1
|
Ju S, Shin Y, Han S, Kwon J, Choi TG, Kang I, Kim SS. The Gut-Brain Axis in Schizophrenia: The Implications of the Gut Microbiome and SCFA Production. Nutrients 2023; 15:4391. [PMID: 37892465 PMCID: PMC10610543 DOI: 10.3390/nu15204391] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Schizophrenia, a severe mental illness affecting about 1% of the population, manifests during young adulthood, leading to abnormal mental function and behavior. Its multifactorial etiology involves genetic factors, experiences of adversity, infection, and gene-environment interactions. Emerging research indicates that maternal infection or stress during pregnancy may also increase schizophrenia risk in offspring. Recent research on the gut-brain axis highlights the gut microbiome's potential influence on central nervous system (CNS) function and mental health, including schizophrenia. The gut microbiota, located in the digestive system, has a significant role to play in human physiology, affecting immune system development, vitamin synthesis, and protection against pathogenic bacteria. Disruptions to the gut microbiota, caused by diet, medication use, environmental pollutants, and stress, may lead to imbalances with far-reaching effects on CNS function and mental health. Of interest are short-chain fatty acids (SCFAs), metabolic byproducts produced by gut microbes during fermentation. SCFAs can cross the blood-brain barrier, influencing CNS activity, including microglia and cytokine modulation. The dysregulation of neurotransmitters produced by gut microbes may contribute to CNS disorders, including schizophrenia. This review explores the potential relationship between SCFAs, the gut microbiome, and schizophrenia. Our aim is to deepen the understanding of the gut-brain axis in schizophrenia and to elucidate its implications for future research and therapeutic approaches.
Collapse
Affiliation(s)
- Songhyun Ju
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea; (S.J.); (Y.S.); (S.H.); (J.K.)
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea;
- Biomedical Science Institute, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Yoonhwa Shin
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea; (S.J.); (Y.S.); (S.H.); (J.K.)
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea;
- Biomedical Science Institute, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Sunhee Han
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea; (S.J.); (Y.S.); (S.H.); (J.K.)
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea;
- Biomedical Science Institute, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Juhui Kwon
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea; (S.J.); (Y.S.); (S.H.); (J.K.)
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea;
- Biomedical Science Institute, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Tae Gyu Choi
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea;
| | - Insug Kang
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea; (S.J.); (Y.S.); (S.H.); (J.K.)
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea;
- Biomedical Science Institute, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Sung Soo Kim
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea; (S.J.); (Y.S.); (S.H.); (J.K.)
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea;
- Biomedical Science Institute, Kyung Hee University, Seoul 02447, Republic of Korea
| |
Collapse
|
2
|
Hattori S, Suda A, Kishida I, Miyauchi M, Shiraishi Y, Noguchi N, Furuno T, Asami T, Fujibayashi M, Tsujita N, Ishii C, Ishii N, Saeki T, Fukushima T, Moritani T, Saigusa Y, Hishimoto A. Differences in autonomic nervous system activity between long-acting injectable aripiprazole and oral aripiprazole in schizophrenia. BMC Psychiatry 2023; 23:135. [PMID: 36869320 PMCID: PMC9983165 DOI: 10.1186/s12888-023-04617-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 02/20/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Distinct oral atypical antipsychotics have different effects on autonomic nervous system (ANS) activity. Among them, oral aripiprazole has been linked to dysfunction of the ANS in schizophrenia. Long-acting injectable aripiprazole is a major treatment option for schizophrenia, but the effect of the aripiprazole formulation on ANS activity remains unclear. In this study, we compared ANS activity between oral aripiprazole and aripiprazole once-monthly (AOM) in schizophrenia. METHODS Of the 122 patients with schizophrenia who participated in this study, 72 received oral aripiprazole and 50 received AOM as monotherapy. We used power spectral analysis of heart rate variability to assess ANS activity. RESULTS Patients who received oral aripiprazole showed significantly diminished sympathetic nervous activity compared with those who received AOM. Multiple regression analysis revealed that the aripiprazole formulation significantly influenced sympathetic nervous activity. CONCLUSION Compared with oral aripiprazole, AOM appears to have fewer adverse effects, such as sympathetic nervous dysfunction.
Collapse
Affiliation(s)
- Saki Hattori
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan. .,Fujisawa Hospital, 383 Kotsuka Fujisawa, Yokohama, 251-8530, Fujisawa, Japan.
| | - Akira Suda
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
| | - Ikuko Kishida
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan.,Fujisawa Hospital, 383 Kotsuka Fujisawa, Yokohama, 251-8530, Fujisawa, Japan
| | - Masatoshi Miyauchi
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
| | - Yohko Shiraishi
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
| | - Nobuhiko Noguchi
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
| | - Taku Furuno
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
| | - Takeshi Asami
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
| | - Mami Fujibayashi
- Division of Physical and Health Education, Setsunan University, 17-8 Ikedanakamachi, Neyagawa, 572- 8508, Osaka, Japan
| | - Natsuki Tsujita
- Graduate School of Human and Environmental Studies, Kyoto University, Yoshidanihonmatsucho, Sakyo-ku, Kyoto, 606-8316, Japan
| | - Chie Ishii
- Fujisawa Hospital, 383 Kotsuka Fujisawa, Yokohama, 251-8530, Fujisawa, Japan
| | - Norio Ishii
- Fujisawa Hospital, 383 Kotsuka Fujisawa, Yokohama, 251-8530, Fujisawa, Japan
| | - Takashi Saeki
- Asahinooka Hospital, 128-1 Kawaihonchou, Asahi-ku, Yokohama, 251-8530, Kanagawa, Japan
| | - Tadashi Fukushima
- Asahinooka Hospital, 128-1 Kawaihonchou, Asahi-ku, Yokohama, 251-8530, Kanagawa, Japan
| | - Toshio Moritani
- Graduate School of Human and Environmental Studies, Kyoto University, Yoshidanihonmatsucho, Sakyo-ku, Kyoto, 606-8316, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
| |
Collapse
|
3
|
Blok-Husum L, Brcelic MAR, Bassi HKFK, Jensen SE, Nielsen RE, Kragholm K, Fleischer J, Laugesen E, Polcwiartek C. Cardiovascular autonomic reflex tests using a handheld device in the diagnosis of cardiovascular autonomic neuropathy in patients with schizophrenia. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 26:100252. [PMID: 38510185 PMCID: PMC10945952 DOI: 10.1016/j.ahjo.2023.100252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 03/22/2024]
Abstract
Study objective This study investigated whether schizophrenia and the duration of schizophrenia were associated with cardiovascular autonomic neuropathy (CAN) by using heart rate variability (HRV) as a marker. Design Cross-sectional study. Setting The examinations were conducted at the Centre for Psychosis Research and at the Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. Participants 240 patients with first-episode and chronic schizophrenia and 180 controls. Interventions CAN was assessed by the cardiovascular reflex tests (CARTs): HR, RS ratio, E:I ratio, and VM using a handheld device. Main outcome measures One abnormal CART was interpreted as borderline CAN and ≥2 abnormal CARTs established definitive CAN. Borderline CAN and definitive CAN together was categorized as overall CAN. Analyses were adjusted for age, sex, smoking, overweight, and hypercholesterolemia. Results A total of 240 patients with schizophrenia (median age 42.5 [28.8, 52.3], 42.9 % women) and 180 controls (median age 45.8 [24.0, 60.1], 47.8 % women) were included, with 50.8 % of patients with schizophrenia having overall CAN compared to 27.2 % among controls. Dividing patients into patients with first-episode and chronic schizophrenia, 32.9 % vs 10 % (p < 0.001) and 59.1 % vs 41 % (p < 0.001) had overall CAN compared with controls, respectively. Schizophrenia was significantly associated with overall CAN (OR, 2.80; 95%CI, 1.75-4.50), with an OR of 2.31 (95%CI, 1.14-4.68) for first-episode schizophrenia and an OR of 2.97 (95%CI, 1.81-4.87) for chronic schizophrenia. Conclusion It was demonstrated that a diagnosis of schizophrenia was associated with CAN. Patients with chronic schizophrenia had a significantly higher prevalence of CAN compared to patients with first-episode schizophrenia, suggesting an association between the duration of schizophrenia and CAN.
Collapse
Affiliation(s)
- Laura Blok-Husum
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | | | | | - Svend Eggert Jensen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rene Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark
| | - Kristian Kragholm
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - Jesper Fleischer
- Steno Diabetes Center Aarhus, Aarhus, Denmark
- Steno Diabetes Center Zealand, Zealand, Denmark
| | - Esben Laugesen
- Regional Hospital Horsens, Department of Medicine, Horsens, Denmark
| | | |
Collapse
|
4
|
Chen PY, Chiu CC, Hsieh TH, Liu YR, Chen CH, Huang CY, Lu ML, Huang MC. The relationship of antipsychotic treatment with reduced brown adipose tissue activity in patients with schizophrenia. Psychoneuroendocrinology 2022; 142:105775. [PMID: 35594830 DOI: 10.1016/j.psyneuen.2022.105775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Antipsychotic drug (APD) treatment has been associated with metabolic abnormalities. Brown adipose tissue (BAT) is the main site of adaptive thermogenesis and secretes various metabolism-improving factors known as batokines. We explored the association of BAT activity with APD treatment and metabolic abnormalities in patients with schizophrenia by measuring the blood levels of bone morphogenetic protein 8b (BMP8b), a batokine secreted by mature BAT. METHODS BMP8b levels were compared among 50 drug-free, 32 aripiprazole-treated, and 91 clozapine-treated patients with schizophrenia. Regression analysis was used to explore factors, including APD types, that might be associated with BMP8b levels and the potential effect of BMP8b on metabolic syndrome (MS). RESULTS APD-treated patients had decreased BMP8b levels relative to drug-free patients. The difference still existed after adjustment for body mass index and Brief Psychiatric Rating Scale scores. Among APD-treated group, clozapine was associated with even lower BMP8b levels than the less obesogenic APD, aripiprazole. Furthermore, higher BMP8b levels were associated with lower risks of MS after adjustment for BMI and APD treatment. CONCLUSION Using drug-free patients as the comparison group to understand the effect of APDs, this is the first study to show APD treatment is associated with reduced BAT activity that is measured by BMP8b levels, with clozapine associated a more significant reduction than aripiprazole treatment. BMP8b might have a beneficial effect against metabolic abnormalities and this effect is independent of APD treatment. Future studies exploring the causal relationship between APD treatment and BMP8b levels and the underlying mechanisms are warranted.
Collapse
Affiliation(s)
- Po-Yu Chen
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychology, National Cheng-chi University, Taiwan
| | - Chih-Chiang Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Tsung-Han Hsieh
- Joint Biobank, Office of Human Research, Taipei Medical University, Taiwan
| | - Yun-Ru Liu
- Joint Biobank, Office of Human Research, Taipei Medical University, Taiwan
| | - Chun-Hsin Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Cho-Yin Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, 250 Wu-Hsing Street, 110 Taipei, Taiwan.
| |
Collapse
|
5
|
Sandhya M, Mittal S, Kathrotia R, Rawat VS, Singh Y, Srikant S, Agrawal M, Mohan L. Cardiovascular Autonomic Function Tests in Patients of Obsessive-Compulsive Disorder: A Cross-Sectional Study. Indian J Psychol Med 2022; 44:30-36. [PMID: 35509660 PMCID: PMC9022922 DOI: 10.1177/02537176211042805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with psychiatric disorders are at an increased risk of developing cardiovascular disease, reducing life expectancy. Autonomic dysfunction has been linked to this increased risk; many studies have found reductions in heart rate variability (HRV). Only a few studies have systematically explored the relationship between obsessive-compulsive disorder (OCD) and autonomic function, and they have found contradicting results. The present study is intended to explore comprehensive autonomic functions in OCD patients and compare them with healthy controls. METHODS A total of 18 OCD patients meeting Diagnostic and Statistical Manual of Mental Disorders - 5 (DSM-5) criteria were enrolled to undergo comprehensive autonomic function testing, and the results were compared with 25 age- and sex-matched healthy controls. RESULTS Time-domain parameters of HRV such as standard deviation of the RR intervals, coefficient of variance of RR intervals, standard deviation of differences between adjacent RR intervals, root square of the mean of the sum of the squares of differences between adjacent RR intervals, and percentage of number of RR interval differences ≥ 50 ms were significantly lower in OCD patients, indicating lesser parasympathetic tone. Frequency-domain parameters such as total power and very low frequency were significantly lower in OCD patients, indicating a significant decrease in autonomic tone. Nonlinear parameters such as dispersion of points perpendicular to the line of identity and dispersion of points along the line of identity were significantly lower in OCD patients, indicating altered vagal and sympathetic tone. In autonomic reactivity tests, the fall in systolic blood pressure during the lying to standing test and change in diastolic blood pressure during the cold pressor test were significantly altered in OCD patients, indicating abnormal sympathetic reactivity. There was no significant correlation between autonomic parameters and the severity of OCD. CONCLUSION OCD is characterized by a decreased parasympathetic tone and abnormal sympathetic reactivity compared to normal controls.
Collapse
Affiliation(s)
- Sandhya M
- Dept. of Physiology, AIIMS, Rishikesh, Uttarakhand, India
| | - Sunita Mittal
- Dept. of Physiology, AIIMS, Rishikesh, Uttarakhand, India
| | | | | | - Yogesh Singh
- Dept. of Physiology, AIIMS, Rishikesh, Uttarakhand, India
| | - Srikant S
- Dept. of Physiology, AIIMS, Rishikesh, Uttarakhand, India
| | - Megha Agrawal
- Dept. of Physiology, Government Medical College, Haldwani, Uttarakhand, India
| | - Latika Mohan
- Dept. of Physiology, AIIMS, Rishikesh, Uttarakhand, India
| |
Collapse
|
6
|
Büki A, Kekesi G, Horvath G, Vécsei L. A Potential Interface between the Kynurenine Pathway and Autonomic Imbalance in Schizophrenia. Int J Mol Sci 2021; 22:10016. [PMID: 34576179 PMCID: PMC8467675 DOI: 10.3390/ijms221810016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
Schizophrenia is a neuropsychiatric disorder characterized by various symptoms including autonomic imbalance. These disturbances involve almost all autonomic functions and might contribute to poor medication compliance, worsened quality of life and increased mortality. Therefore, it has a great importance to find a potential therapeutic solution to improve the autonomic disturbances. The altered level of kynurenines (e.g., kynurenic acid), as tryptophan metabolites, is almost the most consistently found biochemical abnormality in schizophrenia. Kynurenic acid influences different types of receptors, most of them involved in the pathophysiology of schizophrenia. Only few data suggest that kynurenines might have effects on multiple autonomic functions. Publications so far have discussed the implication of kynurenines and the alteration of the autonomic nervous system in schizophrenia independently from each other. Thus, the coupling between them has not yet been addressed in schizophrenia, although their direct common points, potential interfaces indicate the consideration of their interaction. The present review gathers autonomic disturbances, the impaired kynurenine pathway in schizophrenia, and the effects of kynurenine pathway on autonomic functions. In the last part of the review, the potential interaction between the two systems in schizophrenia, and the possible therapeutic options are discussed.
Collapse
Affiliation(s)
- Alexandra Büki
- Department of Physiology, Albert Szent-Györgyi Medical School, University of Szeged, Dóm tér 10., H-6720 Szeged, Hungary; (A.B.); (G.K.); (G.H.)
| | - Gabriella Kekesi
- Department of Physiology, Albert Szent-Györgyi Medical School, University of Szeged, Dóm tér 10., H-6720 Szeged, Hungary; (A.B.); (G.K.); (G.H.)
| | - Gyongyi Horvath
- Department of Physiology, Albert Szent-Györgyi Medical School, University of Szeged, Dóm tér 10., H-6720 Szeged, Hungary; (A.B.); (G.K.); (G.H.)
| | - László Vécsei
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6., H-6725 Szeged, Hungary
- MTA-SZTE Neuroscience Research Group, H-6725 Szeged, Hungary
- Interdisciplinary Excellence Center, Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6., H-6725 Szeged, Hungary
| |
Collapse
|
7
|
García-Portilla MP, García-Álvarez L, González-Blanco L, Dal Santo F, Bobes-Bascarán T, Martínez-Cao C, García-Fernández A, Sáiz PA, Bobes J. Real-World Functioning in Patients With Schizophrenia: Beyond Negative and Cognitive Symptoms. Front Psychiatry 2021; 12:700747. [PMID: 34434128 PMCID: PMC8381019 DOI: 10.3389/fpsyt.2021.700747] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Interest in the idea of recovery for certain patients with schizophrenia has been growing over the last decade. Improving symptomatology and functioning is crucial for achieving this. Our study aims to identify those factors that substantially contribute to real-world functioning in these patients. Methods: We carried out a cross-sectional study in stable outpatients with schizophrenia on maintenance antipsychotic monotherapy. Patients: We studied 144 outpatients with schizophrenia (DSM-IV-TR criteria) meeting the following criteria: (1) 18-65 years of age; (2) being clinically stable for at least the previous three months; (3) on maintenance antipsychotic monotherapy (prescriptions ≤ 10 mg olanzapine, ≤200 mg quetiapine, or ≤100 mg levomepromazine as hypnotics were also allowed); and (4) written informed consent. Assessment: We collected information on demographic and clinical variables by using an ad hoc questionnaire. For psychopathology, we employed the Spanish versions of the following psychometric instruments: the Positive and Negative Syndrome Scale (PANSS), the Brief Negative Symptom Scale (BNSS-Sp), and the Calgary Depression Scale (CDS). In addition, cognitive domains were assessed using the Verbal Fluency Test (VFT), the Digit Symbol Substitution Test (DSST), and the Trail Making Test, parts A and B (TMT-A and TMT-B). Finally, we employed the Spanish versions of the University of California San Diego Performance-based Skills Assessment (Sp-UPSA) and the Personal and Social Performance (PSP) for assessing functional capacity and real-world functioning, respectively. Statistical analysis: A forward stepwise regression was conducted by entering those variables significantly associated with PSP total score into the univariate analyses (Student's t-test, ANOVA with Duncan's post-hoc test, or bivariate Pearson correlation). Results: A total of 144 patients; mean age 40 years, 64% males, mean length of illness 12.4 years, PSP total score 54.3. The final model was a significant predictor of real-world functioning [F (7, 131) = 36.371, p < 0.001] and explained 66.0% of the variance. Variables retained in the model: BNSS-Sp abulia, asociality, and blunted affect, PANSS general psychopathology, Sp-UPSA transportation, TMT-B, and heart rate. Conclusion: Our model will contribute to a more efficient and personalized daily clinical practice by assigning specific interventions to each patient based on specific impaired factors in order to improve functioning.
Collapse
Affiliation(s)
- María Paz García-Portilla
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Leticia García-Álvarez
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
- Department of Psychology, Universidad de Oviedo, Oviedo, Spain
| | - Leticia González-Blanco
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Francesco Dal Santo
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Teresa Bobes-Bascarán
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
- Department of Psychology, Universidad de Oviedo, Oviedo, Spain
| | - Clara Martínez-Cao
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Ainoa García-Fernández
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Pilar A. Sáiz
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Julio Bobes
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| |
Collapse
|
8
|
Stogios N, Gdanski A, Gerretsen P, Chintoh AF, Graff-Guerrero A, Rajji TK, Remington G, Hahn MK, Agarwal SM. Autonomic nervous system dysfunction in schizophrenia: impact on cognitive and metabolic health. NPJ SCHIZOPHRENIA 2021; 7:22. [PMID: 33903594 PMCID: PMC8076312 DOI: 10.1038/s41537-021-00151-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/18/2021] [Indexed: 12/17/2022]
Abstract
Schizophrenia (SCZ) is a psychiatric disorder characterized by a wide range of positive, negative and cognitive symptoms, along with an increased risk of metabolic syndrome and cardiovascular disease that contribute to a 15-20-year reduced life expectancy. Autonomic dysfunction, in the form of increased sympathetic activity and decreased parasympathetic activity, is postulated to be implicated in SCZ and its treatment. The aim of this narrative review is to view SCZ through an autonomic lens and synthesize the evidence relating autonomic dysfunction to different domains of SCZ. Using various methods of assessing autonomic activity, autonomic dysfunction was found to be associated with multiple aspects of SCZ pathophysiology, including symptom severity, cognitive impairment, and the development of cardiometabolic comorbidities, such as metabolic syndrome and high BMI. The strongest association of low heart rate variability was noted among patients on antipsychotic treatment with high-affinity muscarinic antagonism (i.e., clozapine, olanzapine and quetiapine). The review will also suggest ways in which studying autonomic dysfunction can help reduce morbidity and mortality associated with SCZ and its treatment.
Collapse
Affiliation(s)
- Nicolette Stogios
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Center for Addiction and Mental Health (CAMH), Toronto, Canada
| | | | - Philip Gerretsen
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Center for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Araba F Chintoh
- Center for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ariel Graff-Guerrero
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Center for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Tarek K Rajji
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Center for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Center for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Margaret K Hahn
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Center for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sri Mahavir Agarwal
- Institute of Medical Science, University of Toronto, Toronto, Canada. .,Center for Addiction and Mental Health (CAMH), Toronto, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Canada.
| |
Collapse
|
9
|
Liu Y, Huang Y, Zhou J, Li G, Chen J, Xiang Z, Wu F, Wu K. Altered Heart Rate Variability in Patients With Schizophrenia During an Autonomic Nervous Test. Front Psychiatry 2021; 12:626991. [PMID: 33912081 PMCID: PMC8074969 DOI: 10.3389/fpsyt.2021.626991] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/26/2021] [Indexed: 01/12/2023] Open
Abstract
Reduced heart rate variability (HRV) and dysfunction of the autonomic nervous system (ANS) have been observed in schizophrenia patients. HRV parameters of schizophrenia patients in the resting state have been well-documented; however, these parameters of schizophrenia patients who experience continuous psychophysiological stress remain unclear. The objective of this study was to systematically explore the linear and nonlinear HRV parameters between schizophrenia patients and normal controls and to detect the adaptive capabilities of HRV of schizophrenia patients during the stimulation tests of autonomic nervous system. Forty-five schizophrenia patients and forty-five normal controls, matched for age, sex and body mass index, completed a 14 min ANS test. Thirteen linear and nonlinear HRV parameters of all subjects under the ANS test were computed and statistically analyzed between groups and between sessions. The STROBE checklist was adhered to in this study. All time-domain HRV features in the ANS test were significantly different between schizophrenia patients and normal controls (p < 0.01). The schizophrenia patients showed significantly low values in the Poincaré indices, which revealed significantly decreased heart rate fluctuation complexity compared with that of normal controls (p < 0.001). In addition, the normal controls, not schizophrenia patients, showed significant differences between the recovery and stress states in the parameters of low frequency, high frequency, and nonlinear dynamics. Schizophrenia patients showed autonomic dysfunction of the heart in a series of stimulation tests of the autonomic nervous system and could not regain normal physiological functions after stress cessation. Our findings revealed that the dynamic parameters of HRV in psychophysiological stress are sensitive and practical for a diagnosis of schizophrenia.
Collapse
Affiliation(s)
- Ya Liu
- Department of Biomedical Engineering, School of Material Science and Engineering, South China University of Technology, Guangzhou, China.,National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yuanyuan Huang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Jing Zhou
- Department of Biomedical Engineering, School of Material Science and Engineering, South China University of Technology, Guangzhou, China.,National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Guixiang Li
- Department of Scientific Research, Institute of Health Medicine, Guangdong Academy of Sciences, Guangzhou, China.,Guangdong Engineering Technology Research Center for Diagnosis and Rehabilitation of Dementia, Guangzhou, China
| | - Jun Chen
- Department of Scientific Research, Institute of Health Medicine, Guangdong Academy of Sciences, Guangzhou, China.,Guangdong Engineering Technology Research Center for Diagnosis and Rehabilitation of Dementia, Guangzhou, China
| | - Zhiming Xiang
- Department of Radiology, Panyu Central Hospital of Guangzhou, Guangzhou, China
| | - Fengchun Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Kai Wu
- Department of Biomedical Engineering, School of Material Science and Engineering, South China University of Technology, Guangzhou, China.,National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China.,Guangdong Engineering Technology Research Center for Diagnosis and Rehabilitation of Dementia, Guangzhou, China.,Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou, China.,Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| |
Collapse
|
10
|
Cheng SL, Yang FC, Chu HT, Tsai CK, Ku SC, Tseng YT, Yeh TC, Liang CS. Incongruent Expression of Brain-Derived Neurotrophic Factor and Cortisol in Schizophrenia: Results from a Randomized Controlled Trial of Laughter Intervention. Psychiatry Investig 2020; 17:1191-1199. [PMID: 33301667 PMCID: PMC8560332 DOI: 10.30773/pi.2020.0269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/20/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Schizophrenia has been associated with dysfunction of the hypothalamic-pituitary-adrenal axis. Furthermore, alterations in neurotrophic factors might contribute to the pathogenesis of schizophrenia. We aimed to evaluate the effects of a simulated laughter intervention on the levels of cortisol and BDNF and to determine whether the effects associated with simulated laughter could be sustained after discontinuation of the intervention. METHODS In this randomized controlled study, patients with schizophrenia according to DSM-IV clinical criteria were randomly assigned to receive either 8-week-long simulated laughter intervention (n=32) or treatment-as-usual group (control group, n=27). The serum levels of BDNF and cortisol were measured at baseline, week 8, and four weeks after discontinuation (week 12) of the intervention program. RESULTS After an 8-week simulated laughter intervention, the laughter group had significantly higher levels of BDNF; however, four weeks after discontinuation of the intervention, the levels of BDNF significantly dropped. Interestingly, the levels of cortisol did not change significantly at week 8, but they were significantly elevated at week 12. The levels of BDNF and cortisol in the control group did not change significantly between week 0 and week 8. CONCLUSION These findings suggest that the simulated laughter intervention has an early effect on neurogenesis with a significant delayed effect on stress regulation in subjects with schizophrenia.
Collapse
Affiliation(s)
- Shu-Li Cheng
- Department of Nursing, Mackay Medical College, Taipei, Taiwan, ROC
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsuan-Te Chu
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chia-Kuang Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shih-Chieh Ku
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yu-Ting Tseng
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Division of Psychiatry, Penghu Branch, Tri-Service General Hospital, Penghu, Taiwan, ROC
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| |
Collapse
|
11
|
Tai YC, Lin SH, Chen KC, Lee IH, Chen PS, Lee LT, Tsai HC, Yeh TL, Yang YK. Heart Rate Variability with Deep Breathing in Drug-Naïve Patients with Schizophrenia. Appl Psychophysiol Biofeedback 2020; 45:275-282. [PMID: 32997269 DOI: 10.1007/s10484-020-09489-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 01/03/2023]
Abstract
Abnormal autonomic nervous system (ANS) function may result in poor outcomes in patients with schizophrenia. Altered cardio-respiratory coupling, which indicates suppression of vagal activity, was identified as an important trait in patients with schizophrenia and their unaffected relatives. Heart rate variability (HRV) in standardized bedside reflex tests has been studied, mostly in medicated patients with schizophrenia whose ANS function could be influenced by medication. Our study aimed to explore the autonomic function differences between drug-naïve patients with schizophrenia and healthy individuals during challenge tests combining respiration and HRV analysis. Forty-two drug-naïve patients with schizophrenia were matched with 42 healthy controls in terms of age and gender. Their beat-to-beat blood pressure and heart rate were monitored in the supine position as a survey of ANS function, and the mean heart rate range (MHRR) was measured under deep-breathing challenge. A decreased MHRR, a sensitive sign indicating an impaired parasympathetic response, during the deep-breathing challenge among the drug-naïve patients with schizophrenia was found. Drug-naïve patients with schizophrenia may have a parasympathetic dysfunction in the early stages of schizophrenia before medication is introduced, which could be considered a neurobiological marker in the pathophysiology of schizophrenia.
Collapse
Affiliation(s)
- Ying Chun Tai
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist., Tainan, 704, Taiwan
| | - Shih-Hsien Lin
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist., Tainan, 704, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kao Chin Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist., Tainan, 704, Taiwan.
| | - I Hui Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist., Tainan, 704, Taiwan
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist., Tainan, 704, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Lan-Ting Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist., Tainan, 704, Taiwan
| | - Hsin Chun Tsai
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist., Tainan, 704, Taiwan
| | - Tzung Lieh Yeh
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist., Tainan, 704, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist., Tainan, 704, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| |
Collapse
|
12
|
Fitzgerald JL, Hay K, Sheridan J, Chadwick A, Burke A, Haqqani HM. Late Potentials and Early Repolarisation Are Associated With Serious Mental Illness and May Portend Increased Arrhythmic Risk. Heart Lung Circ 2020; 29:1476-1483. [PMID: 32327309 DOI: 10.1016/j.hlc.2020.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 02/17/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patients with serious mental illness (SMI) have an increased risk of sudden death. Higher rates of signal-averaged electrocardiogram (SAECG) abnormal late potentials (LP), which may be a predictor of sudden death risk, have been shown in patients with schizophrenia. We aimed to assess the prevalence and predictors of electrocardiograph (ECG) and SAECG abnormalities in a mixed SMI population. METHODS Consecutive consenting inpatients with SMI had 12-lead ECG and SAECG recorded in addition to demographics, diagnoses and medications. Standard criteria for abnormal SAECG were applied. Multivariate regression analysis was performed to determine predictors of SAECG abnormalities including diagnoses, body mass index, ECG parameters, psychotropic medication use, and medications associated with Long QT or Brugada syndromes. RESULTS Eighty (80) patients, 49% male, mean age 39±17 years were included. SAECG criteria abnormality for 1, 2 or 3 criteria were seen in 19, 3 and 5 cases (34% in total) respectively. Early repolarisation pattern was seen in 19% of patients. SAECG abnormality was associated with male gender (OR 7.3; 95% CI 2.3-23.4), and schizophrenia/schizoaffective disorder diagnosis (OR 7.4; 95% CI 1.9-29.0), but not with medication type or dose. CONCLUSIONS In the mixed SMI population studied, there was a high rate of SAECG-detected late potentials (34%) and early repolarisation pattern (19%). Schizophrenia/schizoaffective disorder diagnosis was the strongest multivariate predictor identified. Further studies are needed to define the mechanism and significance of these cardiac abnormalities in SMI patients.
Collapse
Affiliation(s)
- John L Fitzgerald
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
| | - Judith Sheridan
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Alex Chadwick
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Andrew Burke
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Haris M Haqqani
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia.
| |
Collapse
|
13
|
Hattori S, Suda A, Miyauchi M, Shiraishi Y, Saeki T, Fukushima T, Fujibayashi M, Tsujita N, Ishii C, Ishii N, Moritani T, Saigusa Y, Kishida I. The association of genetic polymorphisms in CYP1A2, UGT1A4, and ABCB1 with autonomic nervous system dysfunction in schizophrenia patients treated with olanzapine. BMC Psychiatry 2020; 20:72. [PMID: 32070304 PMCID: PMC7027321 DOI: 10.1186/s12888-020-02492-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/11/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Use of the antipsychotic drug olanzapine by patients with schizophrenia is associated with autonomic nervous system (ANS) dysfunction. It is presumed that there are interindividual differences in ANS dysfunction that correspond to pharmacogenetics. In this study, we investigated whether genetic polymorphisms in ABCB1, CYP1A2, and UGT1A4 are associated with this observed ANS dysfunction. METHODS A total of 91 schizophrenia patients treated with olanzapine monotherapy participated in this study. A power spectral analysis of heart rate variability was used to assess ANS activity. The TaqMan system was used to genotype seven single nucleotide polymorphisms (SNPs) in CYP1A2 (rs2069514 and rs762551), UGT1A4 (rs2011425), and ABCB1 (rs1045642, rs1128503, rs2032582, rs2235048). RESULTS Sympathetic nervous activity was significantly higher in individuals with the UGT1A4 rs2011425 G allele than in those with the UGT1A4 rs2011425 non-G allele (sympathetic activity, p = .001). Furthermore, sympathetic nervous activity was also significantly associated with UGT1A4 rs2011425 genotype as revealed by multiple regression analysis (sympathetic activity, p = .008). CONCLUSIONS We suggest that the UGT1A4 rs2011425 polymorphism affects olanzapine tolerability because it is associated with the observed side effects of olanzapine in schizophrenia patients, namely sympathetic dysfunction.
Collapse
Affiliation(s)
- Saki Hattori
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Akira Suda
- grid.268441.d0000 0001 1033 6139Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Masatoshi Miyauchi
- grid.268441.d0000 0001 1033 6139Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Yohko Shiraishi
- grid.268441.d0000 0001 1033 6139Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Takashi Saeki
- grid.268441.d0000 0001 1033 6139Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan ,Asahinooka Hospital, 128-1 Kwaihonchou, Asahi-ku, Yokohama, Kanagawa 251-8530 Japan
| | - Tadashi Fukushima
- Asahinooka Hospital, 128-1 Kwaihonchou, Asahi-ku, Yokohama, Kanagawa 251-8530 Japan
| | - Mami Fujibayashi
- grid.412493.90000 0001 0454 7765Division of Physical and Health Education, Setsunan University, 17-8 Ikedanakamachi, Neyagawa, Osaka, 572-8508 Japan
| | - Natsuki Tsujita
- grid.258799.80000 0004 0372 2033Graduate School of Human and Environmental Studies, Kyoto University, Yoshidanihonmatsucho, Sakyo-ku, Kyoto, 606-8316 Japan
| | - Chie Ishii
- Fujisawa Hospital, 383 Kotuka Fujisawa, Kanagawa, 251-8530 Japan
| | - Norio Ishii
- Fujisawa Hospital, 383 Kotuka Fujisawa, Kanagawa, 251-8530 Japan
| | - Tosiho Moritani
- grid.258798.90000 0001 0674 6688Faculty of General Education, Kyoto Sangyo University, Kamo-motoyama, Kita-ku, Kyoto, 606-8555 Japan
| | - Yusuke Saigusa
- grid.268441.d0000 0001 1033 6139Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Ikuko Kishida
- grid.268441.d0000 0001 1033 6139Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan ,Fujisawa Hospital, 383 Kotuka Fujisawa, Kanagawa, 251-8530 Japan
| |
Collapse
|
14
|
Cella M, He Z, Killikelly C, Okruszek Ł, Lewis S, Wykes T. Blending active and passive digital technology methods to improve symptom monitoring in early psychosis. Early Interv Psychiatry 2019; 13:1271-1275. [PMID: 30821079 DOI: 10.1111/eip.12796] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/18/2018] [Accepted: 01/13/2019] [Indexed: 11/29/2022]
Abstract
AIMS Psychotic symptoms fluctuate over time and effective and regular monitoring may contribute to relapse prevention and improve long-term outcomes. In this proof-of-concept study we test the feasibility, acceptability and potential usefulness of a novel digital method assessing the association between physiological signals and psychotic symptom distress. METHODS Fifteen participants with first episode psychosis were asked to use a self-assessment mobile phone application for psychotic symptom monitoring for 10 days while using a wrist worn device continuously recording heart rate variability (HRV) and electrodermal activity (EDA). We compared physiological activity when participants reported experiencing distressing and non-distressing psychotic symptoms. RESULTS Participants completed on average 76% of the mobile phone symptom assessments. When reporting distressing hallucinations and delusions participants had significantly higher EDA levels and non-significant lower HRV values compared to when these symptoms were non-distressing. CONCLUSIONS This study provides further evidence linking psychotic symptom's distress, as experienced in everyday life, and autonomic deregulation. This proof-of-concept study may lead to further longer-term efforts to identify relapse biosignatures using automated methods based on passive monitoring. This method may allow for earlier interventions, contribute to improve relapse prevention and reduce symptoms interfering with recovery.
Collapse
Affiliation(s)
- Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Zhimin He
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Clare Killikelly
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Łukasz Okruszek
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Shon Lewis
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| |
Collapse
|
15
|
Kim Y, Kwon A, Min D, Kim S, Jin MJ, Lee SH. Neurophysiological and Psychological Predictors of Social Functioning in Patients with Schizophrenia and Bipolar Disorder. Psychiatry Investig 2019; 16:718-727. [PMID: 31587532 PMCID: PMC6801316 DOI: 10.30773/pi.2019.07.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/28/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The aim of this study is to examine social functioning in patients with schizophrenia and bipolar disorder and explore the psychological and neurophysiological predictors of social functioning. METHODS Twenty-seven patients with schizophrenia and thirty patients with bipolar disorder, as well as twenty-five healthy controls, completed measures of social functioning (questionnaire of social functioning), neurocognition (Verbal fluency, Korean-Auditory Verbal Learning Test), and social cognition (basic empathy scale and Social Attribution Task-Multiple Choice), and the childhood trauma questionnaire (CTQ). For neurophysiological measurements, mismatch negativity and heart rate variability (HRV) were recorded from all participants. Multiple hierarchical regression was performed to explore the impact of factors on social functioning. RESULTS The results showed that CTQ-emotional neglect significantly predicted social functioning in schizophrenia group, while HRV-high frequency significantly predicted social functioning in bipolar disorder patients. Furthermore, emotional neglect and HRV-HF still predicted social functioning in all of the subjects after controlling for the diagnostic criteria. CONCLUSION Our results implicated that even though each group has different predictors of social functioning, early traumatic events and HRV could be important indicators of functional outcome irrespective of what group they are.
Collapse
Affiliation(s)
- Yourim Kim
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea
| | - Aeran Kwon
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea
| | - Dongil Min
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea
| | - Sungkean Kim
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea.,Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Min Jin Jin
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea.,Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, Republic of Korea
| |
Collapse
|
16
|
Hattori S, Kishida I, Suda A, Kawanishi C, Miyauchi M, Shiraishi Y, Fujibayashi M, Tsujita N, Ishii C, Moritani T, Saigusa Y, Hirayasu Y. A return to work program improves parasympathetic activity and psychiatric symptoms in workers on sick leave due to depression. Heliyon 2019; 5:e02151. [PMID: 31384687 PMCID: PMC6661392 DOI: 10.1016/j.heliyon.2019.e02151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/21/2019] [Accepted: 07/11/2019] [Indexed: 11/25/2022] Open
Abstract
Background People with depression have autonomic function disturbances. In Japan, workers who take leave due to depression often undergo a work-focused intervention program called the return to work (RTW) program at a mental health hospital during their leave of absence. However, its biological efficacy remains unclear. We investigated the biological efficacy of the RTW program, including changes in autonomic nervous system (ANS) activity, in workers on sick leave due to depression in Japan. Methods The study involved 104 workers on sick leave due to major depressive disorder or bipolar disorder who underwent the RTW program for 3 months in Yokohama City University Hospital. The ANS activity of all patients was evaluated using heart rate variability at the beginning and end of the 3-month RTW program. Psychiatric symptoms were evaluated using the Montgomery-Åsberg Depression Rating Scale-Japanese (MADRS-J) and Social Adaptation Self-evaluation Scale (SASS). We followed up 3 months after the end of the program and investigated the association between the success in returning to work within 3 months after the end of the RTW program and several factors, including ANS activity, depressive symptoms, and demographic factors. Results Parasympathetic activity was significantly higher and depressive symptom severity was significantly lower at program end than at baseline. Logistic regression analysis showed that the change in depressive symptoms was significantly associated with success in returning to work. Conclusion We suggest that the RTW program improves parasympathetic activity as well as psychiatric symptoms. ANS activity was not a predictor of a successful return to work within 3 months after the end of the program in workers on sick leave due to depression, but further studies with a larger sample size are needed.
Collapse
Affiliation(s)
- Saki Hattori
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Ikuko Kishida
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.,Fujisawa Hospital, 383 Kotuka, Fujisawa, Kanagawa, 251-8530, Japan
| | - Akira Suda
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Chiaki Kawanishi
- Department of Neuropsychiatry, Sapporo Medical University Graduate School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Masatoshi Miyauchi
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Yohko Shiraishi
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Mami Fujibayashi
- Division of Physical and Health Education, Setsunan University, 17-8 Ikedanakamachi, Neyagawa, Osaka, 572-8508, Japan
| | - Natsuki Tsujita
- Graduate School of Human and Environmental Studies, Kyoto University, Yoshidanihonmatsucho, Sakyo-ku, Kyoto, 606-8316, Japan
| | - Chie Ishii
- Fujisawa Hospital, 383 Kotuka, Fujisawa, Kanagawa, 251-8530, Japan
| | - Toshio Moritani
- Faculty of General Education, Kyoto Sangyo University, Kamo-motoyama, Kita-ku, Kyoto, 606-8555, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Yoshio Hirayasu
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.,Hirayasu Hospital, 346 Kyozuka, Urasoe, Okinawa, 901-2553, Japan
| |
Collapse
|
17
|
Guccione C, di Scalea GL, Ambrosecchia M, Terrone G, Di Cesare G, Ducci G, Schimmenti A, Caretti V. Early Signs of Schizophrenia and Autonomic Nervous System Dysregulation: A Literature Review. CLINICAL NEUROPSYCHIATRY 2019; 16:86-97. [PMID: 34908942 PMCID: PMC8662712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Recent research suggests that early signs of schizophrenia can be detected several years before its onset. Evidence suggests that the identification of at-risk individuals before the psychotic onset can significantly improve the course of the disorder. However, instruments employed for the detection of prodromal symptoms are far from being accurate in the prediction of a future transition to psychosis. The aim of the present review is to summarize literature on the early signs of schizophrenia and to identify physiological markers that may aid the identification of the disorder before psychotic transition. METHOD This critical review includes studies published between 1979 and 2018 that were indexed in major databases with the following keywords: schizophrenia, prodromal phase, basic symptoms, autonomic nervous system, heart rate variability. RESULTS The examination of the relevant literature showed that, despite recent progress in the identification of at-risk states, the currently employed instruments do not allow an effective prediction of a future psychotic onset. Also, evidence suggests a significant association between alterations in the autonomic nervous system (ANS) functioning and psychotic disorders. However, literature on the association between ANS functioning and at-risk states for psychosis is still scarce. The addition of physiological risk indicators may represent a step forward in the detection of at-risk individuals. CONCLUSIONS Overall, the present literature review highlights that a future schizophrenic onset cannot be strongly predicted with current available measures. Given the established correlation between schizophrenia and autonomic dysregulation, an investigation of the ANS functioning in individuals who are at increased risk of developing schizophrenia may be particularly useful to improve the quality of the assessment, to identify at an early stage the dysregulated physiological patterns that have been linked with schizophrenia, and therefore to develop tailored interventions. Accordingly, it is crucial that future research investigates the presence of autonomic deficits in individuals at risk for psychosis.
Collapse
Affiliation(s)
| | | | | | - Grazia Terrone
- Department of Humanities, Literature, and Cultural Heritage, University of Foggia
| | | | | | | | | |
Collapse
|
18
|
Hattori S, Suda A, Kishida I, Miyauchi M, Shiraishi Y, Fujibayashi M, Tsujita N, Ishii C, Ishii N, Moritani T, Saigusa Y, Hirayasu Y. Association between dysfunction of autonomic nervous system activity and mortality in schizophrenia. Compr Psychiatry 2018; 86:119-122. [PMID: 30118994 DOI: 10.1016/j.comppsych.2018.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/31/2018] [Accepted: 08/07/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Patients with schizophrenia have a higher mortality risk than the general population. Additionally, the autonomic nervous system (ANS) activity of patients with schizophrenia is lower and more dysfunctional than that of the general population. Nonetheless, the association between ANS dysfunction and mortality in schizophrenia is unclear. The aim of this study was to investigate the association between ANS activity and mortality in schizophrenia and to evaluate the predictive values of heart rate variability for long-term survival. METHODS This study involves the 10-year follow-up of a sample population consisting of 59 Japanese inpatients with schizophrenia between 60 and 70 years of age from 2007 to 2016. The ANS activity of all patients was evaluated using heart rate variability in 2007. RESULTS Fifty-three participants could be followed up because they stayed in the hospital during the follow-up period. Of these patients, 11 died during follow-up. Their mean age at death was 70.55 ± 3.45 years. The parasympathetic activity of nonsurvivors was significantly lower than that of survivors, and multiple logistic regression analysis showed a significant association between death and parasympathetic activity. CONCLUSION We suggest that decreased parasympathetic activity could be associated with 10-year all-cause mortality in older schizophrenic patients.
Collapse
Affiliation(s)
- Saki Hattori
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Akira Suda
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Ikuko Kishida
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan; Fujisawa Hospital, 383 Kotuka, Fujisawa, Kanagawa 251-8530, Japan
| | - Masatoshi Miyauchi
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Yohko Shiraishi
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Mami Fujibayashi
- Division of Physical and Health Education, Setsunan University, 17-8 Ikedanakamachi, Neyagawa, Osaka 572-8508, Japan
| | - Natsuki Tsujita
- Graduate School of Human and Environmental Studies, Kyoto University, Yoshidanihonmatsucho, Sakyo-ku, Kyoto 606-8316, Japan
| | - Chie Ishii
- Fujisawa Hospital, 383 Kotuka, Fujisawa, Kanagawa 251-8530, Japan
| | - Norio Ishii
- Fujisawa Hospital, 383 Kotuka, Fujisawa, Kanagawa 251-8530, Japan
| | - Toshio Moritani
- Faculty of General Education, Kyoto Sangyo University, Kamo-motoyama, Kita-ku, Kyoto 606-8555, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Yoshio Hirayasu
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan; Hirayasu Hospital, 346 Kyozuka, Urasoe, Okinawa 901-2553, Japan
| |
Collapse
|
19
|
Suda A, Hattori S, Kishida I, Miyauchi M, Shiraishi Y, Fujibayashi M, Tsujita N, Ishii C, Ishii N, Moritani T, Hirayasu Y. Effects of long-acting injectable antipsychotics versus oral antipsychotics on autonomic nervous system activity in schizophrenic patients. Neuropsychiatr Dis Treat 2018; 14:2361-2366. [PMID: 30271152 PMCID: PMC6149934 DOI: 10.2147/ndt.s173617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Long-acting injections (LAIs) of antipsychotics show distinct pharmacokinetic profiles from oral antipsychotics (OAPs). Although there may be differences in adverse event frequency, any differences in their effects on autonomic nervous system (ANS) remain unclear. PATIENTS AND METHODS In total, 270 schizophrenic patients were recruited in this study: 241 received OAPs (risperidone, olanzapine, quetiapine, or aripiprazole) and 29 received LAIs (risperidone LAI, aripiprazole LAI, or paliperidone palmitate) as monotherapy. Heart rate variability was measured as an index of ANS activity, and the low-frequency (0.03-0.15 Hz) component, high-frequency (0.15-0.40 Hz) component, and total power (0.03-0.40 Hz) were calculated. Components were compared between the groups using t-tests. RESULTS A significant difference was detected in the low-frequency component between the OAP and LAI groups (P=0.046). No significant difference was found in total power or the high-frequency component between the two groups. CONCLUSION Compared with OAPs, LAIs have fewer adverse effects on ANS activity, particularly the low-frequency component, as determined using a spectral analysis of heart rate variability.
Collapse
Affiliation(s)
- Akira Suda
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama,
| | - Saki Hattori
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama,
| | - Ikuko Kishida
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama,
- Department of Psychiatry, Fujisawa Hospital, Kanagawa
| | - Masatoshi Miyauchi
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama,
| | - Yohko Shiraishi
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama,
| | - Mami Fujibayashi
- Division of Physical and Health Education, Setsunan University, Osaka
| | - Natsuki Tsujita
- Graduate School of Human and Environmental Studies, Kyoto University
| | - Chie Ishii
- Department of Psychiatry, Fujisawa Hospital, Kanagawa
| | - Norio Ishii
- Department of Psychiatry, Fujisawa Hospital, Kanagawa
| | - Toshio Moritani
- Department of Health and Sports Sociology, Faculty of General Education, Kyoto Sangyo University, Kyoto
| | - Yoshio Hirayasu
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama,
- Department of Psychiatry, Hirayasu Hospital, Okinawa, Japan
| |
Collapse
|
20
|
Hattori S, Suda A, Kishida I, Miyauchi M, Shiraishi Y, Fujibayashi M, Tsujita N, Ishii C, Ishii N, Moritani T, Taguri M, Hirayasu Y. Effects of ABCB1 gene polymorphisms on autonomic nervous system activity during atypical antipsychotic treatment in schizophrenia. BMC Psychiatry 2018; 18:231. [PMID: 30016952 PMCID: PMC6050702 DOI: 10.1186/s12888-018-1817-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/11/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There are interindividual differences in the adverse effects of atypical antipsychotics, which include autonomic nervous system (ANS) dysfunction. Accordingly, to clarify the interindividual differences in the adverse effects of specific atypical antipsychotics in schizophrenia, we investigated the association between ANS dysfunction and ATP-binding cassette transport sub-family B member 1 (ABCB1) gene polymorphisms in patients with schizophrenia. METHODS In total, 233 Japanese patients with schizophrenia participated in this study. All of the participants received an atypical antipsychotic as monotherapy: 89 participants received risperidone, 69 olanzapine, 48 aripiprazole, and 27 quetiapine. ANS activity was assessed by means of a power spectral analysis of heart rate variability. Four single nucleotide polymorphisms (SNPs) in ABCB1 (rs1045642, rs1128503, rs2032582, and rs2235048) were genotyped using the TaqMan method. RESULTS For aripiprazole, sympathetic and total autonomic nervous activities were significantly lower in the rs1045642 T allele carrier-rs2235048 C allele carrier group than in the rs1045642 non-T allele carrier-rs2235048 non-C allele carrier group. In addition, in the aripiprazole group, the T-C-T-A haplotype (rs1045642-rs2235048-rs1128503-rs2032582) was associated with decreased ANS activity. However, there were no significant associations between ANS activity and ABCB1 gene polymorphisms in the risperidone, olanzapine, and quetiapine groups. Multiple regression analysis revealed that sympathetic and total nervous activities were significantly associated with the ABCB1 rs1045642-rs2235048 genotype and the T-C-T-A haplotype (rs1045642-rs2235048-rs1128503-rs2032582). CONCLUSION We suggest that ABCB1 genetic polymorphisms affect aripiprazole-related ANS dysfunction but do not affect risperidone-, olanzapine-, or quetiapine-related ANS dysfunction.
Collapse
Affiliation(s)
- Saki Hattori
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Akira Suda
- 0000 0001 1033 6139grid.268441.dDepartment of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Ikuko Kishida
- 0000 0001 1033 6139grid.268441.dDepartment of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan ,Fujisawa Hospital, 383 Kotuka, Fujisawa, Kanagawa 251-8530 Japan
| | - Masatoshi Miyauchi
- 0000 0001 1033 6139grid.268441.dDepartment of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Yohko Shiraishi
- 0000 0001 1033 6139grid.268441.dDepartment of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Mami Fujibayashi
- 0000 0001 0454 7765grid.412493.9Division of Physical and Health Education, Setsunan University, 17-8 Ikedanakamachi, Neyagawa, Osaka 572-8508 Japan
| | - Natsuki Tsujita
- 0000 0004 0372 2033grid.258799.8Graduate School of Human and Environmental Studies, Kyoto University, Yoshidanihonmatsucho, Sakyo-ku, Kyoto, 606-8316 Japan
| | - Chie Ishii
- Fujisawa Hospital, 383 Kotuka, Fujisawa, Kanagawa 251-8530 Japan
| | - Norio Ishii
- Fujisawa Hospital, 383 Kotuka, Fujisawa, Kanagawa 251-8530 Japan
| | - Toshio Moritani
- 0000 0001 0674 6688grid.258798.9Faculty of General Education, Kyoto Sangyo University, Kamo-motoyama, Kita-ku, Kyoto, 606-8555 Japan
| | - Masataka Taguri
- 0000 0001 1033 6139grid.268441.dDepartment of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Yoshio Hirayasu
- 0000 0001 1033 6139grid.268441.dDepartment of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan ,Hirayasu Hospital, 346 Kyozuka, Urasoe, Okinawa 901-2553 Japan
| |
Collapse
|
21
|
Liu Y, Rodenkirch C, Moskowitz N, Schriver B, Wang Q. Dynamic Lateralization of Pupil Dilation Evoked by Locus Coeruleus Activation Results from Sympathetic, Not Parasympathetic, Contributions. Cell Rep 2018; 20:3099-3112. [PMID: 28954227 DOI: 10.1016/j.celrep.2017.08.094] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 07/25/2017] [Accepted: 08/28/2017] [Indexed: 01/11/2023] Open
Abstract
Pupil size is collectively controlled by the sympathetic dilator and parasympathetic sphincter muscles. Locus coeruleus (LC) activation has been shown to evoke pupil dilation, but how the sympathetic and parasympathetic pathways contribute to this dilation remains unknown. We examined pupil dilation elicited by LC activation in lightly anesthetized rats. Unilateral LC activation evoked bilateral but lateralized pupil dilation; i.e., the ipsilateral dilation was significantly larger than the contralateral dilation. Surgically blocking the ipsilateral, but not contralateral, sympathetic pathway significantly reduced lateralization, suggesting that lateralization is mainly due to sympathetic contribution. Moreover, we found that sympathetic, but not parasympathetic, contribution is correlated with LC activation frequency. Together, our results unveil the frequency-dependent contributions of the sympathetic and parasympathetic pathways to LC activation-evoked pupil dilation and suggest that lateralization in task-evoked pupil dilations may be used as a biomarker for autonomic tone.
Collapse
Affiliation(s)
- Yang Liu
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Charles Rodenkirch
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Nicole Moskowitz
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Brian Schriver
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Qi Wang
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA.
| |
Collapse
|
22
|
Cella M, Okruszek Ł, Lawrence M, Zarlenga V, He Z, Wykes T. Using wearable technology to detect the autonomic signature of illness severity in schizophrenia. Schizophr Res 2018; 195:537-542. [PMID: 28986005 DOI: 10.1016/j.schres.2017.09.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Research suggests that people with schizophrenia have autonomic dysfunctions. These have been linked to functioning problems, symptoms and considered a risk factor for illness chronicity. The aim of this study is to introduce a new Mobile Health (mHealth) method using wearable technology to assessing autonomic activity in people's everyday life. We aim to evaluate the new method acceptability and characterise the association between schizophrenia illness features and autonomic abnormalities. METHOD Thirty participants with schizophrenia and 25 controls were asked to wear a mHealth device measuring autonomic activity and movements during their normal everyday life. Measures of device use acceptability were collected from all participants. Participants with schizophrenia were also assessed for symptoms and functioning levels. Measures of heart rate variability (HRV), electrodermal activity (EDA) and movement were collected by the device and groups were compared. Correlation between physiological measures, functioning, symptoms and medication levels were assessed in people with schizophrenia. RESULTS The mHealth device method proved to be acceptable and produced reliable measures of autonomic activity and behaviour. Compared to controls, people with schizophrenia showed lower levels of HRV, movement and functioning. In people with schizophrenia illness severity, particularly positive symptoms, was associated with parasympathetic deregulation. CONCLUSIONS Autonomic abnormalities can be detected using wearable technology from people's everyday life. These are in line with previous research and support the notion that autonomic deregulation are relevant illness features for mental and physical health in schizophrenia. This method may be developed as a monitoring system for well-being and relapse prevention.
Collapse
Affiliation(s)
- Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Łukasz Okruszek
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Megan Lawrence
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Valerio Zarlenga
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Zhimin He
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| |
Collapse
|
23
|
Salivary Alpha-Amylase Activity Levels in Catatonic Schizophrenia Decrease after Electroconvulsive Therapy. Case Rep Psychiatry 2018; 2018:2623585. [PMID: 29862108 PMCID: PMC5971272 DOI: 10.1155/2018/2623585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/30/2018] [Accepted: 02/22/2018] [Indexed: 11/18/2022] Open
Abstract
Background. Dysfunction of the autonomic nervous system (ANS) in schizophrenia has been detected by electrophysiological methods, but the underlying mechanisms remain unknown. Several studies have suggested that measuring salivary alpha-amylase activity levels is useful for evaluating the ANS activity and that sAA levels increase in schizophrenia and correlate with Brief Psychiatric Rating Scale (BPRS) scores. However, no study has examined the relationship between sAA activity levels and symptoms of schizophrenia with catatonic state. Methods. We present the case of a 59-year-old female with persistent catatonic schizophrenia treated by electroconvulsive therapy. We evaluated the ANS activity by measuring sAA activity levels before and after ECT, and we evaluated her symptoms using the BPRS and Bush–Francis Catatonia Rating Scale (BFCRS). Results. ECT was highly effective and BPRS and BFCRS scores substantially decreased. sAA activity levels decreased from 125 kU/l to 33 kU/l. Conclusions. sAA activity levels could be a potential biomarker of schizophrenia with catatonic state.
Collapse
|
24
|
Matsumoto T, Kimura T, Hayashi T. Does Japanese Citrus Fruit Yuzu (Citrus junos Sieb. ex Tanaka) Fragrance Have Lavender-Like Therapeutic Effects That Alleviate Premenstrual Emotional Symptoms? A Single-Blind Randomized Crossover Study. J Altern Complement Med 2017; 23:461-470. [DOI: 10.1089/acm.2016.0328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Tamaki Matsumoto
- Department of Health Education, Faculty of Education, Shitennoji University, Osaka, Japan
| | - Tetsuya Kimura
- Graduate School of Human Development and Environment, Kobe University, Hyogo, Japan
| | - Tatsuya Hayashi
- Cognitive and Behavioral Science, Graduate School of Human and Environmental Studies, Kyoto University, Kyoto, Japan
| |
Collapse
|
25
|
Miyauchi M, Kishida I, Suda A, Shiraishi Y, Fujibayashi M, Taguri M, Ishii C, Ishii N, Moritani T, Hirayasu Y. Long term effects of smoking cessation in hospitalized schizophrenia patients. BMC Psychiatry 2017; 17:87. [PMID: 28270120 PMCID: PMC5341461 DOI: 10.1186/s12888-017-1250-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of smoking in patients with schizophrenia is higher than that in the general population and is an important medical issue. Short-term smoking cessation tends to worsen psychiatric symptoms in patients with schizophrenia but decreases sympathetic nervous system activity and improves plasma cholesterol levels in healthy people. Few studies have assessed the long-term effects of smoking cessation in patients with schizophrenia. METHODS Subjects were 70 Japanese patients with schizophrenia (38 smokers, 32 non-smokers). We compared the following clinical parameters between the two groups at baseline (before smoking cessation) and in each group separately between baseline and at three years after smoking cessation: autonomic nervous system activity, plasma cholesterol levels, body weight, drug therapy, and Global Assessment of Functioning scores. We also compared the mean changes in clinical parameters throughout this study between the groups at both time points. Autonomic nervous system activity was assessed by power spectral analysis of heart rate variability. RESULTS Parasympathetic nervous system activity and the doses of antiparkinsonian drugs in smokers were significantly higher than those in non-smokers at baseline. Smoking cessation was associated with significantly decreased sympathetic nervous system activity and decreased doses of antipsychotics and antiparkinsonian drugs at three years after smoking cessation. However, there was no significant difference in the mean change in clinical factors scores, except for Global Assessment of Functioning scores, between smokers and non-smokers at three years after smoking cessation. CONCLUSIONS Our results suggest that smoking reduces both autonomic nervous system activity and the effectiveness of drug therapy with antipsychotics and antiparkinsonian drugs in patients with schizophrenia, but that both factors could be ameliorated over the long term by smoking cessation. Taken together with the findings of previous studies, smoking cessation in patients with schizophrenia has many long-term positive physiological effects.
Collapse
Affiliation(s)
- Masatoshi Miyauchi
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan. .,Fujisawa Hospital, 383 Kotsuka, Fujisawa, Kanagawa, 251-8530, Japan.
| | - Ikuko Kishida
- 0000 0001 1033 6139grid.268441.dDepartment of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Akira Suda
- 0000 0001 1033 6139grid.268441.dDepartment of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Yohko Shiraishi
- 0000 0001 1033 6139grid.268441.dDepartment of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan ,0000 0004 1767 0473grid.470126.6Clinical Laboratory Department, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Mami Fujibayashi
- 0000 0001 0454 7765grid.412493.9The Division of Physical and Health Education, Setsunan University, 17-8 Ikedanakamachi, Neyagawa, Osaka 572-8508 Japan
| | - Masataka Taguri
- 0000 0001 1033 6139grid.268441.dDepartment of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Chie Ishii
- Fujisawa Hospital, 383 Kotsuka, Fujisawa, Kanagawa 251-8530 Japan
| | - Norio Ishii
- Fujisawa Hospital, 383 Kotsuka, Fujisawa, Kanagawa 251-8530 Japan
| | - Toshio Moritani
- 0000 0001 0674 6688grid.258798.9Faculty of General Education, Kyoto Sangyo University, Kamo-motoyama, Kita-Ku, Kyoto, 606-8555 Japan
| | - Yoshio Hirayasu
- 0000 0001 1033 6139grid.268441.dDepartment of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| |
Collapse
|
26
|
Miyauchi M, Kishida I, Suda A, Shiraishi Y, Hattori S, Fujibayashi M, Taguri M, Ishii C, Ishii N, Moritani T, Hirayasu Y. Association of the Cholinergic Muscarinic M2 Receptor with Autonomic Nervous System Activity in Patients with Schizophrenia on High-Dose Antipsychotics. Neuropsychobiology 2017; 74:60-67. [PMID: 27923235 DOI: 10.1159/000452770] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/11/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with schizophrenia have abnormal autonomic nervous system (ANS) activity compared with the general population. One reason for this difference is the muscarinic affinity for antipsychotic drugs; therefore, single nucleotide polymorphisms (SNPs) of the muscarinic receptor gene influence this ANS dysfunction. This study sought to determine the effect of SNPs of the cholinergic muscarinic receptor (CHRM) gene on ANS activity in patients with schizophrenia receiving antipsychotic drugs. METHODS A total of 173 Japanese patients with schizophrenia were included in this study. Heart rate variability (HRV) was measured as an index of ANS activity. SNPs in CHRM1 (rs542269 and rs2075748), CHRM2 (rs324640, rs8191992, rs1824024, and rs7810473), and CHRM3 (rs3738435, rs4620530, and rs6429157) were genotyped using the TaqMan® method. Patients were grouped according to standard equivalent conversions of chlorpromazine (CP) into a high-CP group (HG; ≥1,000 mg) and a low-CP group (LG; <1,000 mg). ANS activity was compared between the groups. In addition, we compared the total, low-frequency (LF), high-frequency (HF), and LF/HF components of the patients' HRV, and the genotype of the SNPs in both the HG and LG groups. Bonferroni correction was applied for multiple comparisons, and the Bonferroni-corrected critical p value was <0.005. RESULTS The A allele of the CHRM2 rs8191992 polymorphism in HG was associated with decreased ANS activity. CONCLUSION Our results show reduced ANS activity in association with the CHRM2 rs8191992 polymorphism in patients with schizophrenia on high-dose antipsychotics. CHRM2 polymorphisms may play an important role in ANS activity in patients with schizophrenia.
Collapse
Affiliation(s)
- Masatoshi Miyauchi
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Kim N, Hughes TL, Park CG, Quinn L, Kong ID. Altered Autonomic Functions and Distressed Personality Traits in Male Adolescents with Internet Gaming Addiction. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2017; 19:667-673. [PMID: 27831751 DOI: 10.1089/cyber.2016.0282] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Internet gaming addiction (IGA) has been associated with many negative health outcomes, especially for youth; however, few studies have examined the physiological parameters and personality features related to this addiction. This study aimed to identify differences in autonomic functions and distressed (type D) personality traits among Korean adolescent males with and without IGA. In a cross-sectional study, 68 adolescent males were recruited in a Korean city using convenience and snowball sampling methods. For each subject, heart rate variability (HRV) parameters were measured as autonomic functions and questionnaires were used to identify IGA and type D personality traits. Data were analyzed using descriptive analyses, t tests, χ2 tests, and Pearson's correlation. Most HRV parameters significantly differed between the IGA and non-IGA groups (all p < 0.05). Type D personality total and subscale scores, including those for negative affectivity (NA) and social inhibition, were significantly higher in the IGA group (all p < 0.001). Of the 68 subjects, 46 were classified as having type D personality, with nearly twice as many in the IGA group as in the non-IGA group (p = 0.002). Type D personality total scores negatively correlated with the logarithmic value of total power and low frequency among the HRV parameters (both p < 0.05). Results showed that excessive Internet gaming was related to alterations in autonomic functions and distressed personality traits in male adolescents. These findings provide further understanding of the IGA phenomenon and highlight the need for interventions that address male adolescents with IGA.
Collapse
Affiliation(s)
- Nahyun Kim
- 1 College of Nursing, Keimyung University , Daegu, Republic of Korea
| | - Tonda L Hughes
- 2 College of Nursing, University of Illinois at Chicago , Chicago, Illinois
| | - Chang G Park
- 2 College of Nursing, University of Illinois at Chicago , Chicago, Illinois
| | - Laurie Quinn
- 2 College of Nursing, University of Illinois at Chicago , Chicago, Illinois
| | - In Deok Kong
- 3 Department of Physiology, Wonju College of Medicine, Yonsei University , Wonju, Republic of Korea
| |
Collapse
|
28
|
Monteleone AM, Monteleone P, Di Filippo C, Pellegrino F, Grillo F, Maj M. Investigation of the Endogenous Stress Response System in Patients with Chronic Schizophrenia. Neuropsychobiology 2016; 72:1-7. [PMID: 26287549 DOI: 10.1159/000437437] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/06/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cardiophysiological and neuroendocrine studies suggest that the two components of the endogenous stress response system, the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis, are dysregulated in patients with schizophrenia. However, cardiophysiological measures are influenced by several confounding factors and the secretion of α-amylase in saliva is believed to represent a more reliable index of SNS activity. Therefore, to characterize the functional status of the SNS and HPA axis in schizophrenia we explored the concomitant salivary secretion of cortisol and α-amylase. METHODS Saliva cortisol and α-amylase levels were measured after awakening in 30 patients with chronic schizophrenia and 22 healthy subjects. RESULTS After awakening, saliva cortisol increased in a similar way in both patients and healthy controls, while saliva α-amylase concentrations showed a clear-cut decrease in healthy subjects but not in patients with schizophrenia. No significant correlation emerged between biochemical measures and patients' demographic or psychopathological characteristics. CONCLUSIONS These findings demonstrate normal activity of the HPA axis with an enhanced SNS tone, which suggests a functional dissociation of the two components of the endogenous stress response system in patients with chronic schizophrenia. The pathophysiological significance of such dysregulation needs further studies to be clarified.
Collapse
|
29
|
Alvares GA, Quintana DS, Hickie IB, Guastella AJ. Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis. J Psychiatry Neurosci 2016; 41:89-104. [PMID: 26447819 PMCID: PMC4764485 DOI: 10.1503/jpn.140217] [Citation(s) in RCA: 264] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Autonomic nervous system (ANS) dysfunction is a putative underlying mechanism for increased cardiovascular disease risk in individuals with psychiatric disorders. Previous studies suggest that this risk may be related to psychotropic medication use. In the present study we systematically reviewed and analyzed published studies of heart rate variability (HRV), measuring ANS output, to determine the effect of psychiatric illness and medication use. METHODS We searched for studies comparing HRV in physically healthy adults with a diagnosed psychiatric disorder to controls and comparing HRV pre- and post-treatment with a psychotropic medication. RESULTS In total, 140 case-control (mood, anxiety, psychosis, dependent disorders, k = 151) and 30 treatment (antidepressants, antipsychotics; k = 43) studies were included. We found that HRV was reduced in all patient groups compared to controls (Hedges g = -0.583) with a large effect for psychotic disorders (Hedges g = -0.948). Effect sizes remained highly significant for medication-free patients compared to controls across all disorders. Smaller and significant reductions in HRV were observed for specific antidepressants and antipsychotics. LIMITATIONS Study quality significantly moderated effect sizes in case-control analyses, underscoring the importance of assessing methodological quality when interpreting HRV findings. CONCLUSION Combined findings confirm substantial reductions in HRV across psychiatric disorders, and these effects remained significant even in medication-free individuals. Reductions in HRV may therefore represent a significant mechanism contributing to elevated cardiovascular risk in individuals with psychiatric disorders. The negative impact of specific medications on HRV suggest increased risk for cardiovascular disease in these groups, highlighting a need for treatment providers to consider modifiable cardiovascular risk factors to attenuate this risk.
Collapse
Affiliation(s)
| | | | | | - Adam J. Guastella
- Correspondence to: A.J. Guastella, Brain & Mind Centre, University of Sydney, 94 Mallett St, Camperdown NSW Australia;
| |
Collapse
|
30
|
Clamor A, Lincoln TM, Thayer JF, Koenig J. Resting vagal activity in schizophrenia: meta-analysis of heart rate variability as a potential endophenotype. Br J Psychiatry 2016; 208:9-16. [PMID: 26729841 DOI: 10.1192/bjp.bp.114.160762] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cardiac vagal tone, indexed by heart rate variability (HRV), is a proxy for the functional integrity of feedback mechanisms integrating central and peripheral physiology. AIMS To quantify differences in HRV in individuals with schizophrenia compared with healthy controls. METHOD Databases were systematically searched for studies eligible for inclusion. Random effect meta-analyses of standardised mean differences were calculated for vagal activity indicated by high-frequency HRV and the root mean square of successive R-R interval differences (RMSSD). RESULTS Thirty-four studies were included. Significant main effects were found for high-frequency HRV (P = 0.0008; Hedges' g = -0.98, 95% CI -1.56 to -0.41, k = 29) and RMSSD (P<0.0001; g = -0.91, 95% CI -1.19 to -0.62, k = 24), indicating lower vagal activity in individuals with schizophrenia than in healthy controls. Considerable heterogeneity was evident but effects were robust in subsequent sensitivity analyses. CONCLUSIONS Given the association between low HRV, threat processing, emotion regulation and executive functioning, reduced vagal tone may be an endophenotype for the development of psychotic symptoms.
Collapse
Affiliation(s)
- Annika Clamor
- Annika Clamor, MSc, Tania M. Lincoln, Dr. rer. nat., University of Hamburg, Department of Clinical Psychology and Psychotherapy, Hamburg, Germany; Julian F. Thayer, PhD, The Ohio State University, Department of Psychology, Columbus, Ohio, USA; Julian Koenig, Dr. sc. hum., University of Heidelberg, Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Tania M Lincoln
- Annika Clamor, MSc, Tania M. Lincoln, Dr. rer. nat., University of Hamburg, Department of Clinical Psychology and Psychotherapy, Hamburg, Germany; Julian F. Thayer, PhD, The Ohio State University, Department of Psychology, Columbus, Ohio, USA; Julian Koenig, Dr. sc. hum., University of Heidelberg, Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Julian F Thayer
- Annika Clamor, MSc, Tania M. Lincoln, Dr. rer. nat., University of Hamburg, Department of Clinical Psychology and Psychotherapy, Hamburg, Germany; Julian F. Thayer, PhD, The Ohio State University, Department of Psychology, Columbus, Ohio, USA; Julian Koenig, Dr. sc. hum., University of Heidelberg, Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Julian Koenig
- Annika Clamor, MSc, Tania M. Lincoln, Dr. rer. nat., University of Hamburg, Department of Clinical Psychology and Psychotherapy, Hamburg, Germany; Julian F. Thayer, PhD, The Ohio State University, Department of Psychology, Columbus, Ohio, USA; Julian Koenig, Dr. sc. hum., University of Heidelberg, Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Heidelberg, Germany
| |
Collapse
|
31
|
Montaquila JM, Trachik BJ, Bedwell JS. Heart rate variability and vagal tone in schizophrenia: A review. J Psychiatr Res 2015; 69:57-66. [PMID: 26343595 DOI: 10.1016/j.jpsychires.2015.07.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 07/14/2015] [Accepted: 07/23/2015] [Indexed: 01/08/2023]
Abstract
Recent heart rate variability (HRV) research has identified diminished levels of parasympathetic activity among schizophrenia patients. Over two dozen empirically-based studies have been published on this topic; primarily over the last decade. However, no theoretical review appears to have been published on this work. Further, only one empirical study has evaluated HRV research findings in the context of documented hypothalamic-pituitary-adrenal axis hyperactivity in schizophrenia. HRV research indicates that no abnormalities exist in the initial sympathetic stress response of schizophrenia patients. However, evidence has consistently demonstrated that patients exhibit a diminished capacity to recover from a stress response as a result of deficits in parasympathetic activity. Moreover, this diminished parasympathetic nervous system (PNS) response, also known as decreased vagal tone, has been found to relate to increased symptom severity. Although these findings may cause speculation that the observed vagal tone disruption merely results from anxiety produced by the presence of positive symptomology, additional studies have identified similar parasympathetic dysfunction among nonpsychotic relatives of individuals with schizophrenia. We posit that the resulting sympathovagal imbalance leads to an overall sympathetic dominance despite the fact that sympathetic nervous system activity is not abnormally elevated among patients. Implications are discussed within the context of the diathesis-stress/vulnerability-stress model, including the potential for identifying a mechanism of action by which environmental stressors may contribute to triggering first-episode psychosis.
Collapse
Affiliation(s)
- Julian M Montaquila
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, United States
| | - Benjamin J Trachik
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, United States
| | - Jeffrey S Bedwell
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, United States.
| |
Collapse
|
32
|
Mahintamani T, Ram D, Mitra S. Inside the mind of poor Tom--A multidimensional approach to determine causes for redundant clothing in patients with schizophrenia. Psychiatry Res 2015; 227:219-23. [PMID: 25863820 DOI: 10.1016/j.psychres.2015.03.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 02/03/2015] [Accepted: 03/03/2015] [Indexed: 12/17/2022]
Abstract
Redundant clothing (RC) is a readily observable feature of schizophrenia. While abnormal thermoregulation, thyroid dysfunction and autonomic dysregulation have been postulated to account for RC, no identified factor yet conclusively explains this enigmatic behaviour. This study attempted to determine the cause(s) of RC in schizophrenia. Two groups of 20 age- and sex-matched patients with and without RC were studied. Socio-demographic and clinical characteristics were recorded, and patients were assessed for psychopathology (Positive and Negative Syndrome Scale (PANSS)), cognitive function (Schizophrenia Cognition Rating Scale (SCoRS)), and autonomic and thyroid function. Those with RC differed significantly from those without RC in education, occupation, marital status and duration of untreated psychosis (DUP). They were more disorganised, more withdrawn, and had significant affective impairment. The RC group also had significantly higher negative, general and total psychopathology scores on the Positive and Negative Syndrome Scale, significantly poorer cognitive function, greater autonomic dysfunction, and lower free T3 and free T4 concentrations. We propose that the dimension of RC could define a subgroup with poorer premorbid functioning and a longer DUP, in whom cognitive dysfunction and prominent negative symptoms coloured the manifestations of deranged thermoregulation secondary to lower thyroid hormone levels and autonomic dysfunction, ultimately resulting in redundant clothing.
Collapse
Affiliation(s)
- Tathagata Mahintamani
- Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand 834006, India.
| | - Daya Ram
- Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand 834006, India
| | - Sayantanava Mitra
- K.S. Mani Centre for Cognitive Neurosciences, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand 834006, India
| |
Collapse
|
33
|
Bär KJ. Cardiac Autonomic Dysfunction in Patients with Schizophrenia and Their Healthy Relatives - A Small Review. Front Neurol 2015; 6:139. [PMID: 26157417 PMCID: PMC4478389 DOI: 10.3389/fneur.2015.00139] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 06/03/2015] [Indexed: 12/13/2022] Open
Abstract
The majority of excess mortality among people with schizophrenia seems to be caused by cardiovascular complications, and in particular, coronary heart disease. In addition, the prevalence of heart failure and arrhythmias is increased in this population. Reduced efferent vagal activity, which has been consistently described in these patients and their healthy first-degree relatives, might be one important mechanism contributing to their increased cardiac mortality. A decrease in heart rate variability and complexity was often shown in unmedicated patients when compared to healthy controls. In addition, faster breathing rates, accompanied by shallow breathing, seem to influence autonomic cardiac functioning in acute unmedicated patients substantially. Moreover, low-physical fitness is a further and independent cardiac risk factor present in this patient population. Interestingly, new studies describe chronotropic incompetence during physical exercise as an important additional risk factor in patients with schizophrenia. Some studies report a correlation of the autonomic imbalance with the degree of positive symptoms (i.e., delusions) and some with the duration of disease. The main body of psychiatric research is focused on mental aspects of the disease, thereby neglecting obvious physical health needs of these patients. Here, a joint effort is needed to design interventional strategies in everyday clinical settings to improve physical health and quality of life.
Collapse
Affiliation(s)
- Karl-Jürgen Bär
- Psychiatric Brain and Body Research Group Jena, Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Schiller-University, Jena, Germany
| |
Collapse
|
34
|
Kirkpatrick B, Miller B, García-Rizo C, Fernandez-Egea E. Schizophrenia: a systemic disorder. ACTA ACUST UNITED AC 2015; 8:73-9. [PMID: 23518782 DOI: 10.3371/csrp.kimi.031513] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The concept of schizophrenia that is most widely taught is that it is a disorder in which psychotic symptoms are the main problem, and a dysregulation of dopamine signaling is the main feature of pathophysiology. However, this concept limits clinical assessment, the treatments offered to patients, research, and the development of therapeutics. A more appropriate conceptual model is that: 1) schizophrenia is not a psychotic disorder, but a disorder of essentially every brain function in which psychosis is present; 2) it is not a brain disease, but a disorder with impairments throughout the body; 3) for many patients, neuropsychiatric problems other than psychosis contribute more to impairment in function and quality of life than does psychosis; and, 4) some conditions that are considered to be comorbid are integral parts of the illness. In conclusion, students, patients, and family members should be taught this model, along with its implications for assessment, research, and therapeutics.
Collapse
Affiliation(s)
- Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno, NV
| | - Brian Miller
- Department of Psychiatry and Health Behavior, Georgia Health Sciences University, Augusta, GA
| | - Clemente García-Rizo
- Schizophrenia Program, Department of Psychiatry, Neuroscience Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Emilio Fernandez-Egea
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, Good Outcome Schizophrenia Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK, Huntingdon, UK
| |
Collapse
|
35
|
Chang JS, Hwang SSH, Yi SH, Kim Y, Lee YS, Kim YS, Jung HY. Evaluating subjective domains of antipsychotic-induced adverse effects using heart rate variability. Psychiatry Clin Neurosci 2015; 69:283-91. [PMID: 25066617 DOI: 10.1111/pcn.12226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/18/2014] [Accepted: 07/23/2014] [Indexed: 11/26/2022]
Abstract
AIMS Antipsychotic-induced autonomic dysregulation may lead to a wide range of subjective side-effects in schizophrenia patients. Using heart rate variability (HRV) measures, we prospectively examined the relationship between subjective side-effects and cardiac autonomic regulation in unmedicated schizophrenia patients. METHODS Forty-five unmedicated schizophrenia patients were assessed for antipsychotic-associated side-effects and HRV parameters at baseline and after 6 weeks of treatment. Psychiatric symptoms and subjective side-effects were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Liverpool University Neuroleptic Side-effect Rating Scale (LUNSERS). RESULTS Correlations between subjective adverse effects and HRV measures at baseline and at week 6 varied. Nonetheless, the changes in the psychic side-effects domain were significantly correlated with the changes in time-domain HRV measures and sample entropy (SampEn). In addition, the change in SampEn was significantly associated with that in the scores of extrapyramidal, anticholinergic, miscellaneous, and red herring domains as well as the mean total LUNSERS score. CONCLUSION Baseline HRV measures may predict clinical response and adverse events associated with treatment adherence. Also, subjective side-effects may correspond well with the changes in neurocardiac dynamics, and the changes in SampEn may effectively reflect subjective discomfort in patients receiving antipsychotic treatment.
Collapse
Affiliation(s)
- Jae Seung Chang
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | | | | | | | | | | |
Collapse
|
36
|
Olanzapine-induced weight gain plays a key role in the potential cardiovascular risk: evidence from heart rate variability analysis. Sci Rep 2014; 4:7394. [PMID: 25487560 PMCID: PMC4260225 DOI: 10.1038/srep07394] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/20/2014] [Indexed: 12/02/2022] Open
Abstract
Patients with schizophrenia have a higher risk for cardiovascular disease (CVD) than the general population. Research has suggested that autonomic imbalance is a common pathway to increased morbidity and mortality for CVD. Heart rate variability (HRV) analysis is a non-invasive method that assesses autonomic imbalance, and low HRV is correlated with high cardiovascular risk. Olanzapine, a widely used antipsychotic drug, is considered to have good cardiac safety because of not causing significant corrected QT-interval (QTc) prolongation; however, it is still unclear whether olanzapine affects HRV. We recruited 83 patients with schizophrenia who were medication-free for at least 1 month and tested their HRV at the baseline and 4 weeks after treatment with olanzapine. We found that patients who had substantial weight gain (EWG) manifested significantly lower HRV than those who had non-substantial weight gain (NWG) and that HRV decrease was positively correlated to an increase in body mass index (BMI) and weight gain. Our results indicate that olanzapine-induced weight gain may play an important role in its potential cardiovascular risk. Since olanzapine has a very high potential for weight gain compared with other antipsychotics, further research is needed to explore its cardiovascular safety profile, specifically long-term cardiac safety.
Collapse
|
37
|
Hamilton HK, Sun JC, Green MF, Kee KS, Lee J, Sergi M, Sholty GL, Mathis KI, Jetton C, Williams TJ, Kern R, Horan W, Fiske A, Subotnik KL, Ventura J, Hellemann G, Nuechterlein KH, Yee CM. Social cognition and functional outcome in schizophrenia: The moderating role of cardiac vagal tone. JOURNAL OF ABNORMAL PSYCHOLOGY 2014; 123:764-770. [PMID: 25314266 DOI: 10.1037/a0037813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Individuals with schizophrenia face significant challenges in daily functioning, and although social cognition predicts how well patients respond to these challenges, associated physiological mechanisms remain unspecified. The present study draws from polyvagal theory and tested the hypothesis that respiratory sinus arrhythmia (RSA), an established indicator of the capacity to self-regulate and adapt to environmental demands, combines with social cognition to predict functional outcome. Using data from 41 schizophrenia patients and 36 healthy comparison subjects, we replicated group differences in RSA and social cognition and also demonstrated that RSA and social cognition interact to predict how effectively patients manage work and independent living activities. Specifically, RSA did not enhance functional outcomes when social cognition was already strong, but higher levels of RSA enabled effective role functioning when social-cognitive performance was impaired. Jointly, RSA and social cognition accounted for 40% of the variance in outcome success, compared with 21% when evaluating social cognition alone. As polyvagal theory suggests, physiological flexibility and self-regulatory capacity may compensate for poorer social-cognitive skills among schizophrenia patients.
Collapse
Affiliation(s)
| | | | | | | | - Junghee Lee
- Department of Psychiatry and Biobehavioral Sciences
| | - Mark Sergi
- Department of Psychology, California State University
| | | | | | | | | | - Robert Kern
- Department of Psychiatry and Biobehavioral Sciences
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Chang HA, Chang CC, Tzeng NS, Kuo TBJ, Lu RB, Huang SY. Heart rate variability in unmedicated patients with bipolar disorder in the manic phase. Psychiatry Clin Neurosci 2014; 68:674-82. [PMID: 24612182 DOI: 10.1111/pcn.12178] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 01/29/2014] [Accepted: 02/18/2014] [Indexed: 12/14/2022]
Abstract
AIMS Decreased heart rate variability (HRV) has been proposed in bipolar disorder. To date, there has been no adequate study that has investigated resting HRV in unmedicated patients with bipolar disorder in the manic state. METHODS To examine whether bipolar mania is associated with decreased HRV, 61 unmedicated patients with bipolar mania and 183 healthy volunteers aged 20-65 years were recruited for this case-control analysis. The Young Mania Rating Scale (YMRS), Clinical Global Impression-Severity, Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were used for the clinical ratings. Cardiac autonomic function was evaluated by measuring HRV parameters and the frequency-domain indices of HRV were obtained. RESULTS Patients with bipolar mania exhibited significantly lower mean RR interval, variance, low-frequency (LF)-HRV, and high-frequency (HF)-HRV but higher LF/HF compared to controls. Decreased HRV (variance) was associated with the YMRS total scores. Both the YMRS total scores and the Clinical Global Impression-Severity scores were positively correlated with the LH/HF ratio and inversely correlated with the HF-HRV. There was no significant correlation between the HAM-D/HAM-A scores and any HRV parameter. CONCLUSIONS Bipolar mania is associated with cardiac autonomic dysregulation, highlighting the importance of assessing HRV in manic patients. Further studies examining the influence of anti-manic psychotropic drugs on cardiac autonomic regulation in bipolar mania are needed.
Collapse
Affiliation(s)
- Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
39
|
Watanabe K, Taniguchi Y, Moritani T. Metabolic and cardiovascular responses during voluntary pedaling exercise with electrical muscle stimulation. Eur J Appl Physiol 2014; 114:1801-7. [PMID: 24867595 DOI: 10.1007/s00421-014-2906-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/03/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE We aimed to test the effect of additional electrical muscle stimulation (EMS) during moderate-intensity voluntary pedaling exercise on metabolic and cardiovascular responses. METHODS Eleven healthy male subjects performed moderate-intensity pedaling exercise at a constant workload (80% of ventilatory threshold) for 20 min while EMS was applied to thigh muscles from 5 to 10 min and from 15 to 20 min during the exercise. RESULTS A significantly higher oxygen uptake (VO₂), heart rate, and respiratory gas exchange ratio were observed during the exercise periods with EMS despite the constant workload. These changes were accompanied by an elevated blood lactate concentration, suggesting the existence of additional fast-twitch motor unit (MU) recruitment during the exercise with EMS. CONCLUSION Our data suggest that the use of intermittent EMS during a constant load exercise mimics the high-intensity interval training, possibly due to additional fast-twitch MU recruitment and co-contractions of the quadriceps and hamstrings muscles, leading to higher anaerobic metabolism and a lower mechanical efficiency.
Collapse
Affiliation(s)
- Kohei Watanabe
- School of International Liberal Studies, Chukyo University, Nagoya, Japan,
| | | | | |
Collapse
|
40
|
Evaluation of autonomic nervous system by salivary alpha-amylase level and heart rate variability in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2014; 264:83-7. [PMID: 23645102 DOI: 10.1007/s00406-013-0411-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 04/20/2013] [Indexed: 10/26/2022]
Abstract
Several researches indicate that autonomic nervous system (ANS) dysfunction in patients with schizophrenia. Recently, salivary alpha-amylase (sAA) has been employed as a useful marker for ANS function. We investigated the extent of ANS dysfunction by measuring sAA and heart rate variability (HRV) of 25 patients with schizophrenia compared with controls. Schizophrenia group demonstrated a significant increase in sAA and markedly lower parasympathetic nervous system (PNS) activity in the HRV. However, there were no significant differences between two groups in sympathetic nervous system (SNS) activity. We concluded that PNS might be suppressed and the SNS shows relatively high activity in schizophrenia.
Collapse
|
41
|
Chung MS, Yang AC, Lin YC, Lin CN, Chang FR, Shen SH, Ouyang WC, Loh EW, Chiu HJ. Association of altered cardiac autonomic function with psychopathology and metabolic profiles in schizophrenia. Psychiatry Res 2013; 210:710-5. [PMID: 23978730 DOI: 10.1016/j.psychres.2013.07.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 07/23/2013] [Accepted: 07/27/2013] [Indexed: 12/29/2022]
Abstract
Schizophrenia has been associated with autonomic dysregulation and increased cardiovascular co-morbidity. We hypothesised that autonomic dysregulation in patients with schizophrenia is associated with psychopathology and metabolic profiles. In this study, we aimed to evaluate psychopathology, comprehensive metabolic profiles and cardiac autonomic function using heart-rate variability (HRV) analysis in patients with schizophrenia. A total of 94 patients with schizophrenia and 51 healthy controls were recruited. Each patient underwent a physical examination, laboratory tests and rating scale evaluation, and all subjects underwent a 1-h electrocardiogram monitoring. Analysis of variance was used to compare demographic and HRV variables between control and patient groups. We applied multiple regression analysis with backward selection to examine the association between HRV indices and demographic, metabolic and psychopathology profiles. A decreased HRV was found in patient groups, compared to controls. Reduced vagal-related and complexity domain of HRV indices in patient groups were correlated with increased body mass indices, diastolic pressure, triglycerides, high- and low-density lipoprotein and severity of psychosis mainly in the negative symptom domain. This study provides evidence that altered autonomic function is associated with both psychopathology and metabolic profiles in patients with schizophrenia. These findings may warrant future research in using HRV as objective markers to monitor cardiovascular health and the severity of psychosis in patients with schizophrenia.
Collapse
|
42
|
Iwamoto Y, Kawanishi C, Kishida I, Furuno T, Fujibayashi M, Ishii C, Ishii N, Moritani T, Taguri M, Hirayasu Y. Dose-dependent effect of antipsychotic drugs on autonomic nervous system activity in schizophrenia. BMC Psychiatry 2012; 12:199. [PMID: 23151241 PMCID: PMC3534356 DOI: 10.1186/1471-244x-12-199] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 11/02/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Antipsychotic drugs are considered a trigger factor for autonomic dysregulation, which has been shown to predict potentially fatal arrhythmias in schizophrenia. However, the dose-dependent effect of antipsychotic drugs and other psychotropic drugs on autonomic nervous system (ANS) activity remain unclear. The purpose of this study was to investigate the dose-dependent effect of antipsychotic drugs and other clinical factors on ANS activity in an adequate sample size of patients with schizophrenia. METHODS A total of 211 Japanese patients with schizophrenia and 44 healthy subjects participated in this study. ANS activity was assessed by means of heart rate variability (HRV) power spectral analysis. Antipsychotic drug treatment and various clinical factors were investigated for each participant. The patient group was categorized into three subgroups according to daily dose of antipsychotic drug, and HRV was compared between groups. RESULTS The results showed significantly decreased low-frequency and high-frequency components of HRV in the patient group compared to the control group. The high-dose group showed a significantly lower HRV than the medium-dose group and an even lower HRV than the low-dose group. In addition, a significant association between HRV and antipsychotic drug dose was identified by multiple regression analysis. HRV was not associated with age, sex, body mass index, duration of illness, or daily dose of other psychotropic drugs. CONCLUSION These results suggest that antipsychotic drugs exert a significant dose-dependent effect on the extent of decline in ANS activity, and that optimal antipsychotic medication is required to avoid possible cardiovascular adverse events in patients with schizophrenia.
Collapse
Affiliation(s)
- Yohko Iwamoto
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan,Fujisawa Hospital, Kanagawa Prefecture, Japan
| | - Chiaki Kawanishi
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ikuko Kishida
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan,Fujisawa Hospital, Kanagawa Prefecture, Japan
| | - Taku Furuno
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Mami Fujibayashi
- Graduate School of Human and Environmental Studies, Kyoto University, Kyoto, Japan,The Division of Physical and Health Education, Setsunan University, Osaka, Japan
| | - Chie Ishii
- Fujisawa Hospital, Kanagawa Prefecture, Japan
| | - Norio Ishii
- Fujisawa Hospital, Kanagawa Prefecture, Japan
| | - Toshio Moritani
- Graduate School of Human and Environmental Studies, Kyoto University, Kyoto, Japan
| | - Masataka Taguri
- Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Yoshio Hirayasu
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| |
Collapse
|
43
|
May salivary alpha-amylase level be a useful tool for assessment of the severity of schizophrenia and evaluation of therapy? A case report. Case Rep Psychiatry 2012; 2012:747104. [PMID: 23056984 PMCID: PMC3465892 DOI: 10.1155/2012/747104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 09/02/2012] [Indexed: 11/24/2022] Open
Abstract
Background. Previous studies suggested dysfunction of the autonomic nervous system (ANS) in schizophrenia patients, but the mechanism remains unclear. Recently, the measurement of salivary alpha-amylase (sAA) has been considered a useful tool for evaluating ANS, especially the sympathoadrenal medullary system. Furthermore, there was a report that patients with schizophrenia showed much higher sAA level than normal controls.
Methods. We present the case of a 51-year-old female with catatonic schizophrenia. She needed the treatment of electroconvulsive therapy (ECT). We evaluated her sAA level and her psychiatric symptoms during the treatment. Results. Before ECT treatment, she showed high sAA level. Her sAA level decreased during the course of ECT, and this attenuation was accompanied by improvement of schizophrenic symptoms. Conclusion. We consider that measurement of the sAA level may be one of the useful biological markers for assessment of psychotic state and efficacy of treatment in patients with schizophrenia.
Collapse
|
44
|
van Venrooij JAE.M, Fluitman SBAHA, Lijmer JG, Kavelaars A, Heijnen CJ, Westenberg HGM, Kahn RS, Gispen-de Wied CC. Impaired neuroendocrine and immune response to acute stress in medication-naive patients with a first episode of psychosis. Schizophr Bull 2012; 38:272-9. [PMID: 20558533 PMCID: PMC3283141 DOI: 10.1093/schbul/sbq062] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Little is known about how the biological stress response systems--the autonomic nervous system (ANS), the hypothalamic-pituitary-adrenal (HPA) axis, and the immune system--function during psychosis. Results of studies on the effect of stress on the immune and autonomic system in patients with schizophrenia are inconsistent. The present study investigates whether the stress response is impaired in medication-naive patients with a first episode of psychosis. Ten male patients with a first episode of psychosis and 15 controls were exposed to the stress of public speaking. Parameters of the ANS (heart rate and catecholamines), the HPA axis (plasma adrenocorticotropic hormone [ACTH] and cortisol), and the immune system (number and activity of natural killer [NK] cells) were measured. Peak responses were calculated to examine the relationship between stress-induced activation of the different systems. Subjective stress and anxiety before and during the task were assessed. Patients and controls displayed similar autonomic responses to acute stress. However, there was an impaired HPA axis response, slow onset and return of ACTH, and flattened cortisol response and a reduced increase in number NK cells and NK cell activity in patients with a first episode of psychosis. Furthermore, in patients, the relationship between the different stress response systems was weaker or absent compared with controls. These findings indicate that impairments in stress processing are associated with the endophenotype of psychosis and are not a result of illness progression or antipsychotic medication.
Collapse
Affiliation(s)
- Janine A. E .M. van Venrooij
- The Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sjoerd B. A. H. A. Fluitman
- The Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands,To whom correspondence should be addressed; Department of Psychiatry, University Medical Center Utrecht, House (A.01.126), PO Box 85500, 3508 GA Utrecht, the Netherlands; tel: +31-88-755-9019, fax: +31-88-755-5443, e-mail:
| | - Jeroen G. Lijmer
- The Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Annemieke Kavelaars
- Laboratory for Psychoneuroimmunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cobi J. Heijnen
- Laboratory for Psychoneuroimmunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Herman G. M. Westenberg
- The Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - René S. Kahn
- The Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Christine C. Gispen-de Wied
- The Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
45
|
Chang LR, Lin YH, Kuo TBJ, Wu Chang HC, Liu CM, Liu CC, Hwu HG, Yang CCH. Autonomic modulation and health-related quality of life among schizophrenic patients treated with non-intensive case management. PLoS One 2011; 6:e26378. [PMID: 22073161 PMCID: PMC3208549 DOI: 10.1371/journal.pone.0026378] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 09/26/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Schizophrenia is associated with autonomic dysfunction and this may increase cardiovascular mortality. Past studies on autonomic modulation of schizophrenic patients focused on inpatients rather than individuals in a community setting, especially those receiving non-intensive case management (non-ICM). Besides, autonomic modulation and its association with health-related quality of life (HRQoL) in this population remain unexplored. METHODS A total of 25 schizophrenic patients treated by non-ICM and 40 healthy volunteers were matched by age, gender and body mass index; smokers were excluded. Between the two groups, we compared the individuals' 5 min resting assessments of heart rate variability and their HRQoL, which was measured using EuroQoL-5D (EQ-5D). Patients with schizophrenia were assessed for psychopathology using the Positive and Negative Syndrome Scale for Schizophrenia (PANSS). We examined the relationship between heart rate variability measurements, HRQoL scores, PANSS scores, and other clinical variables among the schizophrenic patients treated by non-ICM. RESULTS Compared to the controls, patients with schizophrenia showed a significant impairment of autonomic modulation and a worse HRQoL. Cardiovagal dysfunction among the schizophrenic patients could be predicted independently based on lower educational level and more negative symptoms. Sympathetic predominance was directly associated with anticholinergics use and EQ-5D using a visual analogue scale (EQ-VAS). CONCLUSION Patients with schizophrenia treated by non-ICM show a significant impairment of their autonomic function and HRQoL compared to the controls. Since the sympathovagal dysfunction is associated with more negative symptoms or higher VAS score, the treatment of the negative symptoms as well as the monitoring of HRQoL might help to manage cardiovascular risk among these individuals. In addition, EQ-VAS scores must be interpreted more cautiously in such a population.
Collapse
Affiliation(s)
- Li-Ren Chang
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Yu-Hsuan Lin
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Terry B. J. Kuo
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- Research Center for Adaptive Data Analysis, National Central University, Taoyuan, Taiwan
| | - Hung-Chieh Wu Chang
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Gwo Hwu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheryl C. H. Yang
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
46
|
Bradley AJ, Dinan TG, Chiang SC, Chen JJ, Chen CH, Sun HJ, Hwu HG, Lai MS. A randomised controlled study of risperidone and olanzapine for schizophrenic patients with neuroleptic-induced acute dystonia or parkinsonism. J Psychopharmacol 2010; 24:91-8. [PMID: 18801830 PMCID: PMC2951595 DOI: 10.1177/0269881108096070] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The objective of this study was to compare the effects of risperidone and olanzapine in schizophrenic patients with intolerant extrapyramidal side effects (EPS) on first generation antipsychotics. We conducted an 8-week, rater-blinded, flexible dose study. Seventy patients with schizophrenia, who met the DSM-IV research criteria of having neuroleptic-induced acute dystonia or parkinsonism, were randomly assigned to risperidone or olanzapine group. The primary outcome was a comparison of the incidence of concomitant anticholinergic drugs usage between the groups to manage their acute dystonia and parkinsonism. The average doses of risperidone and olanzapine from baseline to study end point were 1.8-3.5 mg/day and 7.7-11.7 mg/day, respectively. There were no significant differences in demographic data, severity of EPS or psychotic symptoms between the groups at baseline assessment. Patients taking risperidone had significantly higher incidence of using anticholinergic drugs to manage acute dystonia or parkinsonism overall during the study (OR = 5.17, 95%CI = 1.49-17.88, P = 0.013). There was no significant between-group difference in the changing of rating scales of EPS and psychotic symptoms. The results of our study favour olanzapine as a better choice in schizophrenic patients with intolerant EPS. Double-blinded, fixed dose and different ethnical study for EPS-intolerant schizophrenic patients is needed to confirm the results of our study.
Collapse
Affiliation(s)
- Andrew J Bradley
- Eli Lilly and Company Ltd, Basingstoke, UK.,Andrew J Bradley, Eli Lilly and Company Ltd, Lilly House, Priestly Road, Basingstoke, Hampshire RG24 9NL, United Kingdom
| | - Timothy G Dinan
- Department of Psychiatry, Cork University Hospital, Cork, Ireland
| | | | | | | | | | | | | |
Collapse
|
47
|
Bradley AJ, Dinan TG. A systematic review of hypothalamic-pituitary-adrenal axis function in schizophrenia: implications for mortality. J Psychopharmacol 2010; 24:91-118. [PMID: 20923924 PMCID: PMC2951595 DOI: 10.1177/1359786810385491] [Citation(s) in RCA: 183] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
There is convincing evidence that environmental stress plays a significant role in modifying both mental and physical health. The biological mechanisms linking stress to ill health are not fully understood, but significant evidence points to a central role of the stress axes; the hypothalamic- pituitary-adrenal (HPA) axis and the sympathetic nervous system. Together these two systems link the brain and the body and are crucial in maintaining homeostasis as well as improving an organism's survival chances in the face of environmental challenge. There is evidence of altered HPA axis function in people with a range of mental disorders, and this may in part explain the poor physical health of people with psychotic, mood and anxiety disorders. This paper systematically reviews HPA axis function in people with schizophrenia and relates this to the pattern of physical health seen in this disease. In summary, the evidence suggests people with schizophrenia can experience both hyper- and hypo-function of the HPA axis. It is likely that this contributes to the pattern of poor physical health and premature mortality suffered by people with schizophrenia, in particular the high rates of cardiovascular and metabolic disturbance.
Collapse
Affiliation(s)
| | - Timothy G Dinan
- Department of Psychiatry, Cork University Hospital, Cork, Ireland
| |
Collapse
|
48
|
Inagaki T, Miyaoka T, Okazaki S, Yasuda H, Kawamukai T, Utani E, Wake R, Hayashida M, Horiguchi J, Tsuji S. High salivary alpha-amylase levels in patients with schizophrenia: A pilot study. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:688-91. [PMID: 20347911 DOI: 10.1016/j.pnpbp.2010.03.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 03/04/2010] [Accepted: 03/15/2010] [Indexed: 10/19/2022]
Abstract
Previous studies have demonstrated the autonomic dysregulation in patients with schizophrenia using electrophysiological methods, such as electrodermal measures and heart rate analysis. Several theories have been proposed to explain the underlying mechanisms of schizophrenia and its autonomic function. Recently, the measurement of salivary alpha-amylase has been considered to be a useful tool for evaluating the sympathetic-adrenal-medullary (SAM) system. Psychosocial stress increases the release of salivary alpha-amylase. Although some studies have evaluated salivary alpha-amylase under psychosocial stress, no studies have demonstrated the change in the salivary alpha-amylase (sAA) activity level in schizophrenic patients. We examined the relationship between sAA level and psychiatric state in patients with schizophrenia (n=54) using a portable and rapid hand-held monitor to investigate sAA. The sAA activity in the patients was significantly higher than that in the control subjects (n=55) (p<0.01). The correlation between amylase level and psychiatric symptoms was highly significant (r=0.37, p<0.01). These findings indicate that higher increases in sAA may indicate severe psychiatric symptoms. These results indicate a predominant role of the sympathetic nervous system in the secretion of sAA, together with parasympathetic withdrawal, under psychosocial stress.
Collapse
Affiliation(s)
- Takuji Inagaki
- Department of Psychology and Special Support Education, Faculty of Education, Shimane University, Matsue, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|