapse
|
23
|
Is it still correct to differentiate between early and very early onset psychosis? Schizophr Res 2016; 170:211-6. [PMID: 26639553 DOI: 10.1016/j.schres.2015.11.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/17/2015] [Accepted: 11/20/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE It remains unclear whether very early onset psychosis (VEOP; ≤12years of age) and early onset psychosis (EOP; onset 13-17years of age) are homogeneous in their clinical presentation. We investigated the predictive value of age of psychosis onset for severity, functioning and demographic variation by: 1) comparing groups based on traditional cut-offs for age of psychosis onset, and 2) using receiver operating characteristic (ROC)-curve calculations, without a priori age of onset cut-offs. METHOD Participants were 88 (45 female, 43 male) children and adolescents with a recent onset of psychosis (age range=6.7-17.5years; M=13.74, SD=2.37). RESULTS The VEOP group had significantly shorter duration of untreated illness and untreated psychosis, and lower functioning than the EOP group. The VEOP and EOP groups did not differ significantly on gender proportion, urbanicity, psychotic diagnosis, family history of psychotic disorder, psychotic, depressive and anxiety symptoms or IQ. When applying ROC-curves to the lowest three quartiles of positive psychotic symptoms scores, the optimal age-cut-off was 14.0years (sensitivity=0.62; specificity=0.75). For the highest quartile of functioning scores, the optimal differentiating cut-off for age of psychosis onset was 14.7years (sensitivity=0.71; specificity=0.70). CONCLUSIONS Larger samples of patients, assessed at presentation and followed-up, are necessary to clearly examine clinical presentation and outcome as a function of social and neural development to better understand if the differentiation between VEOP and EOP is justified. This will aid the development of predictive diagnostic tools, more accurate prognosis prediction, and age-tailored therapeutic interventions.
Collapse
|
24
|
Håkansson A, Johansson BA. Atypical course in severe catatonic schizophrenia in a cannabis-dependent male adolescent: a case report. J Med Case Rep 2015; 9:200. [PMID: 26388066 PMCID: PMC4576396 DOI: 10.1186/s13256-015-0678-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 08/18/2015] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Adolescents with psychoses usually have full recovery from their first psychotic episode, but the first relapse often arises within 2 years of the first episode. Cannabis-related psychoses are difficult to distinguish from schizophrenic psychoses. Here, we describe a particularly severe clinical case, with a first psychotic episode occurring after heavy cannabis smoking, an atypically long symptom-free duration, and a subsequent non-substance-related episode. CASE PRESENTATION A 17-year-old male adolescent of Middle-East origin presented with delusions and hallucinations after extensive cannabis smoking. His first psychotic episode, with paranoid delusions and hallucinations, progressed into severe catatonic symptoms. His symptoms were treated with electroconvulsive therapy and risperidone and he was transferred to a residential substance abuse treatment center. He remained drug-free and non-psychotic for 3.5 years. Given the temporal association with extensive cannabis use, and his full remission of symptoms lasting several years, a cannabis-induced psychosis-though atypically extended-could be suspected. However, after 3.5 years without psychiatric care, and in a drug-free state, our patient again presented with positive psychotic symptoms, possibly induced by a period of severe psychosocial stress. CONCLUSION We here discuss whether a primary schizophrenic episode possibly induced by cannabis can increase the risk of subsequent non-drug-related schizophrenic episodes.
Collapse
Affiliation(s)
- Anders Håkansson
- Department of Clinical Sciences Lund, Division of Psychiatry, Lund University, Malmö Addiction Centre, Södra Förstadsgatan 35, Malmö, S-205 02, Sweden.
| | - Björn Axel Johansson
- Department of Clinical Sciences Lund, Division of Child & Adolescent Psychiatry, Lund University, Malmö, Sweden.
- Office for Healthcare 'Sund', Child & Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Malmö, Sweden.
| |
Collapse
|
25
|
Díaz-Caneja CM, Pina-Camacho L, Rodríguez-Quiroga A, Fraguas D, Parellada M, Arango C. Predictors of outcome in early-onset psychosis: a systematic review. NPJ SCHIZOPHRENIA 2015; 1:14005. [PMID: 27336027 PMCID: PMC4849440 DOI: 10.1038/npjschz.2014.5] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 01/31/2023]
Abstract
Given the global burden of psychotic disorders, the identification of patients with early-onset psychosis (EOP; that is, onset before the age of 18) at higher risk of adverse outcome should be a priority. A systematic search of Pubmed, Embase, and PsycInfo (1980 through August 2014) was performed to identify longitudinal observational studies assessing correlates and/or predictors of clinical, functional, cognitive, and biological outcomes in EOP. Seventy-five studies were included in the review. Using multivariate models, the most replicated predictors of worse clinical, functional, cognitive, and biological outcomes in EOP were premorbid difficulties and symptom severity (especially of negative symptoms) at baseline. Longer duration of untreated psychosis (DUP) predicted worse clinical, functional, and cognitive outcomes. Higher risk of attempting suicide was predicted by greater severity of psychotic illness and of depressive symptoms at the first episode of psychosis. Age at onset and sex were not found to be relevant predictors of outcome in most multivariate models, whereas studies using bivariate analyses yielded inconsistent results. Lower intelligence quotient at baseline predicted lower insight at follow-up, worse functional outcomes, and a diagnostic outcome of schizophrenia. Biological predictors of outcome in EOP have been little studied and have not been replicated. Lower levels of antioxidants at baseline predicted greater brain volume changes and worse cognitive functioning at follow-up, whereas neuroimaging markers such as regional cortical thickness and gray matter volume at baseline predicted remission and better insight at follow-up, respectively. EOP patients with poorer premorbid adjustment and prominent negative symptoms at initial presentation are at risk of poor outcome. They should therefore be the target of careful monitoring and more intensive interventions to address whether the disease course can be modified in this especially severely affected group. Early intervention strategies to reduce DUP may also improve outcome in EOP.
Collapse
Affiliation(s)
- Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - Laura Pina-Camacho
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | - Alberto Rodríguez-Quiroga
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - David Fraguas
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| |
Collapse
|
26
|
Kumar A, Datta SS, Wright SD, Furtado VA, Russell PS. Atypical antipsychotics for psychosis in adolescents. Cochrane Database Syst Rev 2013:CD009582. [PMID: 24129841 DOI: 10.1002/14651858.cd009582.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Schizophrenia often presents in adolescence, but current treatment guidelines are based largely on studies of adults with psychosis. Over the past decade, the number of studies on treatment of adolescent-onset psychosis has increased. The current systematic review collates and critiques evidence obtained on the use of various atypical antipsychotic medications for adolescents with psychosis. OBJECTIVES To investigate the effects of atypical antipsychotic medications in adolescents with psychosis. We reviewed in separate analyses various comparisons of atypical antipsychotic medications with placebo or a typical antipsychotic medication or another atypical antipsychotic medication or the same atypical antipsychotic medication but at a lower dose. SEARCH METHODS We searched the Cochrane Schizophrenia Group Register (October 2011), which is based on regular searches of BIOSIS, CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected references of all identified studies and contacted study authors and relevant pharmaceutical companies to ask for more information. SELECTION CRITERIA We included all relevant randomised controlled trials (RCTs) that compared atypical antipsychotic medication with placebo or another pharmacological intervention or with psychosocial interventions, standard psychiatric treatment or no intervention in children and young people aged 13 to 18 years with a diagnosis of schizophrenia, schizoaffective disorder, acute and transient psychoses or unspecified psychosis. We included studies published in English and in other languages that were available in standardised databases. DATA COLLECTION AND ANALYSIS Review authors AK and SSD selected the studies, rated the quality of the studies and performed data extraction. For dichotomous data, we estimated risk ratios (RRs) with 95% confidence intervals (CIs) using a fixed-effect model. When possible, for binary data presented in the 'Summary of findings' table, we calculated illustrative comparative risks. We summated continuous data using the mean difference (MD). Risk of bias was assessed for included studies. MAIN RESULTS We included 13 RCTs, with a total of 1112 participants. We found no data on service utilisation, economic outcomes, behaviour or cognitive response. Trials were classified into the following groups. 1. Atypical antipsychotics versus placebo: Only two studies compared one atypical antipsychotic medication with placebo. In one study, the number of non-responders treated with olanzapine was not different from the number treated with placebo (1 RCT, n = 107, RR 0.84, 95% CI 0.65 to 1.10); however, significantly more (57% vs 32%) people left the study early (1 RCT, n = 107, RR 0.56, 95% CI 0.36 to 0.87) from the placebo group compared with the olanzapine group. With regard to adverse effects, young people treated with aripiprazole had significantly lower serum cholesterol compared with those given placebo (1 RCT, n = 302, RR 3.77, 95% CI 1.88 to 7.58). 2. Atypical antipsychotics versus typical antipsychotics: When the findings of all five trials comparing atypical antipsychotic medications with a typical antipsychotic medication were collated, no difference in the mean end point Brief Psychiatric Rating Scale (BPRS) score was noted between the two arms (5 RCTs, n = 236, MD -1.08, 95% CI -3.08 to 0.93). With regard to adverse effects, the mean end point serum prolactin concentration was much higher than the reference range for treatment with risperidone, olanzapine and molindone in one of the studies. However, fewer adolescents who were receiving atypical antipsychotic medications left the study because of adverse effects (3 RCTs, n = 187, RR 0.65, 95% CI 0.36 to 1.15) or for any reason (3 RCTs, n = 187, RR 0.62, 95% CI 0.39 to 0.97).3. One atypical antipsychotic versus another atypical antipsychotic: The mean end point BPRS score was not significantly different for people who received risperidone compared with those who received olanzapine; however, the above data were highly skewed. Overall no difference was noted in the number of people leaving the studies early because of any adverse effects between each study arm in the three studies comparing olanzapine and risperidone (3 RCTs, n = 130, RR 1.15, 95% CI 0.44 to 3.04). Specific adverse events were not reported uniformly across the six different studies included in this section of the review; therefore it was difficult to do a head-to-head comparison of adverse events for different atypical antipsychotic medications.4. Lower-dose atypical antipsychotic versus standard/higher-dose atypical antipsychotic: Three studies reported comparisons of lower doses of the atypical antipsychotic medication with standard/higher doses of the same medication. One study reported better symptom reduction with a standard dose of risperidone as compared with a low dose (1 RCT, n = 257, RR -8.00, 95% CI -13.75 to -2.25). In another study, no difference was reported in the number of participants not achieving remission between the group receiving 10 mg/d and those who received 30 mg/d of aripiprazole (1 RCT, n = 196, RR 0.84, 95% CI 0.48 to 1.48). Similarly in the other study, authors reported no statistically significant difference in clinical response between the two groups receiving lower-dose (80 mg/d) and higher-dose (160 mg/d) ziprasidone, as reflected by the mean end point BPRS score (1 RCT, n = 17, MD -4.40, 95% CI -19.20 to 10.40). AUTHORS' CONCLUSIONS No convincing evidence suggests that atypical antipsychotic medications are superior to typical medications for the treatment of adolescents with psychosis. However, atypical antipsychotic medications may be more acceptable to young people because fewer symptomatic adverse effects are seen in the short term. Little evidence is available to support the superiority of one atypical antipsychotic medication over another, but side effect profiles are different for different medications. Treatment with olanzapine, risperidone and clozapine is often associated with weight gain. Aripiprazole is not associated with increased prolactin or with dyslipidaemia. Adolescents may respond better to standard-dose as opposed to lower-dose risperidone, but for aripiprazole and ziprasidone, lower doses may be equally effective. Future trials should ensure uniform ways of reporting.
Collapse
Affiliation(s)
- Ajit Kumar
- Psychiatry, Leeds and York Partnership NHS Foundation Trust, Linden House, St Mary's Hospital, Green Hill Road, Leeds, UK, LS12 3QE
| | | | | | | | | |
Collapse
|
27
|
Facial emotional expression in schizophrenia adolescents during verbal interaction with a parent. Eur Arch Psychiatry Clin Neurosci 2013; 263:529-36. [PMID: 23238780 DOI: 10.1007/s00406-012-0386-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 11/22/2012] [Indexed: 10/27/2022]
Abstract
Research on emotional expression in adult schizophrenia patients has indicated an impairment of the patients' facial expressions during social interaction. However, it is unclear whether schizophrenia adolescent-onset patients show comparable disturbances in facial expression. Our aim was to analyze facial emotions in adolescents with schizophrenia spectrum psychoses compared with non-patient controls during a problem-solving discussion with their primary caregivers. We assessed facial expressions of emotions and speaker position (speaking vs. listening) in schizophrenia and non-patient adolescents matched for age and gender. The facial emotions were coded with the Emotional Facial Action Coding System. Schizophrenia adolescents showed significantly lower rates per minute of expressions indicating positive emotions compared with non-patient adolescents (β = -0.95, 95 % CI [-1.34, -0.57], t (37.92) = -5.00, p ≤ 0.001). In contrast, there was no lower rate of expressions indicating negative emotions of schizophrenia adolescents (β = 0.10, CI [-0.42, 0.61], t (35.03) = 0.38, p = 0.709). While the negative facial expressions of non-patient adolescents were related to speaking (β = 0.63, CI [0.34, 0.92], t (26) = 4.50, p = < 0.001), this relationship was not observed in schizophrenia adolescents. Our results indicated an emotion-specific impairment of positive facial expressions in schizophrenia adolescents early in the course of illness and a deviant relation between facial emotional expressions and speech.
Collapse
|
28
|
McClellan J, Stock S. Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry 2013; 52:976-90. [PMID: 23972700 DOI: 10.1016/j.jaac.2013.02.008] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 02/21/2013] [Indexed: 01/16/2023]
Abstract
This Practice Parameter reviews the literature on the assessment and treatment of children and adolescents with schizophrenia. Early-onset schizophrenia is diagnosed using the same criteria as in adults and appears to be continuous with the adult form of the disorder. Clinical standards suggest that effective treatment includes antipsychotic medications combined with psychoeducational, psychotherapeutic, and educational interventions. Since this Practice Parameter was last published in 2001, several controlled trials of atypical antipsychotic agents for early-onset schizophrenia have been conducted. However, studies suggest that many youth with early-onset schizophrenia do not respond adequately to available agents and are vulnerable to adverse events, particularly metabolic side effects. Further research is needed to develop more effective and safer treatments.
Collapse
|
29
|
David CN, Rapoport JL, Gogtay N. Treatments in context: transcranial direct current brain stimulation as a potential treatment in pediatric psychosis. Expert Rev Neurother 2013; 13:447-58. [PMID: 23545058 PMCID: PMC4063712 DOI: 10.1586/ern.13.29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Childhood-onset schizophrenia is a chronic, severe form of schizophrenia, and is typically treatment resistant. Even after optimized pharmacotherapy, a majority (over 70%) of these pediatric patients present lasting psychotic symptoms and impaired cognition, necessitating the need for novel treatment modalities. Recent work in transcranial magnetic stimulation suggests moderate efficacy in symptom reduction in adult patients with schizophrenia; however, the transcranial magnetic stimulation treatment is cumbersome for this severely ill population. Transcranial direct current stimulation may provide a safe and effective adjuvant treatment for continued residual symptoms of schizophrenia.
Collapse
Affiliation(s)
- Christopher N David
- Child Psychiatry Branch, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Building 10, Room 3N202, 10 Center Drive, Bethesda, MD 20890, USA
| | - Judith L Rapoport
- Child Psychiatry Branch, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Building 10, Room 3N202, 10 Center Drive, Bethesda, MD 20890, USA
| | - Nitin Gogtay
- Child Psychiatry Branch, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Building 10, Room 3N202, 10 Center Drive, Bethesda, MD 20890, USA
| |
Collapse
|
30
|
Abstract
The DSM-5 list of diagnoses concerning schizophrenia spectrum and other psychotic disorders is expected to be revised and graduated from mild to severe. The proposed changes for the diagnosis of schizophrenia affect demands for characteristic symptoms, clarify relation to pervasive developmental disorders, and eliminate the classic subtypes of schizophrenia. A dimensional assessment will be measured on a 0-4 point scale. It is recommended that the concept of attenuated psychosis syndrome is further investigated. The propositions affecting characteristic symptoms of schizophrenia might increase diagnostic reliability and validity, but it is estimated to exclude about 2 % of patients currently diagnosed with DSM-IV schizophrenia from fulfilling criteria for DSM-5 schizophrenia. It might generate a problem for future young patients if the changes concerning demands on characteristic symptoms turn out to be more restrictive, leaving out a percentage of patients with psychotic symptoms from a diagnosis of schizophrenia; which in practice opens possibilities for intensive treatment options. On the other hand, not including attenuated psychosis syndrome at the present might protect patients from stigmatization and pharmacological treatment on poor indication. The introduction of dimensional assessments may make schizophrenia subtyping redundant and has the potential to enrich clinical practice and bridge communication between child and adolescent and adult psychiatry. The most recent guidelines for assessment and treatment of children and adolescents with schizophrenia are from 2001. They provide differentiated recommendations regarding diagnostics, assessment of symptoms and functioning and treatment strategies. There is an urgent need for updated guidelines in this field, especially concerning specific treatment guidelines.
Collapse
Affiliation(s)
- Anne Katrine Pagsberg
- Mental Health Centre for Child and Adolescent Psychiatry Bispebjerg, Copenhagen University Hospitals Capital Region, Bispebjerg Bakke 30, 16D 2400 Kbh NV, Denmark.
| |
Collapse
|
31
|
|
32
|
Remschmidt H, Theisen F. Early-onset schizophrenia. Neuropsychobiology 2012; 66:63-9. [PMID: 22797279 DOI: 10.1159/000338548] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 03/29/2012] [Indexed: 01/07/2023]
Abstract
The available study findings on the course and outcome of schizophrenia beginning in childhood or adolescence can be summarized as follows. (1) Schizophrenic psychoses that arise before the age of 13 have a very poor prognosis. The disease usually continues to progress in adolescence and adulthood. It can be diagnosed with the same criteria that are used for adults. (2) Patients whose disease is of acute onset, with productive schizophrenic manifestations such as hallucinations and delusions (positive manifestations), have a better prognosis than those whose disease begins insidiously and takes an unfavorable course, with depressive states and continually worsening impairment of cognitive function. (3) The patient's premorbid personality plays a major role. Patients who were described as socially active, intelligent, and integrated children and adolescents before they became ill have a better prognosis than those who were intellectually impaired, timid, introverted and uncommunicative before they became ill. (4) The prognosis seems to be better for patients who have no family history of schizophrenia, those whose families cooperate well, and those whose condition improves rapidly during inpatient treatment. (5) The few available studies on the course and outcome of schizophrenia beginning in childhood and early adolescence confirm that they are much worse than in adult-onset schizophrenia. (6) A 42-year longitudinal study of patients with childhood-onset schizophrenia revealed their suicide rate to be higher than that of patients with adult-onset schizophrenia. No further longitudinal studies are available to confirm this finding.
Collapse
Affiliation(s)
- Helmut Remschmidt
- Department of Child and Adolescent Psychiatry, Philipps University, Marburg, Germany.
| | | |
Collapse
|
33
|
Mordre M, Groholt B, Sandstad B, Myhre AM. The impact of ADHD symptoms and global impairment in childhood on working disability in mid-adulthood: a 28-year follow-up study using official disability pension records in a high-risk in-patient population. BMC Psychiatry 2012; 12:174. [PMID: 23083209 PMCID: PMC3554475 DOI: 10.1186/1471-244x-12-174] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 10/16/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with ADHD have been associated with more employment difficulties in early adulthood than healthy community controls. To examine whether this association is attributable specifically to disturbance of activity and attention (ADHD) or to psychopathology in general, we wanted to extend existing research by comparing the rate of mid-adulthood working disabilities for individuals diagnosed with ADHD as children with the rate for clinical controls diagnosed with either conduct disorder, emotional disorder or mixed disorder of conduct and emotions. METHODS Former Norwegian child-psychiatric in-patients (n = 257) were followed up 17-39 years after hospitalization by record linkage to the Norwegian national registry of disability pension (DP) awards. Based on the hospital records, the patients were re-diagnosed according to ICD-10. Associations between the diagnoses, other baseline factors and subsequent DP were investigated using Kaplan-Meier survival analyses and logrank testing. RESULTS At follow-up, 19% of the participants had received a DP award. In the logrank testing, ADHD was the only disorder associated with a subsequent DP, with 30% being disabled at follow-up (p = 0.01). Low psychosocial functioning (assessed by the Children's Global Assessment Scale) at admission uniquely predicted future DP (p = 0.04). CONCLUSIONS ADHD in childhood was highly associated with later receiving a DP. Our finding of worse prognosis in ADHD compared with other internalizing and externalizing disorders in mid-adulthood supports the assumption of ADHD being specifically linked to working disability. Assessment of psychosocial functioning in addition to diagnostic features could enhance prediction of children who are most at risk of future disability.
Collapse
Affiliation(s)
- Marianne Mordre
- Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4959, Nydalen 0424, Oslo, Norway.
| | - Berit Groholt
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Berit Sandstad
- Unit of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Anne Margrethe Myhre
- Division of Mental Health and Addiction, Oslo University Hospital, Norway and Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
34
|
Courvoisie H, Labellarte MJ, Riddle MA. Psychosis in children: diagnosis and treatment. DIALOGUES IN CLINICAL NEUROSCIENCE 2012. [PMID: 22033588 PMCID: PMC3181648 DOI: 10.31887/dcns.2001.3.2/hcourvoisie] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The diagnosis of childhood psychosis raises a host of unresolved problems, despite the Diagnostic and Statistical Manual Of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) giving identical symptoms and definitions for children, adolescents, and adults. The fantasy lives of children, and issues of developing language and cognition (including retardation), all impair diagnostic accuracy, particularly when differentiating between childhood-onset schizophrenia (COS) (≤12 years), bipolar affective disorder, major depressive disorder, and even obsessive-compulsive disorder and attention-deficit/hyperactivity disorder: the catch-all classification, psychosis not otherwise specified (PNOS), is always available for conundra that prove unsolvable. Typical if nonpathognomonic features include neurocognitive difficulties. Multiple screening instruments and specialized versions of semistructured diagnostic interviews are available. Although smooth-pursuit eye-tracking movements may prove a genetic marker for COS, etiologies are likely to be oligogenetic rather than related to a single gene. No specific biological markers or neuroimages have been identified. As such, psychoses may be indicative of a more general pattern of brain dysfunction. Drug treatments are largely based on the adult literature because of a dearth of controlled data below age 18. There are still no rigorous studies of psychosocial treatments and psychotherapy specific to childhood psychosis.
Collapse
Affiliation(s)
- H Courvoisie
- Division of Child and Adolescent Psychiatry, Johns Hopkins Medical Institutions, Baltimore, Md, USA
| | | | | |
Collapse
|
35
|
Processing speed and executive functions predict real-world everyday living skills in adolescents with early-onset schizophrenia. Eur Child Adolesc Psychiatry 2012; 21:315-26. [PMID: 22354179 DOI: 10.1007/s00787-012-0262-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
Abstract
Cognition and clinical variables are known to be among the most predictive factors of real-world social functioning and daily living skills in adult-onset schizophrenia. Fewer studies have focused on their impact in adolescents with early-onset schizophrenia (EOS). The aim of this study is to examine the relationships and the predictive value of cognition and clinical variables on real-world daily living skills in a sample of adolescents with EOS. Cognitive, clinical and real-world everyday living skills measures were administered to 45 clinically and pharmacologically stabilized adolescent outpatients with EOS and 45 healthy control subjects matched by age and sex. Multi-variant analyses to compare cognitive and real-world functioning profiles between patients and controls and regression analysis to identify predictors of real-world functioning scores in patients were used. Adolescents with EOS showed a generalized cognitive and real-world daily living skills dysfunction. Several cognitive and clinical variables significantly correlated with real-world daily living skills functioning but only the processing speed and executive functions emerged as independent predictors of everyday living skills scores, explaining 25.1% of the variance. Slowness in processing information and executive dysfunction showed a significant impact on real-world daily living skills in EOS, independently from clinical symptoms and other cognitive variables. Nevertheless, much of the variance in the daily living skills measure remained unaccounted for, suggesting that other factors were involved as well in this young population.
Collapse
|
36
|
Kryzhanovskaya LA, Xu W, Millen BA, Acharya N, Jen KY, Osuntokun O. Comparison of long-term (at least 24 weeks) weight gain and metabolic changes between adolescents and adults treated with olanzapine. J Child Adolesc Psychopharmacol 2012; 22:157-65. [PMID: 22372514 DOI: 10.1089/cap.2010.0020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of these analyses was to compare the weight and other metabolic changes between adolescents and adults during long-term (at least 24 weeks) olanzapine treatment. METHOD The adult database included 86 studies with 12,425 patients with schizophrenia, schizoaffective disorder, depression, borderline personality disorder, or bipolar I disorder; the adolescent database comprised six studies with 489 patients with schizophrenia, schizoaffective disorder, borderline personality disorder, bipolar I disorder, or prodromal psychosis. Patients who had at least 24 weeks of olanzapine exposure (N=4,280 from adult database and N=179 from adolescent database) were analyzed in this study. Weight data were collected for all patients, fasting glucose and lipids data were collected in some patients. For weight gain, data in 34.5% adults (4,280/12,425) and 36.6% adolescents (179/489) were analyzed while for glucose and lipids, data in 8.4% (1,038/12,425) adults and 24.9% adolescents (122/489) were analyzed. Adult patients were treated with oral (5-20 mg/day) or depot formulations (doses equivalent to oral doses of 5-20 mg/day) of olanzapine and adolescent patients were treated with oral olanzapine (2.5-20 mg/day). The incidences of potentially clinically significant categorical changes in weight and metabolic parameters were calculated with a 95% confidence interval (CI). Nonoverlapping 95% CIs were considered as indicating a statistically significant difference. Weight, lipid, and glucose change comparisons are summarized. RESULTS The mean age for adolescents and adults was 15.8 and 38.8, respectively. The percentage of the male population was similar for both adults (58.5%) and adolescents (62.8%). The median duration of the follow-up period was 201 days for adolescent database and 280 days for adult database. The mean weight gain from baseline to endpoint in adolescents was 11.24 kg when compared with 4.81 kg in adults. The 95% CI for adolescents (10.1, 12.4) and adults (4.57, 5.04) are not overlapping, which indicates that the difference between adolescents and adults is statistically significant. The percentage of olanzapine-treated adolescents with ≥ 7% mean weight gain was 89.4% compared with 55.4% in adults (Number need to harm [NNH]=3). Mean changes from baseline to endpoint were also greater for adolescents than for adults in fasting total cholesterol (5.49 mg/dL vs. 2.06 mg/dL), LDL (5.41 mg/dL vs. 0.49 mg/dL), and triglycerides (20.49 mg/dL vs. 16.72 mg/dL), but overlapping 95% CIs were observed for all lipid parameters. Mean changes from baseline to endpoint in fasting glucose values were similar between adolescents and adults (3.13 mg/dL vs. 3.95 mg/dL). However, the incidence of treatment-emergent significant glucose changes was greater in adults. Among olanzapine-treated adults and adolescents, 8.9% and 0.9% experienced a shift from normal to high and 12.5% and 3.3% experienced a shift from normal/impaired glucose tolerance (IGT) to high fasting glucose, respectively. The incidence of IGT to high elevations in glucose was greater in adolescents, but overlapping 95% CI was observed. CONCLUSIONS The types of metabolic changes during the long-term olanzapine treatment in adolescents were similar to those observed in adults. However, the magnitude of changes in weight and lipid parameters was greater in adolescents. Patients should receive regular monitoring of weight, fasting blood glucose, and lipid profile at the beginning of, and periodically during, treatment with olanzapine.
Collapse
|
37
|
Affiliation(s)
- Stephen D Wright
- Leeds Partnerships NHS Foundation Trust; Central & North West Community Mental Health Team; Malham House 25 Hyde Terrace Leeds West Yorkshire UK LS2 9LN
| | - Soumitra S Datta
- Institute of Psychiatry, Kings College London; Department of Child and Adolescent Psychiatry PO85; De Crespigny Park London UK SE5 8AF
| | - Ajit Kumar
- University of Leeds; School of Medicine; 5 Willow Avenue Leeds UK LS4 2HF
| |
Collapse
|
38
|
Datta SS, Kumar A, Wright SD, Russell P. Typical antipsychotics for psychosis in adolescents. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Soumitra S Datta
- Institute of Psychiatry, Kings College London; Department of Child and Adolescent Psychiatry PO85; De Crespigny Park London UK SE5 8AF
| | - Ajit Kumar
- University of Leeds; School of Medicine; 5 Willow Avenue Leeds UK LS4 2HF
| | - Stephen D Wright
- Leeds Partnerships NHS Foundation Trust; Central & North West Community Mental Health Team; Malham House 25 Hyde Terrace Leeds West Yorkshire UK LS2 9LN
| | - Paul Russell
- Christian Medical College; Child & Adolescent Psychiatry; Vellore Tamil Nadu India 632002
| |
Collapse
|
39
|
Walker DM, Standen PJ. Level and pattern of neuropsychological functioning in early-onset psychoses. Eur Child Adolesc Psychiatry 2011; 20:551-60. [PMID: 21989901 DOI: 10.1007/s00787-011-0219-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 09/21/2011] [Indexed: 11/30/2022]
Abstract
The present study aimed to compare the level and pattern of cognitive deficits in patients with early-onset psychoses with an age, gender and IQ matched control group. In order to ensure a representative sample of patients with psychoses, participants with an IQ of less than 70 were included. Forty-eight patients with an onset of psychoses before the age of 16, and 47 age, gender and IQ matched controls without psychoses were recruited. Psychotic symptomatology was assessed using the Schedules for Clinical Assessment to obtain DSM-IV and ICD-10 diagnoses. Positive and negative symptoms were assessed using the Positive and Negative Symptoms Scale. Levels of cognitive function were measured using a comprehensive neuropsychological battery. A pattern of specific impairments was not found, with few significant differences between the two cohorts. However both cohort groups performed lower than age derived norms. Therefore it appears that there are global cognitive deficits rather than specific deficits in early-onset psychoses when compared to normative data, in-line with conclusions of early-onset schizophrenia research, but patients did not have greater deficit than controls when matched on IQ, gender and age, even after excluding participants with IQ less than 70.
Collapse
Affiliation(s)
- D-M Walker
- Division of Child and Adolescent Psychiatry, Medical School, Queen's Medical Centre, University of Nottingham, UK.
| | | |
Collapse
|
40
|
Carlson GA. Diagnostic stability and bipolar disorder in youth. J Am Acad Child Adolesc Psychiatry 2011; 50:1202-4. [PMID: 22115139 PMCID: PMC3224340 DOI: 10.1016/j.jaac.2010.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Revised: 07/13/2010] [Accepted: 07/15/2010] [Indexed: 10/15/2022]
|
41
|
Hassan GAM, Taha GRA. Long term functioning in early onset psychosis: two years prospective follow-up study. BEHAVIORAL AND BRAIN FUNCTIONS : BBF 2011; 7:28. [PMID: 21801438 PMCID: PMC3162891 DOI: 10.1186/1744-9081-7-28] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Accepted: 07/30/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND There were few studies on the outcome of schizophrenia in developing countries. Whether the outcome is similar to or different from developed world is still a point for research. The main aim of the current study was to know if patients with early onset non affective psychosis can behave and function properly after few years from start of the illness or not. Other aims included investigation of possible predictors and associated factors with remission and outcome. METHOD The study prospectively investigated a group of 56 patients with onset of psychosis during childhood or adolescence. Diagnosis made according to DSM-IV criteria and included; schizophrenia, psychotic disorder not otherwise specified and acute psychosis. Severity of psychosis was measured by PANSS. Measures of the outcome included; remission criteria of Andreasen et al 2005, the children's global assessment scale and educational level. RESULTS Analysis of data was done for only 37 patients. Thirty patients diagnosed as schizophrenia and 7 with Psychotic disorder not otherwise specified. Mean duration of follow up was 38.4 +/- 16.9 months. At the end of the study, 6 patients (16.2%) had one episode, 23 (62.1%) had multiple episodes and 8 (21.6%) continuous course. Nineteen patients (51.4%) achieved full remission, and only 11 (29.7%) achieved their average educational level for their age. Twenty seven percent of the sample had good outcome and 24.3% had poor outcome. Factors associated with non remission and poor outcome included gradual onset, low IQ, poor premorbid adjustment, negative symptoms at onset of the illness and poor adherence to drugs. Moreover, there was tendency of negative symptoms at illness start to predict poor outcome. CONCLUSION Some patients with early onset non affective psychosis can behave and function properly after few years from the start of the illness. Although remission is a difficult target in childhood psychosis, it is still achievable.
Collapse
Affiliation(s)
- Ghada AM Hassan
- Institute of Psychiatry, Ain Shams University, WHO Collaborating Center for Training and Research, Abbasia, Cairo, Egypt
| | - Ghada RA Taha
- Institute of Psychiatry, Ain Shams University, WHO Collaborating Center for Training and Research, Abbasia, Cairo, Egypt
| |
Collapse
|
42
|
Diagnostic stability of first-episode psychosis and predictors of diagnostic shift from non-affective psychosis to bipolar disorder: a retrospective evaluation after recurrence. Psychiatry Res 2011; 188:29-33. [PMID: 21056477 DOI: 10.1016/j.psychres.2010.09.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/28/2010] [Accepted: 09/30/2010] [Indexed: 11/21/2022]
Abstract
Diagnostic changes during follow-up are not uncommon with a first-episode psychosis (FEP). This study aimed to evaluate the diagnostic stability of the FEP and to identify factors associated with a diagnostic shift from non-affective psychosis to bipolar disorder. Considering that the diagnosis of FEP is frequently more definite after recurrence in many clinical settings, a retrospective evaluation after recurrence was preformed. Subjects were 150 patients with psychotic disorders who had been admitted to a psychiatric ward both for first episode and recurrence of their psychosis. Consensus diagnosis was made for each episode through a review of hospital records. Patients diagnosed with non-affective psychoses at the first episode were included in the analysis of predictive factors of a diagnostic shift to bipolar disorder. First-episode diagnoses were revised upon recurrence in 20.7% of patients. The most common change was to bipolar disorder accounting for more than half of all diagnostic changes. Schizophrenia exhibited the highest prospective and retrospective diagnostic consistencies. Female gender, short duration of untreated psychosis, high level of premorbid functioning, and several symptoms including lability, mood elation, hyperactivity, and delusions with religious or grandiose nature were identified as predictive factors for a diagnostic shift from non-affective psychosis to bipolar disorder. Clinical features of psychoses seem to evolve during the disease course resulting in diagnostic changes upon recurrence in a significant portion of FEP. Special consideration on a diagnostic shift to bipolar disorder is required in patients exhibiting the predictive factors identified in the current study.
Collapse
|
43
|
Chan J, Stringaris A, Ford T. Bipolar Disorder in Children and Adolescents Recognised in the UK: A Clinic-Based Study. Child Adolesc Ment Health 2011; 16:71-78. [PMID: 32847219 DOI: 10.1111/j.1475-3588.2010.00566.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diagnoses of paediatric bipolar disorder have increased over the last two decades in the United States, where high levels of comorbidity with ADHD have also been reported. AIMS To explore how British clinicians apply these diagnoses. METHOD We compared 378 young people under the age of 18 who received a diagnosis of bipolar disorder and/or ADHD from a large NHS mental health trust between 1992 and 2007. RESULTS Children with bipolar disorder were rare in this sample (n = 35, 1.0%), particularly under the age of 13 (n = 9, 0.3%). Children with bipolar disorder presented more often with affective and psychotic symptoms than children with ADHD. Irritability was common in both disorders. Core ADHD symptoms were prevalent in both conditions but occurred in a greater proportion of children with ADHD. CONCLUSION Our findings suggest that psychiatrists in England use the traditional adult criteria of bipolar disorder rather than the broader criteria being adopted by some practitioners in the US.
Collapse
Affiliation(s)
- Judy Chan
- The Cottage, St. Marks Hospital, Maidenhead SL6 6DU, UK. E-mail:
| | - Argyris Stringaris
- Institute of Psychiatry, King's College London, Denmark Hill, London SE5 8AF, UK
| | - Tamsin Ford
- Tamsin Ford, Peninsula College of Medicine and Dentistry, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
| |
Collapse
|
44
|
Cullen K, Guimaraes A, Wozniak J, Anjum A, Schulz SC, White T. Trajectories of social withdrawal and cognitive decline in the schizophrenia prodrome. ACTA ACUST UNITED AC 2011; 4:229-38. [PMID: 21177240 DOI: 10.3371/csrp.4.4.3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Schizophrenia is a heterogeneous neurodevelopmental disorder. Patients with high levels of negative symptoms have been identified as a specific subtype, but little is known about how the neurodevelopmental course may differ in this group. This study aimed to characterize developmental trajectories of premorbid social withdrawal and cognitive decline between patients with high versus low levels of negative symptoms in youth with schizophrenia-spectrum disorders. METHOD A standardized timeline was used to delineate the emergence of psychosis, social withdrawal, and cognitive decline in 52 subjects aged 8 to 19 with schizophrenia (n=36), schizophreniform (n=6), or schizoaffective disorder (n=10). The sample was divided into subgroups of high- (n=26) versus low- (n=26) negative symptoms, and developmental trajectories of premorbid symptoms were compared between groups. RESULTS Mean ages for emergence of social withdrawal, cognitive decline, and psychosis were 11.1 years (SD=2.5), 11.9 (SD=4.4) and 13.2 years (SD=1.2), respectively. In the high-negative symptom group, the premorbid developmental trajectory for social withdrawal was more protracted. This group also had more severe cognitive decline at the onset of psychosis, but the premorbid trajectories for cognitive decline did not differ significantly between groups. CONCLUSIONS This work documents a more severe and protracted trajectory of premorbid social withdrawal in patients with high levels of negative symptoms in comparison to those with low-negative symptoms. The findings reported here are supportive of the hypothesis that patients with illness characterized by high levels of negative symptoms may represent a subgroup with distinct neurodevelopmental abnormalities.
Collapse
Affiliation(s)
- Kathryn Cullen
- Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, USA.
| | | | | | | | | | | |
Collapse
|
45
|
Hua LL, Wilens TE, Martelon M, Wong P, Wozniak J, Biederman J. Psychosocial functioning, familiality, and psychiatric comorbidity in bipolar youth with and without psychotic features. J Clin Psychiatry 2011; 72:397-405. [PMID: 21450156 PMCID: PMC3740758 DOI: 10.4088/jcp.10m06025yel] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 05/04/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Few studies have examined the correlates of psychosis in children and adolescents with bipolar disorder (BPD). We examined psychiatric comorbidity, familiality, and psychosocial functioning in multiple domains in BPD children and adolescents with and without psychotic features. METHOD As part of 2 ongoing family-based studies of children and adolescents with DSM-IV-defined BPD, we compared youth and their families with psychotic symptoms (BPD+P) and without psychotic symptoms (BPD-P). All youth and family members were assessed using indirect and direct structured psychiatric interviews (Kiddie Schedule for Affective Disorders-Epidemiologic Version and DSM-IV Structured Clinical Interview) in a blinded manner. One study was conducted from January 2000 through December 2004, and the other study was conducted from February 1997 through September 2006. RESULTS Of the 226 youth with BPD, 33% manifested psychotic symptoms, as defined by the presence of hallucinations or delusions. We found that BPD+P youth had a greater number of BPD episodes (P < .01), more psychiatric hospitalizations (P < .01), and significantly higher rates of psychiatric comorbidity compared to BPD-P youth (all P values < .05). Additionally, a higher percentage of BPD+P youth had a family history of psychosis (P = .01). There was a lower processing speed (P = .03) and lower arithmetic scaled score (P = .04) in BPD+P youth, but no other meaningful differences in cognitive variables were identified between the 2 BPD groups. Psychosis in BPD was also associated with decreased family cohesion (P = .04) and poorer overall global functioning (P < .01). CONCLUSIONS In children and adolescents with BPD, those who manifest psychotic features have higher rates of comorbid psychopathology, family history of psychosis, and poorer overall functioning in multiple domains than BPD children without psychosis. Future studies should examine neuroimaging correlates, medication response, and longitudinal course of children and adolescents with BPD who manifest psychosis as part of their clinical picture.
Collapse
Affiliation(s)
- Liwei L Hua
- Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, USA
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
AIM Early-onset schizophrenia (onset before adulthood) is a rare and severe form of the disorder that shows phenotypic and neurobiological continuity with adult-onset schizophrenia. Here, we provide a synthesis of keynote findings in this enriched population to understand better the neurobiology and pathophysiology of early-onset schizophrenia. METHODS A synthetic and integrative approach is applied to review studies stemming from epidemiology, phenomenology, cognition, genetics and neuroimaging data. We provide conclusions and future directions of research on early-onset schizophrenia. RESULTS Childhood and adolescent-onset schizophrenia is associated with severe clinical course, greater rates of premorbid abnormalities, poor psychosocial functioning and increased severity of brain abnormalities. Early-onset cases show similar neurobiological correlates and phenotypic deficits to adult-onset schizophrenia, but show worse long-term psychopathological outcome. Emerging technological advances have provided important insights into the genomic architecture of early-onset schizophrenia, suggesting that some genetic variations may occur more frequently and at a higher rate in young-onset than adult-onset cases. CONCLUSIONS Clinical, cognitive, genetic and imaging data suggest increased severity in early-onset schizophrenia. Studying younger-onset cases can provide useful insights into the neurobiological mechanisms of schizophrenia and the complexity of gene-environment interactions leading to the emergence of this debilitating disorder.
Collapse
Affiliation(s)
- Nora S Vyas
- Child Psychiatry Branch, National Institute of Mental Health, NIH, Bethesda, Maryland, USA.
| | | | | |
Collapse
|
47
|
Carlisle LL, McClellan J. Psychopharmacology of schizophrenia in children and adolescents. Pediatr Clin North Am 2011; 58:205-18, xii. [PMID: 21281857 DOI: 10.1016/j.pcl.2010.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The past 5 five years have seen major advances in the diagnosis and treatment of schizophrenia in children and adolescents. This article, reviews the clinical and diagnostic characteristics of schizophrenia in youth with an eye toward recent findings. This article also provides a more extensive review and update of the psychopharmacology of early-onset schizophrenia.
Collapse
Affiliation(s)
- L Lee Carlisle
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA.
| | | |
Collapse
|
48
|
Le Galudec M, Stephan F, Mascret R, Bourgin J, Walter M. Diagnostic précoce dans la schizophrénie : une mission pour les médecins généralistes ? Presse Med 2011; 40:3-9. [DOI: 10.1016/j.lpm.2010.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 09/07/2010] [Accepted: 09/09/2010] [Indexed: 10/18/2022] Open
|
49
|
|
50
|
Ramirez N, Arranz B, Salavert J, Alvarez E, Corripio I, Dueñas RM, Perez V, San L. Predictors of schizophrenia in patients with a first episode of psychosis. Psychiatry Res 2010; 175:11-4. [PMID: 19923008 DOI: 10.1016/j.psychres.2009.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 02/17/2009] [Accepted: 03/19/2009] [Indexed: 11/19/2022]
Abstract
Early identification of schizophrenia in patients with a first episode of psychosis (FEP) may help to avoid inappropriate treatment and may enhance long-term outcome by addressing issues such as family network, treatment adherence and functional and symptomatic outcome. It was the aim of the study to determine baseline variables that significantly predicted a diagnosis of schizophrenia in patients with FEP. The sample consisted of 133 FEP patients hospitalized for at least 6 weeks, in whom a DSM-IV diagnosis was confirmed after 1 year follow-up. Patients were divided into two groups, those with a diagnosis of schizophrenia (Schizophrenia group, n=63; 47.8%), and those with other psychosis, who were grouped under Non-Schizophrenic Psychosis (NSP, n=70; 52.2%). Sociodemographic (marital status, educational level) and clinical variables were recorded for each patient. Substance use (alcohol, cannabis and cocaine) did not statistically differ between the two groups. Absence of characteristics defined as criteria for good prognosis, lack of > or = 20% improvement in the total Positive and Negative Syndrome Scale score at 6 weeks, and a poor premorbid adjustment as determined by the Premorbid Adjustment Scale score significantly predicted the presence of schizophrenia. The regression model including these three variables achieved a predictive value of 76.3%, with a sensitivity of 74.6% and a specificity of 77.9%.
Collapse
Affiliation(s)
- Nicolas Ramirez
- Department of Psychiatry, Hospital San Rafael, Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|