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Thalhammer M, Schulz J, Scheulen F, Oubaggi MEM, Kirschner M, Kaiser S, Schmidt A, Borgwardt S, Avram M, Brandl F, Sorg C. Distinct Volume Alterations of Thalamic Nuclei Across the Schizophrenia Spectrum. Schizophr Bull 2024; 50:1208-1222. [PMID: 38577901 PMCID: PMC11349018 DOI: 10.1093/schbul/sbae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND HYPOTHESIS Abnormal thalamic nuclei volumes and their link to cognitive impairments have been observed in schizophrenia. However, whether and how this finding extends to the schizophrenia spectrum is unknown. We hypothesized a distinct pattern of aberrant thalamic nuclei volume across the spectrum and examined its potential associations with cognitive symptoms. STUDY DESIGN We performed a FreeSurfer-based volumetry of T1-weighted brain MRIs from 137 healthy controls, 66 at-risk mental state (ARMS) subjects, 89 first-episode psychosis (FEP) individuals, and 126 patients with schizophrenia to estimate thalamic nuclei volumes of six nuclei groups (anterior, lateral, ventral, intralaminar, medial, and pulvinar). We used linear regression models, controlling for sex, age, and estimated total intracranial volume, both to compare thalamic nuclei volumes across groups and to investigate their associations with positive, negative, and cognitive symptoms. STUDY RESULTS We observed significant volume alterations in medial and lateral thalamic nuclei. Medial nuclei displayed consistently reduced volumes across the spectrum compared to controls, while lower lateral nuclei volumes were only observed in schizophrenia. Whereas positive and negative symptoms were not associated with reduced nuclei volumes across all groups, higher cognitive scores were linked to lower volumes of medial nuclei in ARMS. In FEP, cognition was not linked to nuclei volumes. In schizophrenia, lower cognitive performance was associated with lower medial volumes. CONCLUSIONS Results demonstrate distinct thalamic nuclei volume reductions across the schizophrenia spectrum, with lower medial nuclei volumes linked to cognitive deficits in ARMS and schizophrenia. Data suggest a distinctive trajectory of thalamic nuclei abnormalities along the course of schizophrenia.
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Affiliation(s)
- Melissa Thalhammer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Julia Schulz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Felicitas Scheulen
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Mohamed El Mehdi Oubaggi
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Kirschner
- Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Kaiser
- Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - André Schmidt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Mihai Avram
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Felix Brandl
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Sorg
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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Sirts K, Anni K, Balõtšev R, Jakobsoo S, Jaanson KL, Haring L. Adapting the early recognition inventory ERIraos to Estonian: A validation study. Early Interv Psychiatry 2024. [PMID: 38385961 DOI: 10.1111/eip.13519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 11/09/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
AIM Validated assessment tools are needed to identify clinically high risk for psychosis. This study aimed to validate the early recognition inventory ERIraos, which consists of the ERIraos Checklist for risk screening and the ERIraos Symptom List for a more thorough risk assessment in the Estonian language to detect psychotic prodromal symptoms. METHODS A prospective cohort study provided an opportunity to evaluate the characteristics of the ERIraos instrument in predicting the increased risk of a psychotic disorder in the future. The 177 study participants, aged 13-42 years old, were divided into groups without an increased risk and three risk groups with different risk severity levels based on the ERIraos Symptom List assessment. RESULTS The results indicated excellent inter-rater reliability for the ERIraos Symptom List total score. The ability of the ERIraos checklist to screen persons with an elevated psychosis risk was very good (ROC-AUC = 0.86). The capability of the ERIraos Symptom List scores to predict the probability of transitioning to psychosis within 2 years was very good (ROC-AUC = 0.83). Brief limited intermittent psychotic symptoms and observable behavioural and affective symptoms were statistically significant predictors of transition to psychosis. There were strong and statistically significant correlations between the ERIraos Symptom List scores and other clinical measures assessing functioning and psychopathology. CONCLUSIONS The results of this study demonstrate the reliability and validity of the Estonian version of the ERIraos instrument and support the usability of ERIraos as a two-step tool for the early recognition of psychosis risk.
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Affiliation(s)
- Kairit Sirts
- Institute of Psychology, University of Tartu, Tartu, Estonia
| | - Kätlin Anni
- Institute of Psychology, University of Tartu, Tartu, Estonia
| | - Roman Balõtšev
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Psychiatry Clinic of Tartu University Hospital, Tartu, Estonia
| | - Siim Jakobsoo
- Institute of Psychology, University of Tartu, Tartu, Estonia
| | | | - Liina Haring
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Psychiatry Clinic of Tartu University Hospital, Tartu, Estonia
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Hagler MA, Ferrara M, Yoviene Sykes LA, Li F, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Perkins DO, Mathalon DH, Seidman LJ, Tsuang MT, Walker EF, Powers AR, Allen AR, Srihari VH, Woods SW. Sampling from different populations: Sociodemographic, clinical, and functional differences between samples of first episode psychosis individuals and clinical high-risk individuals who progressed to psychosis. Schizophr Res 2023; 255:239-245. [PMID: 37028205 PMCID: PMC10207144 DOI: 10.1016/j.schres.2023.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/24/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
Over the past two decades, research and clinical resources on clinical high risk (CHR) for psychosis have both expanded, with goals to better understanding risk and protective factors on the course of illness and inform early intervention efforts. However, some studies have highlighted potential sampling bias among CHR research studies, raising questions about generalizability of findings and inequitable access to early detection and intervention. The current study sought to explore these questions by comparing 94 participants in a CHR longitudinal monitoring study across North America (NAPLS-2) who converted to syndromal psychosis over the course of the study (CHR-CV) to 171 participants who presented for treatment at a localized first-episode psychosis service (FES) after converting. CHR-CV participants were significantly more likely to be White and have a college-educated parent, while FES participants were more likely to be Black and first- or second-generation immigrants. On average, CHR-CV participants were younger at onset of attenuated positive symptoms, had a longer period of attenuated symptoms prior to conversion, and were more likely to be treated with antipsychotics prior to conversion compared to those in FES programs. After controlling for time since conversion, CHR-CV participants had higher global functioning and were less likely to have experienced recent psychiatric hospitalization. Findings suggest that CHR research and FES clinics may be sampling from different populations, although conclusions are limited by inconsistent sampling frames and methods. Integrated early detection that targets defined geographic catchments may deliver more epidemiologically representative samples to both CHR research and FES.
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Affiliation(s)
- Matthew A Hagler
- Department of Psychiatry, Yale University, New Haven, CT, United States of America.
| | - Maria Ferrara
- Department of Psychiatry, Yale University, New Haven, CT, United States of America; Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | | - Fangyong Li
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Departments of Psychology and Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, United States of America
| | | | - Tyrone D Cannon
- Departments of Psychology and Psychiatry, Yale University, New Haven, CT, United States of America
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States of America
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States of America
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, San Francisco, CA, United States of America
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, CA, United States of America
| | - Elaine F Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, United States of America
| | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Adrienne R Allen
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Vinod H Srihari
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
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Lin B, Li XB, Ruan S, Wu YX, Zhang CY, Wang CY, Wang LB. Convergent and divergent gray matter volume abnormalities in unaffected first-degree relatives and ultra-high risk individuals of schizophrenia. SCHIZOPHRENIA 2022; 8:55. [PMID: 35853913 PMCID: PMC9261104 DOI: 10.1038/s41537-022-00261-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/24/2022] [Indexed: 01/10/2023]
Abstract
High-risk populations of schizophrenia can be mainly identified as genetic high-risk based on putative endophenotypes or ultra-high-risk (UHR) based on clinically manifested symptoms. Previous studies have consistently shown brain structural abnormalities in both genetic high-risk and UHR individuals. In this study, we aimed to disentangle the convergent and divergent pattern of gray matter alterations between UHR and unaffected first-degree relatives from genetic high-risk individuals. We used structural MRI scans and voxel-based morphometry method to examine gray matter volume (GMV) differences among 23 UHR subjects meeting the Structured Interview for Prodromal Syndromes (SIPS) criteria, 18 unaffected first-degree relatives (UFDR), 26 first-episode schizophrenia patients (FES) and 54 healthy controls (CN). We found that a number of brain regions exhibited a monotonically decreasing trend of GMV from CN to UFDR to UHR to FES. Compared with CN, the UHR subjects showed significant decreases of GMV similar to the patients in the inferior temporal gyrus, fusiform gyrus, middle occipital gyrus, insula, and limbic regions. Moreover, the UHR transformed subgroup had significantly lower GMV than UHR non-transformed subgroup in the right inferior temporal/fusiform gyrus. On the other hand, the UFDR subjects only showed significant GMV decreases in the inferior temporal gyrus and fusiform. Moreover, we found GMV in the occipital lobe was negatively correlated with the UHR subjects’ composite positive symptom of SIPS, and GMV in the cerebellum was positively correlated with FES subjects’ symptom severity. Our results suggest that GMV deficits and regional dysfunction are evident prior to the onset of psychosis and are more prominent in the UHR than the UFDR individuals.
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Identification of texture MRI brain abnormalities on first-episode psychosis and clinical high-risk subjects using explainable artificial intelligence. Transl Psychiatry 2022; 12:481. [PMID: 36385133 PMCID: PMC9668814 DOI: 10.1038/s41398-022-02242-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022] Open
Abstract
Structural MRI studies in first-episode psychosis and the clinical high-risk state have consistently shown volumetric abnormalities. Aim of the present study was to introduce radiomics texture features in identification of psychosis. Radiomics texture features describe the interrelationship between voxel intensities across multiple spatial scales capturing the hidden information of underlying disease dynamics in addition to volumetric changes. Structural MR images were acquired from 77 first-episode psychosis (FEP) patients, 58 clinical high-risk subjects with no later transition to psychosis (CHR_NT), 15 clinical high-risk subjects with later transition (CHR_T), and 44 healthy controls (HC). Radiomics texture features were extracted from non-segmented images, and two-classification schemas were performed for the identification of FEP vs. HC and FEP vs. CHR_NT. The group of CHR_T was used as external validation in both schemas. The classification of a subject's clinical status was predicted by importing separately (a) the difference of entropy feature map and (b) the contrast feature map, resulting in classification balanced accuracy above 72% in both analyses. The proposed framework enhances the classification decision for FEP, CHR_NT, and HC subjects, verifies diagnosis-relevant features and may potentially contribute to identification of structural biomarkers for psychosis, beyond and above volumetric brain changes.
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Korda AI, Andreou C, Avram M, Handels H, Martinetz T, Borgwardt S. Chaos analysis of the brain topology in first-episode psychosis and clinical high risk patients. Front Psychiatry 2022; 13:965128. [PMID: 36311536 PMCID: PMC9606602 DOI: 10.3389/fpsyt.2022.965128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Structural MRI studies in first-episode psychosis (FEP) and in clinical high risk (CHR) patients have consistently shown volumetric abnormalities in frontal, temporal, and cingulate cortex areas. The aim of the present study was to employ chaos analysis for the identification of brain topology differences in people with psychosis. Structural MRI were acquired from 77 FEP, 73 CHR and 44 healthy controls (HC). Chaos analysis of the gray matter distribution was performed: First, the distances of each voxel from the center of mass in the gray matter image was calculated. Next, the distances multiplied by the voxel intensity were represented as a spatial-series, which then was analyzed by extracting the Largest-Lyapunov-Exponent (lambda). The lambda brain map depicts thus how the gray matter topology changes. Between-group differences were identified by (a) comparing the lambda brain maps, which resulted in statistically significant differences in FEP and CHR compared to HC; and (b) matching the lambda series with the Morlet wavelet, which resulted in statistically significant differences in the scalograms of FEP against CHR and HC. The proposed framework using spatial-series extraction enhances the between-group differences of FEP, CHR and HC subjects, verifies diagnosis-relevant features and may potentially contribute to the identification of structural biomarkers for psychosis.
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Affiliation(s)
- Alexandra I. Korda
- Translational Psychiatry, Department of Psychiatry and Psycotherapy, University of Lübeck, Lübeck, Germany
| | - Christina Andreou
- Translational Psychiatry, Department of Psychiatry and Psycotherapy, University of Lübeck, Lübeck, Germany
| | - Mihai Avram
- Translational Psychiatry, Department of Psychiatry and Psycotherapy, University of Lübeck, Lübeck, Germany
| | - Heinz Handels
- Institute of Medical Informatics, University of Lübeck, Lübeck, Germany
| | - Thomas Martinetz
- Institute for Neuro- and Bioinformatics, University of Lübeck, Lübeck, Germany
| | - Stefan Borgwardt
- Translational Psychiatry, Department of Psychiatry and Psycotherapy, University of Lübeck, Lübeck, Germany
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Lee TY, Hwang WJ, Kim NS, Park I, Lho SK, Moon SY, Oh S, Lee J, Kim M, Woo CW, Kwon JS. Prediction of psychosis: model development and internal validation of a personalized risk calculator. Psychol Med 2022; 52:2632-2640. [PMID: 33315005 PMCID: PMC9647536 DOI: 10.1017/s0033291720004675] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Over the past two decades, early detection and early intervention in psychosis have become essential goals of psychiatry. However, clinical impressions are insufficient for predicting psychosis outcomes in clinical high-risk (CHR) individuals; a more rigorous and objective model is needed. This study aims to develop and internally validate a model for predicting the transition to psychosis within 10 years. METHODS Two hundred and eight help-seeking individuals who fulfilled the CHR criteria were enrolled from the prospective, naturalistic cohort program for CHR at the Seoul Youth Clinic (SYC). The least absolute shrinkage and selection operator (LASSO)-penalized Cox regression was used to develop a predictive model for a psychotic transition. We performed k-means clustering and survival analysis to stratify the risk of psychosis. RESULTS The predictive model, which includes clinical and cognitive variables, identified the following six baseline variables as important predictors: 1-year percentage decrease in the Global Assessment of Functioning score, IQ, California Verbal Learning Test score, Strange Stories test score, and scores in two domains of the Social Functioning Scale. The predictive model showed a cross-validated Harrell's C-index of 0.78 and identified three subclusters with significantly different risk levels. CONCLUSIONS Overall, our predictive model showed a predictive ability and could facilitate a personalized therapeutic approach to different risks in high-risk individuals.
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Affiliation(s)
- Tae Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Wu Jeong Hwang
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Nahrie S. Kim
- Department of Psychiatry, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Inkyung Park
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Silvia Kyungjin Lho
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Moon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sanghoon Oh
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Junhee Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minah Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Choong-Wan Woo
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
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Manninen M, Koivukangas J, Holm M, Lindgren M. Lifetime psychiatric diagnoses among adolescents with severe conduct problems - A register-based follow-up study. CHILD ABUSE & NEGLECT 2022; 131:105765. [PMID: 35763955 DOI: 10.1016/j.chiabu.2022.105765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 05/26/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Both delinquency and out-of-home care (OOHC) are associated with a wide spectrum of psychiatric disorders. Reform schools (RS) are Finnish OOHC institutions for adolescents with severe conduct problems. OBJECTIVE We investigated the prevalence of psychiatric diagnoses among individuals with a history of RS placement. PARTICIPANTS AND SETTING The data consisted of individuals placed in a RS on the last day of the years 1991, 1996, 2001, 2006 or 2011 (N = 1074) and a matched comparison group (N = 5313). METHODS Information on lifetime psychiatric diagnoses, grouped into eight categories, was collected from the nationwide health care registry. The follow-up time ranged from 17 to 44 years. RESULTS Among RS population, 59.5 % had some psychiatric diagnosis, which was 12-fold compared to general population peers (hazard ratio HR = 12.4). The most prevalent categories were Conduct disorders and/or ADHD (30.7 %, HR = 41.5), Substance use disorders (29.3 %, HR = 16.8,), Other childhood disorders (8.6 %, HR = 11.9) and Personality disorders (10.9 %, HR = 11.6) followed by Mental retardation (6.4 %, HR = 8.4), Schizophrenia spectrum disorders (9.7 %, HR = 7.9), Affective disorders (17.9 %, HR = 7.3), and Disorders of psychological development (6.1 %, HR = 4.4). All differences were statistically significant (p < .001). CONCLUSIONS RS background associates with an excess of psychiatric disorders, which adds to the burden of other known risk factors for adult age well-being. Effective screening and intervention for psychiatric problems should be available both during the RS placement and after-care.
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Affiliation(s)
- Marko Manninen
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Jenny Koivukangas
- Department of Psychology and Logopedics, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Minna Holm
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
| | - Maija Lindgren
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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Insulin-like Growth Factor 2 (IGF-2) and Insulin-like Growth Factor Binding Protein 7 (IGFBP-7) Are Upregulated after Atypical Antipsychotics in Spanish Schizophrenia Patients. Int J Mol Sci 2022; 23:ijms23179591. [PMID: 36076984 PMCID: PMC9455262 DOI: 10.3390/ijms23179591] [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: 07/26/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022] Open
Abstract
Insulin-like growth factor 2 (IGF-2) and IGF binding protein 7 (IGFBP-7) have been related to schizophrenia (SZ) due to their implication in neurodevelopment. The purpose of this study was to assess whether the alterations in IGF-2 and IGFBP-7 in SZ patients are intrinsically related to the psychiatric disorder itself or are a secondary phenomenon due to antipsychotic treatment. In order to test this hypothesis, we measured plasma IGF-2 and IGFBP-7 in drug-naïve first episode (FE) and multiple episodes or chronic (ME) SZ Caucasian patients who have been following treatment for years. A total of 55 SZ patients (FE = 15, ME = 40) and 45 healthy controls were recruited. The Positive and Negative Syndrome Scale (PANSS) and the Self-Assessment Anhedonia Scale (SAAS) were employed to check schizophrenic symptomatology and anhedonia, respectively. Plasma IGF-2 and IGFBP-7 levels were measured by Enzyme-Linked Immunosorbent Assay (ELISA). The FE SZ patients had much lower IGF-2, but not IGFBP-7, than controls. Moreover, both IGF-2 and IGFBP-7 significantly increased after atypical antipsychotic treatment (aripiprazole, olanzapine, or risperidone) in these patients. On the other hand, chronic patients showed higher levels of both proteins when compared to controls. Our study suggests that circulatory IGF-2 and IGFBP-7 increase after antipsychotic treatment, regardless of long-term conditions and being lower in drug-naïve FE patients.
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Millman ZB, West ML, Thibeau H, Sanders AS, Guyer M, Keshavan M, Lilly M, Friedman-Yakoobian M, Woodberry KA, Johnson KA, Kline ER. Changes in community providers' screening behaviours, referral practices, and clinical confidence following participation in an early psychosis educational campaign. Early Interv Psychiatry 2022; 16:744-751. [PMID: 34532946 PMCID: PMC10591393 DOI: 10.1111/eip.13215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/07/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
AIM Successful delivery of care to individuals with early psychosis depends on the ability of community providers to identify and refer appropriate candidates for services. Although specialty centres commonly rely upon education and outreach campaigns to building bridges with community providers, few studies have examined the effectiveness of these campaigns or the mechanisms by which they may achieve their intended effects. METHODS We surveyed community clinicians (N = 39) about their screening behaviours, referral practices, and confidence in managing early psychosis just before and 3-6 months after attending an educational event designed to promote recognition and quality treatment of early psychosis. RESULTS Three to six months following attendance, providers reported screening a greater proportion of clients for early psychosis, referring a greater number of clients to specialty services, and feeling more confident in their ability to respond to clients with early psychosis. Increases in confidence following attendance were associated with corresponding increases in screening behaviour. CONCLUSIONS The results suggest that outreach campaigns designed to enhance community providers' knowledge about early psychosis assessment and resources may be effective in promoting screening, referrals, and confidence in managing psychosis. Gains in provider confidence may contribute to increases in screening. Given the lack of control group and relatively short follow-up period, more research is needed to determine the effects of early psychosis educational events and the mechanisms by which they may promote successful treatment delivery for young people in need.
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Affiliation(s)
- Zachary B. Millman
- Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle L. West
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- University of Colorado, Aurora, Colorado, USA
| | - Heather Thibeau
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - A. Simone Sanders
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Margaret Guyer
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Department of Mental Health, Boston, Massachusetts, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Megan Lilly
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michelle Friedman-Yakoobian
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kristen A. Woodberry
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Center for Psychiatric Research, Maine Medical Center, Portland, Maine, USA
- Department of Psychiatry, Tufts School of Medicine, Boston, Massachusetts, USA
| | - Kelsey A. Johnson
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Emily R. Kline
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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11
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Hochstrasser L, Studerus E, Riecher-Rössler A, Schimmelmann BG, Lambert M, Lang UE, Borgwardt S, Stieglitz RD, Huber CG. Latent state-trait structure of BPRS subscales in clinical high-risk state and first episode psychosis. Sci Rep 2022; 12:6652. [PMID: 35459763 PMCID: PMC9033870 DOI: 10.1038/s41598-022-10207-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/21/2022] [Indexed: 11/08/2022] Open
Abstract
To investigate the longitudinal latent state-trait structure of the different dimensions of psychosis symptoms in clinical high-risk state (CHRS) and first episode psychosis (FEP) individuals over a one year time-span. This paper examines if the symptom clusters Positive Symptoms, Negative Symptoms, Affectivity, Resistance, Activation, and Excitement according to the Brief Psychiatric Rating Scale (BPRS) differ in their trait and state characters in 196 CHRS and 131 FEP individuals. Statistical analysis was performed using latent state-trait analysis. On average, trait differences accounted for 72.2% of Positive Symptoms, 81.1% of Negative Symptoms, 57.0% of Affectivity, and 69.2% of Activation, whereas 15.0% of the variance of Resistance and 13.2% of the variance of Excitement were explained by trait differences. Explorative analyses showed a trait components' increase of 0.408 in Positive Symptoms from baseline up to the 9th month and an increase of 0.521 in Affectivity from baseline up to the 6th month. Negative Symptoms had the highest trait component levels of all subscales between baseline and 6 months. The finding that an increasing proportion of psychosis symptoms is persisting over time underlines the importance of early intervention programs in individuals with psychotic disorders.
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Affiliation(s)
- Lisa Hochstrasser
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, 4012, Basel, Switzerland.
| | - Erich Studerus
- Department of Clinical Psychology and Psychiatry, University of Basel, Faculty of Psychology, Missionsstr. 60/62, 4055, Basel, Switzerland
| | - Anita Riecher-Rössler
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, 4012, Basel, Switzerland
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Effingerstr. 12, 3011, Bern, Switzerland
- Klinik für Kinder- und Jugendpsychiatrie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Lambert
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Undine E Lang
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, 4012, Basel, Switzerland
| | - Stefan Borgwardt
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, 4012, Basel, Switzerland
| | - Rolf-Dieter Stieglitz
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, 4012, Basel, Switzerland
- Department of Clinical Psychology and Psychiatry, University of Basel, Faculty of Psychology, Missionsstr. 60/62, 4055, Basel, Switzerland
| | - Christian G Huber
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, 4012, Basel, Switzerland
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12
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Estradé A, Salazar de Pablo G, Zanotti A, Wood S, Fisher HL, Fusar-Poli P. Public health primary prevention implemented by clinical high-risk services for psychosis. Transl Psychiatry 2022; 12:43. [PMID: 35091529 PMCID: PMC8799684 DOI: 10.1038/s41398-022-01805-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
Clinical High Risk for Psychosis (CHR-P) services have been primarily developed to support young people with attenuated symptoms (indicated prevention). No evidence-based appraisal has systematically investigated to what extent these clinics may implement other preventive approaches. PRISMA 2020-compliant systematic review of Web of Science, Cochrane Central Register of Reviews, and Ovid/PsychINFO, from inception until 14th June 2021, identifying original studies describing public health strategies: (a) service characteristics (configuration of mental health service, outreach, pathways to care); (b) universal interventions (general population); (c) selective interventions targeting CHR-P service-users or family/carers. Public health preventive initiatives were systematically stratified according to core social determinants of mental disorders associated with the 2030 Sustainable Development Goals promoted by the United Nations Member States (UN 2030 SDG) and good mental health outcomes. A total of 66 publications were included, providing data on 13 standalone, 40 integrated, three networks, and six regional or international surveys of CHR-P services across Europe, Asia, Oceania, Africa, North and South America, providing care to >28 M people. CHR-P services implement numerous public health initiatives targeting social and cultural (16 initiatives), economic (seven initiatives), demographic (six initiatives), environmental events (four initiatives) and neighbourhood (three initiatives) UN 2030 SGD determinants of mental disorders. There is additional evidence for CHR-P services promoting good mental health. The main barriers were the lack of resources for expanding public health prevention at a large scale. CHR-P services implement numerous public health prevention initiatives and promotion of good mental health beyond indicated prevention of psychosis.
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Affiliation(s)
- Andrés Estradé
- grid.13097.3c0000 0001 2322 6764Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Gonzalo Salazar de Pablo
- grid.13097.3c0000 0001 2322 6764Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,grid.410526.40000 0001 0277 7938Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain ,grid.37640.360000 0000 9439 0839Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
| | - Alice Zanotti
- grid.8982.b0000 0004 1762 5736Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Scott Wood
- grid.47100.320000000419368710Yale School of Medicine, Yale University, New Heaven, CT USA
| | - Helen L. Fisher
- grid.13097.3c0000 0001 2322 6764King’s College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK ,grid.13097.3c0000 0001 2322 6764Economic & Social Research Council (ESRC) Centre for Society and Mental Health, King’s College London, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. .,National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK. .,OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK.
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13
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Studerus E, Ittig S, Beck K, Del Cacho N, Vila-Badia R, Butjosa A, Usall J, Riecher-Rössler A. Relation between self-perceived stress, psychopathological symptoms and the stress hormone prolactin in emerging psychosis. J Psychiatr Res 2021; 136:428-434. [PMID: 32948308 DOI: 10.1016/j.jpsychires.2020.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Psychosocial stress and the stress hormone prolactin are assumed to play an important role in the pathogenesis of schizophrenia and related psychoses, and have been frequently observed to be increased in antipsychotic-naïve patients with a clinical high risk for psychosis (CHR-P) or first episode of psychosis (FEP). The aim of this study was to further elucidate the relationships between self-perceived stress, psychopathological symptoms and prolactin levels in these patients. METHODS In this cross-sectional study, 45 healthy controls, 31 CHR-P patients and 87 FEP patients were recruited from two different study centers. Prolactin was measured under standardized conditions between 8 and 10 am. All patients were antipsychotic-naïve and not taking any prolactin influencing medication. Self-perceived stress during the last month was measured with the perceived stress scale (PSS-10) immediately before blood taking. RESULTS Both CHR-P and FEP patients showed significantly higher levels of self-perceived stress and prolactin than controls. Hyperprolactinemia (i.e. prolactin levels above the reference range) was observed in 26% of CHR-P and 45% of FEP patients. Self-perceived stress was significantly positively associated with affective symptoms, but not with other symptoms. There was no significant association between self-perceived stress and prolactin levels. CONCLUSION Our results confirm that CHR-P and FEP patients have higher stress levels than healthy controls and frequently have hyperprolactinemia, independent of antipsychotic medication. However, although it is well established that prolactin increases in response to stress, our results do not support the notion that increased prolactin levels in these patients are due to stress.
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Affiliation(s)
- Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland; University of Basel, Department of Psychology, Division of Personality and Developmental Psychology, Basel, Switzerland.
| | - Sarah Ittig
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Katharina Beck
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland; University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland
| | - Nuria Del Cacho
- Parc Sanitari Sant Joan de Déu, Research and Development Unit, Sant Boi de Llobregat, Spain
| | - Regina Vila-Badia
- Parc Sanitari Sant Joan de Déu, Research and Development Unit, Sant Boi de Llobregat, Spain
| | - Anna Butjosa
- Parc Sanitari Sant Joan de Déu, Research and Development Unit, Sant Boi de Llobregat, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Research and Development Unit, Sant Boi de Llobregat, Spain
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
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14
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Salazar de Pablo G, Estradé A, Cutroni M, Andlauer O, Fusar-Poli P. Establishing a clinical service to prevent psychosis: What, how and when? Systematic review. Transl Psychiatry 2021; 11:43. [PMID: 33441556 PMCID: PMC7807021 DOI: 10.1038/s41398-020-01165-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 01/29/2023] Open
Abstract
The first rate-limiting step to successfully translate prevention of psychosis in to clinical practice is to establish specialised Clinical High Risk for Psychosis (CHR-P) services. This study systematises the knowledge regarding CHR-P services and provides guidelines for translational implementation. We conducted a PRISMA/MOOSE-compliant (PROSPERO-CRD42020163640) systematic review of Web of Science to identify studies until 4/05/2020 reporting on CHR-P service configuration, outreach strategy and referrals, service user characteristics, interventions, and outcomes. Fifty-six studies (1998-2020) were included, encompassing 51 distinct CHR-P services across 15 countries and a catchment area of 17,252,666 people. Most services (80.4%) consisted of integrated multidisciplinary teams taking care of CHR-P and other patients. Outreach encompassed active (up to 97.6%) or passive (up to 63.4%) approaches: referrals came mostly (90%) from healthcare agencies. CHR-P individuals were more frequently males (57.2%). Most (70.6%) services accepted individuals aged 12-35 years, typically assessed with the CAARMS/SIPS (83.7%). Baseline comorbid mental conditions were reported in two-third (69.5%) of cases, and unemployment in one third (36.6%). Most services provided up to 2-years (72.4%), of clinical monitoring (100%), psychoeducation (81.1%), psychosocial support (73%), family interventions (73%), individual (67.6%) and group (18.9%) psychotherapy, physical health interventions (37.8%), antipsychotics (87.1%), antidepressants (74.2%), anxiolytics (51.6%), and mood stabilisers (38.7%). Outcomes were more frequently ascertained clinically (93.0%) and included: persistence of symptoms/comorbidities (67.4%), transition to psychosis (53.5%), and functional status (48.8%). We provide ten practical recommendations for implementation of CHR-P services. Health service knowledge summarised by the current study will facilitate translational efforts for implementation of CHR-P services worldwide.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Clinical and Health Psychology, Catholic University, Montevideo, Uruguay
| | - Marcello Cutroni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Olivier Andlauer
- Heads UP Service, East London NHS Foundation Trust, London, UK
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK.
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK.
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15
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EEG microstates as biomarker for psychosis in ultra-high-risk patients. Transl Psychiatry 2020; 10:300. [PMID: 32839449 PMCID: PMC7445239 DOI: 10.1038/s41398-020-00963-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 02/01/2023] Open
Abstract
Resting-state EEG microstates are brief (50-100 ms) periods, in which the spatial configuration of scalp global field power remains quasi-stable before rapidly shifting to another configuration. Changes in microstate parameters have been described in patients with psychotic disorders. These changes have also been observed in individuals with a clinical or genetic high risk, suggesting potential usefulness of EEG microstates as a biomarker for psychotic disorders. The present study aimed to investigate the potential of EEG microstates as biomarkers for psychotic disorders and future transition to psychosis in patients at ultra-high-risk (UHR). We used 19-channel clinical EEG recordings and orthogonal contrasts to compare temporal parameters of four normative microstate classes (A-D) between patients with first-episode psychosis (FEP; n = 29), UHR patients with (UHR-T; n = 20) and without (UHR-NT; n = 34) later transition to psychosis, and healthy controls (HC; n = 25). Microstate A was increased in patients (FEP & UHR-T & UHR-NT) compared to HC, suggesting an unspecific state biomarker of general psychopathology. Microstate B displayed a decrease in FEP compared to both UHR patient groups, and thus may represent a state biomarker specific to psychotic illness progression. Microstate D was significantly decreased in UHR-T compared to UHR-NT, suggesting its potential as a selective biomarker of future transition in UHR patients.
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16
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Leanza L, Studerus E, Mackintosh AJ, Beck K, Seiler L, Andreou C, Riecher-Rössler A. Predictors of study drop-out and service disengagement in patients at clinical high risk for psychosis. Soc Psychiatry Psychiatr Epidemiol 2020; 55:539-548. [PMID: 31646355 DOI: 10.1007/s00127-019-01796-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/09/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE Study drop-out during follow-up and service disengagement frequently occur in patients at clinical high risk for psychosis (CHR-P). However, little is known about their predictors. Therefore, we aimed to analyze the rate and reasons for drop-out and service disengagement in CHR-P patients and investigate their sociodemographic and clinical predictors. METHODS Data from 200 patients of the prospective Früherkennung von Psychosen (FePsy) study were analyzed with competing risks survival models, considering drop-out and transition to psychosis as competing events. To investigate whether symptoms changed immediately before drop-out, t tests were applied. RESULTS Thirty-six percent of patients dropped out within 5 years. Almost all drop-outs also disengaged from our service. Hence, study drop-out was used as a proxy for service disengagement. Patients with more severe baseline disorganized symptoms and a late inclusion into the study were significantly more likely to disengage. Immediately before disengagement, there was significant improvement in negative symptoms only. CONCLUSION A considerable proportion of CHR-P patients disengaged from our clinical study and service. Patients who were included during a later study period with more assessments disengaged more often, which might have been due to more frequent invitations to follow-up assessments and thereby increasing participation burden. Hence, our study provides a cautionary note on high-frequency follow-up assessments. Larger-scale studies evaluating predictors on multiple domains would help to further elucidate drop-out and disengagement.
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Affiliation(s)
- Letizia Leanza
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Erich Studerus
- Division of Personality and Developmental Psychology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Amatya J Mackintosh
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Katharina Beck
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Leonie Seiler
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
| | - Christina Andreou
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
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17
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Ittig S, Studerus E, Papmeyer M, Uttinger M, Koranyi S, Ramyead A, Riecher-Rössler A. Sex Differences in Cognitive Functioning in At-Risk Mental State for Psychosis, First Episode Psychosis and Healthy Control Subjects. Eur Psychiatry 2020; 30:242-50. [DOI: 10.1016/j.eurpsy.2014.11.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/30/2014] [Accepted: 11/09/2014] [Indexed: 10/24/2022] Open
Abstract
AbstractBackground:Several sex differences in schizophrenia have been reported including differences in cognitive functioning. Studies with schizophrenia patients and healthy controls (HC) indicate that the sex advantage for women in verbal domains is also present in schizophrenia patients. However, findings have been inconsistent. No study focused on sex-related cognitive performance differences in at-risk mental state for psychosis (ARMS) individuals yet. Thus, the aim of the present study was to investigate sex differences in cognitive functioning in ARMS, first episode psychosis (FEP) and HC subjects. We expected a better verbal learning and memory performance of women in all groups.Methods:The neuropsychological data analysed in this study were collected within the prospective Früherkennung von Psychosen (FePsy) study. In total, 118 ARMS, 88 FEP individuals and 86 HC completed a cognitive test battery covering the domains of executive functions, attention, working memory, verbal learning and memory, IQ and speed of processing.Results:Women performed better in verbal learning and memory regardless of diagnostic group. By contrast, men as compared to women showed a shorter reaction time during the working memory task across all groups.Conclusion:The results provide evidence that women generally perform better in verbal learning and memory, independent of diagnostic group (ARMS, FEP, HC). The finding of a shorter reaction time for men in the working memory task could indicate that men have a superior working memory performance since they responded faster during the target trials, while maintaining a comparable overall working memory performance level.
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18
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Abstract
This article narrates a consensus history of the proposal to include diagnostic criteria for a psychosis risk syndrome in the DSM-5, in part, to document what happened, but also to potentially help focus future efforts at clinically useful early detection. The purpose of diagnosing a risk state would be to slow and ideally prevent the development of the full disorder. Concerns about diagnosing a psychosis risk state included a high false positive rate, potentially harmful use of anti-psychotic medication with people who would not transition to psychosis, and stigmatization. Others argued that educating professionals about what 'risk' entails could reduce inappropriate treatments. During the revision, the proposal shifted from diagnosing risk to emphasizing current clinical need associated with attenuated psychotic symptoms. Within the community of researchers who studied psychosis risk, people disagreed about whether risk and/or attenuated symptoms should be an official DSM-5 diagnosis. Once it became clear that the DSM-5 field trials did not include enough cases to establish the reliability of the proposed criteria, everyone agreed that the criteria should be put in a section on conditions for further study rather the main section of the DSM-5. We close with recommendations about some practical benchmarks that should be met for including criteria for early detection in the classification system.
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Affiliation(s)
- Peter Zachar
- Department of Psychology, Auburn University Montgomery, Montgomery, AL, USA
| | - Michael B First
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Kenneth S Kendler
- Virginia Institute for Psychiatry and Behavioral Genetics and Departments of Psychiatry, and Human Genetics, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA, USA
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19
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Studerus E, Beck K, Fusar-Poli P, Riecher-Rössler A. Development and Validation of a Dynamic Risk Prediction Model to Forecast Psychosis Onset in Patients at Clinical High Risk. Schizophr Bull 2020; 46:252-260. [PMID: 31355885 PMCID: PMC7442327 DOI: 10.1093/schbul/sbz059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The prediction of outcomes in patients at Clinical High Risk for Psychosis (CHR-P) almost exclusively relies on static data obtained at a single snapshot in time (ie, baseline data). Although the CHR-P symptoms are intrinsically evolving over time, available prediction models cannot be dynamically updated to reflect these changes. Hence, the aim of this study was to develop and internally validate a dynamic risk prediction model (joint model) and to implement this model in a user-friendly online risk calculator. Furthermore, we aimed to explore the prognostic performance of extended dynamic risk prediction models and to compare static with dynamic prediction. One hundred ninety-six CHR-P patients were recruited as part of the "Basel Früherkennung von Psychosen" (FePsy) study. Psychopathology and transition to psychosis was assessed at regular intervals for up to 5 years using the Brief Psychiatric Rating Scale-Expanded (BPRS-E). Various specifications of joint models were compared with regard to their cross-validated prognostic performance. We developed and internally validated a joint model that predicts psychosis onset from BPRS-E disorganization and years of education at baseline and BPRS-E positive symptoms during the follow-up with good prognostic performance. The model was implemented as online risk calculator (http://www.fepsy.ch/DPRP/). The use of extended joint models slightly increased the prognostic accuracy compared to basic joint models, and dynamic models showed a higher prognostic accuracy than static models. Our results confirm that extended joint modeling could improve the prediction of psychosis in CHR-P patients. We implemented the first online risk calculator that can dynamically update psychosis risk prediction.
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Affiliation(s)
- Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland,To whom correspondence should be addressed; tel: +41-61-325-59-95, e-mail:
| | - Katharina Beck
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland,Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,OASIS Service, South London and Maudsley National Health Service Foundation Trust, London, UK,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,National Institute of Health Research—Mental Health—Translational Research Collaboration—Early Psychosis Workstream, London, UK
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
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20
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Mackintosh AJ, Borgwardt S, Studerus E, Riecher-Rössler A, de Bock R, Andreou C. EEG Microstate Differences in Medicated vs. Medication-Naïve First-Episode Psychosis Patients. Front Psychiatry 2020; 11:600606. [PMID: 33329154 PMCID: PMC7732503 DOI: 10.3389/fpsyt.2020.600606] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/30/2020] [Indexed: 12/21/2022] Open
Abstract
There has been considerable interest in the role of synchronous brain activity abnormalities in the pathophysiology of psychotic disorders and their relevance for treatment; one index of such activity are EEG resting-state microstates. These reflect electric field configurations of the brain that persist over 60-120 ms time periods. A set of quasi-stable microstates classes A, B, C, and D have been repeatedly identified across healthy participants. Changes in microstate parameters coverage, duration and occurrence have been found in medication-naïve as well as medicated patients with psychotic disorders compared to healthy controls. However, to date, only two studies have directly compared antipsychotic medication effects on EEG microstates either pre- vs. post-treatment or between medicated and unmedicated chronic schizophrenia patients. The aim of this study was therefore to directly compare EEG resting-state microstates between medicated and medication-naïve (untreated) first-episode (FEP) psychosis patients (mFEP vs. uFEP). We used 19-channel clinical EEG recordings to compare temporal parameters of four prototypical microstate classes (A-D) within an overall sample of 47 patients (mFEP n = 17; uFEP n = 30). The results demonstrated significant decreases of microstate class A and significant increases of microstate class B in mFEP compared to uFEP. No significant differences between groups were found for microstate classes C and D. Further studies are needed to replicate these results in longitudinal designs that assess antipsychotic medication effects on neural networks at the onset of the disorder and over time during illness progression. As treatment response and compliance in FEP patients are relatively low, such studies could contribute to better understand treatment outcomes and ultimately improve treatment strategies.
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Affiliation(s)
- Amatya J Mackintosh
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Erich Studerus
- Division of Personality and Developmental Psychology, Department of Psychology, University of Basel, Basel, Switzerland
| | | | - Renate de Bock
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.,University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland
| | - Christina Andreou
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
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Hinney B, Walter A, Aghlmandi S, Andreou C, Borgwardt S. Does Hippocampal Volume Predict Transition to Psychosis in a High-Risk Group? A Meta-Analysis. Front Psychiatry 2020; 11:614659. [PMID: 33519555 PMCID: PMC7840882 DOI: 10.3389/fpsyt.2020.614659] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/14/2020] [Indexed: 01/11/2023] Open
Abstract
Schizophrenia has a prodromal phase of several years in most patients, making it possible to identify patients at clinical high risk (CHR) for developing the disorder. So far, these individuals are identified based on clinical criteria alone, and there is no reliable biomarker for predicting the transition to psychosis. It is well-established that reductions in brain volume, especially in the hippocampus, are associated with schizophrenia. Therefore, hippocampal volume may serve as a biomarker for psychosis. Several studies have already investigated hippocampal volume in CHR groups. Based on these studies, the present meta-analysis compares the baseline left and right hippocampal volume of CHR patients who developed a psychosis with that of CHR patients without such a transition. Our results show no statistically significant effect of the hippocampal volume on the transition risk for psychosis.
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Affiliation(s)
- Bernd Hinney
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Anna Walter
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Christina Andreou
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
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22
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Studerus E, Corbisiero S, Mazzariello N, Ittig S, Leanza L, Egloff L, Beck K, Heitz U, Andreou C, Stieglitz RD, Riecher-Rössler A. Can neuropsychological testing facilitate differential diagnosis between at-risk mental state (ARMS) for psychosis and adult attention-deficit/hyperactivity disorder (ADHD)? Eur Psychiatry 2020; 52:38-44. [DOI: 10.1016/j.eurpsy.2018.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 01/22/2023] Open
Abstract
AbstractBackground:Patients with an at-risk mental state (ARMS) for psychosis and patients with attention-deficit/hyperactivity disorder (ADHD) have many overlapping signs and symptoms and hence can be difficult to differentiate clinically. The aim of this study was to investigate whether the differential diagnosis between ARMS and adult ADHD could be improved by neuropsychological testing.Methods:168 ARMS patients, 123 adult ADHD patients and 109 healthy controls (HC) were recruited via specialized clinics of the University of Basel Psychiatric Hospital. Sustained attention and impulsivity were tested with the Continuous Performance Test, verbal learning and memory with the California Verbal Learning Test, and problem solving abilities with the Tower of Hanoi Task. Group differences in neuropsychological performance were analyzed using generalized linear models. Furthermore, to investigate whether adult ADHD and ARMS can be correctly classified based on the pattern of cognitive deficits, machine learning (i.e. random forests) was applied.Results:Compared to HC, both patient groups showed deficits in attention and impulsivity and verbal learning and memory. However, in adult ADHD patients the deficits were comparatively larger. Accordingly, a machine learning model predicted group membership based on the individual neurocognitive performance profile with good accuracy (AUC = 0.82).Conclusions:Our results are in line with current meta-analyses reporting that impairments in the domains of attention and verbal learning are of medium effect size in adult ADHD and of small effect size in ARMS patients and suggest that measures of these domains can be exploited to improve the differential diagnosis between adult ADHD and ARMS patients.
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23
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Zarogianni E, Storkey AJ, Borgwardt S, Smieskova R, Studerus E, Riecher-Rössler A, Lawrie SM. Individualized prediction of psychosis in subjects with an at-risk mental state. Schizophr Res 2019; 214:18-23. [PMID: 28935170 DOI: 10.1016/j.schres.2017.08.061] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 11/19/2022]
Abstract
Early intervention strategies in psychosis would significantly benefit from the identification of reliable prognostic biomarkers. Pattern classification methods have shown the feasibility of an early diagnosis of psychosis onset both in clinical and familial high-risk populations. Here we were interested in replicating our previous classification findings using an independent cohort at clinical high risk for psychosis, drawn from the prospective FePsy (Fruherkennung von Psychosen) study. The same neuroanatomical-based pattern classification pipeline, consisting of a linear Support Vector Machine (SVM) and a Recursive Feature Selection (RFE) achieved 74% accuracy in predicting later onset of psychosis. The discriminative neuroanatomical pattern underlying this finding consisted of many brain areas across all four lobes and the cerebellum. These results provide proof-of-concept that the early diagnosis of psychosis is feasible using neuroanatomical-based pattern recognition.
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Affiliation(s)
- Eleni Zarogianni
- Division of Psychiatry, School of Clinical Sciences, University of Edinburgh, The Royal Edinburgh Hospital, Morningside Park, UK.
| | - Amos J Storkey
- Institute for Adaptive and Neural Computation, University of Edinburgh, UK
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Switzerland
| | - Renata Smieskova
- Department of Psychiatry (UPK), University of Basel, Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Switzerland
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Switzerland
| | - Stephen M Lawrie
- Division of Psychiatry, School of Clinical Sciences, University of Edinburgh, The Royal Edinburgh Hospital, Morningside Park, UK
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24
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Haidl TK, Seves M, Eggers S, Rostamzadeh A, Genske A, Jünger S, Woopen C, Jessen F, Ruhrmann S, Vogeley K. Health literacy in clinical-high-risk individuals for psychosis: A systematic mixed-methods review. Early Interv Psychiatry 2019; 13:1293-1309. [PMID: 30688012 DOI: 10.1111/eip.12776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/30/2018] [Accepted: 12/26/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Numerous studies suggest that health literacy (HL) plays a crucial role in maintaining and improving individual health. Empirical findings highlight the relation between levels of a person's HL and her/his clinical outcome. To date, the role of HL in persons at-risk for psychosis has not been systematically reviewed. METHODS We conducted a systematic review using a mixed-methods approach to analyse a variety of study types. Peer-reviewed publications were systematically searched in PUBMED, Cochrane Library, PsycINFO and Web of Science. RESULTS The search string returned 10587 publications. After screening, 15 quantitative, four qualitative studies and two reviews were included. Only one study assessed HL as primary outcome, assessing knowledge and beliefs about psychosis among the general population. In the other studies, sub-dimensions of HL were investigated. None of the publications operationalized HL or it's sub-dimensions with a validated measure. CONCLUSIONS A lack of understanding of their condition, and fear of stigmatization, were associated with a delay in help-seeking among people with clinical-high-risk state for psychosis. Family members, school personnel, general practitioners and the internet play a crucial role in the HL process. Considerable barriers in obtaining adequate specialist support emphasize the urgent need of a "HL environment" for persons at risk for psychosis.
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Affiliation(s)
- Theresa K Haidl
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Mauro Seves
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Susanne Eggers
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Ayda Rostamzadeh
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Anna Genske
- Cologne Center for Ethics, Rights, Economics and Social Sciences of Health (CERES), University of Cologne, Cologne, Germany.,Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany
| | - Saskia Jünger
- Cologne Center for Ethics, Rights, Economics and Social Sciences of Health (CERES), University of Cologne, Cologne, Germany.,Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany
| | - Christiane Woopen
- Cologne Center for Ethics, Rights, Economics and Social Sciences of Health (CERES), University of Cologne, Cologne, Germany.,Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
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25
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Beck K, Studerus E, Andreou C, Egloff L, Leanza L, Simon AE, Borgwardt S, Riecher-Rössler A. Clinical and functional ultra-long-term outcome of patients with a clinical high risk (CHR) for psychosis. Eur Psychiatry 2019; 62:30-37. [PMID: 31514058 DOI: 10.1016/j.eurpsy.2019.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/15/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Few studies have followed up patients with a clinical high risk (CHR) for psychosis for more than 2-3 years. We aimed to investigate the rates and baseline predictors for remission from CHR and transition to psychosis over a follow-up period of up to 16 years. Additionally, we examined the clinical and functional long-term outcome of CHR patients who did not transition. METHODS We analyzed the long-term course of CHR patients that had been included in the longitudinal studies "Früherkennung von Psychosen" (FePsy) or "Bruderholz" (BHS). Those patients who had not transitioned to psychosis during the initial follow-up periods (2/5 years), were invited for additional follow-ups. RESULTS Originally, 255 CHR patients had been included. Of these, 47 had transitioned to psychosis during the initial follow-ups. Thus, 208 were contacted for the long-term follow-up, of which 72 (34.6%) participated. From the original sample of 255, 26%, 31%, 35%, and 38% were estimated to have transitioned after 3, 5, 10, and 16 years, respectively, and 51% had remitted from their high risk status at the latest follow-up. Better psychosocial functioning at baseline was associated with a higher rate of remission. Of the 72 CHR patients re-assessed at long-term follow-up, 60 had not transitioned, but only 28% of those were fully recovered clinically and functionally. CONCLUSIONS Our study shows the need for follow-ups and clinical attention longer than the usual 2-3 years as there are several CHR patients with later transitions and only a minority of CHR those without transition fully recovers.
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Affiliation(s)
- Katharina Beck
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland; University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland
| | - Erich Studerus
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland; University of Basel, Department of Psychology, Division of Developmental and Personality Psychology, Basel, Switzerland
| | - Christina Andreou
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Laura Egloff
- University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland; Department of Psychiatry, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Letizia Leanza
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland; University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland
| | - Andor E Simon
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland; Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, Bruderholz, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel Psychiatric Hospital, Basel, Switzerland
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26
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Heitz U, Papmeyer M, Studerus E, Egloff L, Ittig S, Andreou C, Vogel T, Borgwardt S, Graf M, Eckert A, Riecher-Rössler A. Plasma and serum brain-derived neurotrophic factor (BDNF) levels and their association with neurocognition in at-risk mental state, first episode psychosis and chronic schizophrenia patients. World J Biol Psychiatry 2019; 20:545-554. [PMID: 29938562 DOI: 10.1080/15622975.2018.1462532] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objectives: Brain-derived neurotrophic factor (BDNF) is involved in numerous cognitive processes. Since cognitive deficits are a core feature of psychotic disorders, the investigation of BDNF levels in psychosis and their correlation with cognition has received increased attention. However, there are no studies investigating BDNF levels in individuals with an at-risk mental state (ARMS) for psychosis. Hence, the aims of the present study were: (1) assessing peripheral BDNF levels across different (potential) stages of psychosis; (2) investigating their association with cognition.Methods: Plasma and serum BDNF levels and neuropsychological performance were assessed in 16 ARMS, six first-episode psychosis (FEP), and 11 chronic schizophrenia (CS) patients. Neuropsychological assessment covered intelligence, verbal memory, working memory, attention and executive functioning.Results: Both plasma and serum BDNF levels were highest in CS, intermediate in FEP and lowest in ARMS. Multiple regression analysis revealed a significant positive association of plasma BDNF levels with planning ability across all groups.Conclusions: The lower peripheral BDNF levels in ARMS compared to FEP and CS might point towards an important drop of this neurotrophin prior to the onset of frank psychosis. The associations of peripheral BDNF with planning-abilities match previous findings.
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Affiliation(s)
- Ulrike Heitz
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Martina Papmeyer
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland.,Rehabilitation Services and Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Laura Egloff
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Sarah Ittig
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Christina Andreou
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Tobias Vogel
- Department of Forensic Psychiatry, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Marc Graf
- Department of Forensic Psychiatry, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Anne Eckert
- Neurobiology Laboratory for Brain Aging and Mental Health, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
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27
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Peralta D, Studerus E, Andreou C, Beck K, Ittig S, Leanza L, Egloff L, Riecher-Rössler A. Exploring the predictive power of the unspecific risk category of the Basel Screening Instrument for Psychosis. Early Interv Psychiatry 2019; 13:969-976. [PMID: 30019850 DOI: 10.1111/eip.12719] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/13/2018] [Accepted: 06/19/2018] [Indexed: 01/21/2023]
Abstract
AIM Ultrahigh risk (UHR) criteria, consisting of brief limited intermittent psychotic symptoms (BLIPS), attenuated psychotic symptoms (APS) and genetic risk and deterioration (GRD) syndrome are the most widely used criteria for assessing the clinical high-risk state for psychosis (CHR-P). The Basel Screening Instrument for Psychosis (BSIP) includes a further risk category, the unspecific risk category (URC). However, little is known about the predictive power of this risk category compared to other risk categories. METHODS Two hundred CHR-P patients were detected as part of the Früherkennung von Psychosen (FePsy) study using the BSIP. Transition to psychosis was assessed in regular intervals for up to 7 years. RESULTS Patients meeting only the URC criterion (n = 40) had a significantly lower risk of transition to psychosis than the UHR group (including BLIPS, APS and GRD) (HR 0.19 [0.05; 0.80] (P = 0.024). Furthermore, the URC only risk group had a lower transition risk than the APS without BLIPS group (P = 0.015) and a trendwise lower risk than the BLIPS group (P = 0.066). However, despite the lower transition risk in the URC only group, there were still two patients (5%) in this group with a later transition to psychosis. CONCLUSIONS The URC includes patients who have a lower risk of transition than those included by the UHR categories and thereby increases the sensitivity of the BSIP. This offers the possibility of a stratified intervention, with these subjects receiving low intensity follow-up and treatment.
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Affiliation(s)
- David Peralta
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland.,Inpatient Unit, Zamudio Psychiatric Hospital, Mental Health Network of Biscay (Osakidetza), Bilbao, Spain
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Christina Andreou
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Katharina Beck
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Sarah Ittig
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Letizia Leanza
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Laura Egloff
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
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28
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Bykowsky O, Harrisberger F, Schmidt A, Smieskova R, Hauke DJ, Egloff L, Riecher-Rössler A, Fusar-Poli P, Huber CG, Lang UE, Andreou C, Borgwardt S. Association of antidepressants with brain morphology in early stages of psychosis: an imaging genomics approach. Sci Rep 2019; 9:8516. [PMID: 31186482 PMCID: PMC6560086 DOI: 10.1038/s41598-019-44903-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/28/2019] [Indexed: 11/09/2022] Open
Abstract
Depressive symptoms in subjects at Clinical High Risk for Psychosis (CHR-P) or at first-episode psychosis (FEP) are often treated with antidepressants. Our cross-sectional study investigated whether brain morphology is altered by antidepressant medication. High-resolution T1-weighted structural MRI scans of 33 CHR-P and FEP subjects treated with antidepressants, 102 CHR-P and FEP individuals without antidepressant treatment and 55 controls, were automatically segmented using Freesurfer 6.0. Linear mixed-effects modelling was applied to assess the differences in subcortical volume, surface area and cortical thickness in treated, non-treated and healthy subjects, taking into account converted dosages of antidepressants. Increasing antidepressant dose was associated with larger volume of the pallidum and the putamen, and larger surface of the left inferior temporal gyrus. In a pilot subsample of separately studied subjects of known genomic risk loci, we found that in the right postcentral gyrus, the left paracentral lobule and the precentral gyrus antidepressant dose-associated surface increase depended on polygenic schizophrenia-related-risk score. As the reported regions are linked to the symptoms of psychosis, our findings reflect the possible beneficial effects of antidepressant treatment on an emerging psychosis.
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Affiliation(s)
- Oleg Bykowsky
- Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), University of Basel, Basel, Switzerland.,Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland.,Center for Addiction Medicine, Châlons-en-Champagne General Hospital, Châlons-en-Champagne, France
| | - Fabienne Harrisberger
- Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), University of Basel, Basel, Switzerland.,Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland
| | - André Schmidt
- Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), University of Basel, Basel, Switzerland.,Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland
| | - Renata Smieskova
- Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), University of Basel, Basel, Switzerland.,Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland
| | - Daniel J Hauke
- Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), University of Basel, Basel, Switzerland.,Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland.,Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Laura Egloff
- Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), University of Basel, Basel, Switzerland.,Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland
| | | | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical Detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Christian G Huber
- Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland
| | - Undine E Lang
- Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland
| | - Christina Andreou
- Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), University of Basel, Basel, Switzerland. .,Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland. .,Early Psychosis: Interventions and Clinical Detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
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29
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Heitz U, Studerus E, Menghini-Müller S, Papmeyer M, Egloff L, Ittig S, Navarra A, Andreou C, Riecher-Rössler A. Gender differences in first self-perceived signs and symptoms in patients with an at-risk mental state and first-episode psychosis. Early Interv Psychiatry 2019; 13:582-588. [PMID: 29235240 DOI: 10.1111/eip.12528] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 08/22/2017] [Accepted: 11/08/2017] [Indexed: 12/28/2022]
Abstract
AIM Gender differences in the current symptomatology of patients with psychotic disorders have previously been described in the literature. However, it has not yet been investigated whether gender differences exist in the very first self-perceived signs or symptoms of illness onset. The aim of this study was to investigate this aspect in at-risk mental state (ARMS) and first-episode psychosis (FEP) patients. METHODS ARMS and FEP were recruited via the early detection of psychosis (FePsy) clinic Basel, Switzerland. The Basel Interview for Psychosis (BIP) was used to retrospectively assess the first 3 self-perceived signs and symptoms at illness onset. Differences between gender and patient groups on single item and symptom cluster levels were analysed using logistic regression models. RESULTS One-hundred-thirty six ARMS (91 men, 45 women) and 89 FEP patients (63 men, 26 women) could be recruited for this study. On a single item level, women more frequently reported "unusual anxiety, fears" and men (at a trend level) "social withdrawal" as being among their 3 first self-perceived symptoms, independent of diagnostic group. On the symptom cluster level, women more frequently reported "increased worrying/anxiety" and (sub-threshold) "hallucinations", independent of diagnostic group. Problems with "thinking, concentration" were reported more frequently by men in the ARMS group only. CONCLUSION Our results suggest that only few and relatively small gender differences exist in the first self-perceived signs and symptoms. While men initially mainly notice negative/cognitive symptoms, women first notice (sub-threshold) positive and affective symptoms.
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Affiliation(s)
- Ulrike Heitz
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Stephanie Menghini-Müller
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Martina Papmeyer
- Rehabilitation Services and Care Unit, Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland
| | - Laura Egloff
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Sarah Ittig
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Astrid Navarra
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Christina Andreou
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
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30
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Malda A, Boonstra N, Barf H, de Jong S, Aleman A, Addington J, Pruessner M, Nieman D, de Haan L, Morrison A, Riecher-Rössler A, Studerus E, Ruhrmann S, Schultze-Lutter F, An SK, Koike S, Kasai K, Nelson B, McGorry P, Wood S, Lin A, Yung AY, Kotlicka-Antczak M, Armando M, Vicari S, Katsura M, Matsumoto K, Durston S, Ziermans T, Wunderink L, Ising H, van der Gaag M, Fusar-Poli P, Pijnenborg GHM. Individualized Prediction of Transition to Psychosis in 1,676 Individuals at Clinical High Risk: Development and Validation of a Multivariable Prediction Model Based on Individual Patient Data Meta-Analysis. Front Psychiatry 2019; 10:345. [PMID: 31178767 PMCID: PMC6537857 DOI: 10.3389/fpsyt.2019.00345] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/01/2019] [Indexed: 12/26/2022] Open
Abstract
Background: The Clinical High Risk state for Psychosis (CHR-P) has become the cornerstone of modern preventive psychiatry. The next stage of clinical advancements rests on the ability to formulate a more accurate prognostic estimate at the individual subject level. Individual Participant Data Meta-Analyses (IPD-MA) are robust evidence synthesis methods that can also offer powerful approaches to the development and validation of personalized prognostic models. The aim of the study was to develop and validate an individualized, clinically based prognostic model for forecasting transition to psychosis from a CHR-P stage. Methods: A literature search was performed between January 30, 2016, and February 6, 2016, consulting PubMed, Psychinfo, Picarta, Embase, and ISI Web of Science, using search terms ("ultra high risk" OR "clinical high risk" OR "at risk mental state") AND [(conver* OR transition* OR onset OR emerg* OR develop*) AND psychosis] for both longitudinal and intervention CHR-P studies. Clinical knowledge was used to a priori select predictors: age, gender, CHR-P subgroup, the severity of attenuated positive psychotic symptoms, the severity of attenuated negative psychotic symptoms, and level of functioning at baseline. The model, thus, developed was validated with an extended form of internal validation. Results: Fifteen of the 43 studies identified agreed to share IPD, for a total sample size of 1,676. There was a high level of heterogeneity between the CHR-P studies with regard to inclusion criteria, type of assessment instruments, transition criteria, preventive treatment offered. The internally validated prognostic performance of the model was higher than chance but only moderate [Harrell's C-statistic 0.655, 95% confidence interval (CIs), 0.627-0.682]. Conclusion: This is the first IPD-MA conducted in the largest samples of CHR-P ever collected to date. An individualized prognostic model based on clinical predictors available in clinical routine was developed and internally validated, reaching only moderate prognostic performance. Although personalized risk prediction is of great value in the clinical practice, future developments are essential, including the refinement of the prognostic model and its external validation. However, because of the current high diagnostic, prognostic, and therapeutic heterogeneity of CHR-P studies, IPD-MAs in this population may have an limited intrinsic power to deliver robust prognostic models.
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Affiliation(s)
- Aaltsje Malda
- GGZ Friesland Mental Health Institute, Leeuwarden, Netherlands
- University of Groningen, Groningen, Netherlands
| | - Nynke Boonstra
- GGZ Friesland Mental Health Institute, Leeuwarden, Netherlands
- NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands
| | - Hans Barf
- NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands
| | | | - Andre Aleman
- University of Groningen, Groningen, Netherlands
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, Netherlands
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Marita Pruessner
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Dorien Nieman
- Amsterdam University Medical Centers, Location AMC, Department of Psychiatry, Amsterdam, Netherlands
| | - Lieuwe de Haan
- Amsterdam University Medical Centers, Location AMC, Department of Psychiatry, Amsterdam, Netherlands
| | - Anthony Morrison
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | | | - Erich Studerus
- University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Suk Kyoon An
- Department of Psychiatry, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Shinsuke Koike
- University of Tokyo Institute for Diversity and Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Tokyo Center for Integrative Science of Human Behaviour (CiSHuB), The University of Tokyo, Tokyo, Japan
- The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan
| | - Kiyoto Kasai
- University of Tokyo Institute for Diversity and Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Tokyo Center for Integrative Science of Human Behaviour (CiSHuB), The University of Tokyo, Tokyo, Japan
- The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephen Wood
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Alison Y. Yung
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | | | - Marco Armando
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva, School of Medicine, Geneva, Switzerland
| | - Stefano Vicari
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Masahiro Katsura
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Kazunori Matsumoto
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Sarah Durston
- NICHE Lab, Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center, Utrecht, Netherlands
| | - Tim Ziermans
- Amsterdam University Medical Centers, Location AMC, Department of Psychiatry, Amsterdam, Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Lex Wunderink
- GGZ Friesland Mental Health Institute, Leeuwarden, Netherlands
- University Medical Center Groningen, Groningen, Netherlands
| | - Helga Ising
- Department of Clinical Psychology, VU University, Amsterdam, Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University, Amsterdam, Netherlands
- Parnassia Psychiatric Institute, Department of Psychosis Research, Den Haag, Netherlands
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Institute for Health Research, Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Gerdina Hendrika Maria Pijnenborg
- University of Groningen, Groningen, Netherlands
- GGZ Drenthe Mental Health Care Center, Department of Psychotic Disorders, Assen, Netherlands
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Egloff L, Lenz C, Studerus E, Heitz U, Harrisberger F, Smieskova R, Schmidt A, Leanza L, Andreou C, Borgwardt S, Riecher‐Rössler A. No associations between medial temporal lobe volumes and verbal learning/memory in emerging psychosis. Eur J Neurosci 2019; 50:3060-3071. [DOI: 10.1111/ejn.14427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 03/26/2019] [Accepted: 04/07/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Laura Egloff
- Department of Psychiatry University of Basel Psychiatric Hospital Basel Switzerland
- Division of Clinical Psychology and Epidemiology Department of Psychology University of Basel Basel Switzerland
- Center for Gender Research and Early Detection University of Basel Psychiatric Hospital Basel Switzerland
| | - Claudia Lenz
- Institute of Forensic Medicine University of Basel Basel Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection University of Basel Psychiatric Hospital Basel Switzerland
| | - Ulrike Heitz
- Center for Gender Research and Early Detection University of Basel Psychiatric Hospital Basel Switzerland
| | | | - Renata Smieskova
- Department of Psychiatry University of Basel Psychiatric Hospital Basel Switzerland
| | - André Schmidt
- Department of Psychiatry University of Basel Psychiatric Hospital Basel Switzerland
| | - Letizia Leanza
- Division of Clinical Psychology and Epidemiology Department of Psychology University of Basel Basel Switzerland
- Center for Gender Research and Early Detection University of Basel Psychiatric Hospital Basel Switzerland
| | - Christina Andreou
- Department of Psychiatry University of Basel Psychiatric Hospital Basel Switzerland
- Center for Gender Research and Early Detection University of Basel Psychiatric Hospital Basel Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry University of Basel Psychiatric Hospital Basel Switzerland
| | - Anita Riecher‐Rössler
- Center for Gender Research and Early Detection University of Basel Psychiatric Hospital Basel Switzerland
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32
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Crump FM, Arndt L, Grivel M, Horga G, Corcoran CM, Brucato G, Girgis RR. Attenuated first-rank symptoms and conversion to psychosis in a clinical high-risk cohort. Early Interv Psychiatry 2018; 12:1213-1216. [PMID: 29230968 PMCID: PMC5997532 DOI: 10.1111/eip.12529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 09/06/2017] [Accepted: 11/08/2017] [Indexed: 11/28/2022]
Abstract
AIM We sought to examine attenuated first-rank symptoms (FRS) and subcomponents of the Unusual Thought Content (P.1.) section of the Structured Interview for Psychosis-Risk Syndromes (SIPS) to investigate the robust relationship between total P.1. and conversion. We hypothesized that attenuated FRS would drive the association and, additionally, be most predictive of a schizophrenia diagnosis. METHOD We assessed 189 clinical high-risk participants. Two independent raters separately scored attenuated FRS and each subcomponent of P.1. as if each were the only symptom reported. Total P.1. was also scored. Participants were evaluated for conversion up to 2 years. RESULTS While total P.1. score significantly predicted conversion in the 54 converters, attenuated FRS, which were relatively uncommon in this sample, nor any subcomponent of P.1., was independently predictive. FRS did not predict conversion to schizophrenia among 35 subjects. CONCLUSION Although attenuated FRS, and subcomponents of P.1. of the SIPS, did not significantly predict transition to psychosis, our results support previous research affirming the value of total P.1. score as a tool for predicting conversion to psychosis.
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Affiliation(s)
| | | | - Margaux Grivel
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York
| | - Guillermo Horga
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York
| | - Cheryl M. Corcoran
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York
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Voxel-Based Morphometry Correlates of an Agitated-Aggressive Syndrome in the At-Risk Mental State for Psychosis and First Episode Psychosis. Sci Rep 2018; 8:16516. [PMID: 30409978 PMCID: PMC6224526 DOI: 10.1038/s41598-018-33770-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/06/2018] [Indexed: 12/29/2022] Open
Abstract
There are mixed reports on structural neuroimaging correlates of aggression in schizophrenia with weak evidence due to cohort overlaps and lack of replications. To our knowledge, no study examined volumetric neuroimaging correlates of aggression in early stages of psychosis. An agitated-aggressive syndrome is present in at-risk mental state (ARMS) and in first-episode psychosis (FEP) - it is unclear whether this syndrome is associated with structural brain abnormalities in early stages of psychosis. Using three-dimensional magnetic resonance imaging and a whole brain voxel-based morphometry approach, we examined 56 ARMS patients, 55 FEP patients and 25 healthy controls. We operationalized aggression using the Excited Component of the Brief Psychiatric Rating Scale (BPRS-EC) and dichotomized our patient group by median split into "BPRS-EC high" (n = 49) and "BPRS-EC low" groups (n = 62). The "BPRS-EC high" group had significantly smaller left lingual gyrus volume than HC. This finding was not present in the "BPRS-EC low" group. In addition, grey matter volume in the left lingual gyrus showed a negative linear correlation with BPRS-EC over all subjects (ρ = -0.318; p = 0.0001) and in the patient group (ρ = -0.202; p = 0.033). These findings provide first hints on structural brain abnormalities associated with an agitated-aggressive syndrome in ARMS and FEP patients.
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Papmeyer M, Aston J, Everts-Graber J, Heitz U, Studerus E, Borgwardt SJ, Stieglitz RD, Riecher-Rössler A. Outcome of individuals "not at risk of psychosis" and prognostic accuracy of the Basel Screening Instrument for Psychosis (BSIP). Early Interv Psychiatry 2018; 12:907-914. [PMID: 28429847 DOI: 10.1111/eip.12401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 05/03/2016] [Accepted: 09/20/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to determine the prognostic accuracy of the Basel Screening Instrument for Psychosis (BSIP) in terms of specificity, sensitivity, positive and negative predictive value by following up individuals that were initially not considered to be at increased risk of psychosis based on the BSIP. Moreover, clinical characteristics of these individuals were examined given the relative lack of such information in the literature. METHODS As part of the "Früherkennung von Psychosen" (FePsy) study, 87 individuals were screened with the BSIP. Of these, 64 were classified at baseline as being in an at-risk mental state (ARMS+) for psychosis using the BSIP and followed up at regular time intervals for at least 2 years to determine a putative transition to psychosis. Twenty-three individuals were classified at baseline as not being in an at-risk mental state (ARMS-) using the BSIP and re-assessed after 4 years. Sensitivity, specificity, positive and negative predictive value of the BSIP were computed. Clinical characteristics of the ARMS- group were analysed descriptively. RESULTS During the follow-up period, none of the ARMS- individuals, but 21 of ARMS+ had developed psychosis. Sensitivity of the BSIP was 1.0, specificity was 0.35. The majority of ARMS- individuals showed depressive disorders or anxiety disorders and varying levels of functioning. CONCLUSIONS The BSIP has good prognostic accuracy for detecting the prodromal phase of psychosis with an excellent sensitivity and a specificity similar to other risk instruments and the advantage of a relatively short duration. Depressive and anxiety symptoms commonly develop in ARMS- individuals.
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Affiliation(s)
- Martina Papmeyer
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland.,Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Jacqueline Aston
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Judith Everts-Graber
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Ulrike Heitz
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Erich Studerus
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Stefan J Borgwardt
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Rolf-Dieter Stieglitz
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Anita Riecher-Rössler
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
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35
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Leanza L, Egloff L, Studerus E, Andreou C, Heitz U, Ittig S, Beck K, Uttinger M, Riecher-Rössler A. The relationship between negative symptoms and cognitive functioning in patients at clinical high risk for psychosis. Psychiatry Res 2018; 268:21-27. [PMID: 29986173 DOI: 10.1016/j.psychres.2018.06.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/28/2018] [Accepted: 06/17/2018] [Indexed: 10/28/2022]
Abstract
Negative symptoms and neurocognitive performance have been reported to be negatively associated in patients with emerging psychosis. However, most previous studies focused on patients with frank psychosis and did not differentiate between subdomains of negative symptoms. Hence, we aimed to elucidate the specific relationship between negative symptoms and cognitive functioning in patients at clinical high risk (CHR) for psychosis. Data from 154 CHR patients collected within the prospective Früherkennung von Psychosen (FePsy) study were analyzed. Negative symptoms were assessed with the Scale for the Assessment of Negative Symptoms (SANS) and cognitive functioning with an extensive neuropsychological test battery. Regression analyses revealed significant negative associations between negative symptoms and cognitive functioning, particularly in the domains of nonverbal intelligence and verbal fluency. When analyzing each negative symptom domain separately, alogia and asociality/anhedonia were significantly negatively associated with nonverbal intelligence and alogia additionally with verbal fluency. Overall, our results in CHR patients are similar to those reported in patients with frank psychosis. The strong negative association between verbal fluency and negative symptoms may be indicative of an overlap between these constructs. Verbal fluency might have a strong influence on the clinical impression of negative symptoms (particularly alogia) and vice versa.
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Affiliation(s)
- Letizia Leanza
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Basel, Switzerland
| | - Laura Egloff
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Basel, Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| | - Christina Andreou
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| | - Ulrike Heitz
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| | - Sarah Ittig
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| | - Katharina Beck
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Basel, Switzerland
| | - Martina Uttinger
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland.
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Egloff L, Lenz C, Studerus E, Harrisberger F, Smieskova R, Schmidt A, Huber C, Simon A, Lang UE, Riecher-Rössler A, Borgwardt S. Sexually dimorphic subcortical brain volumes in emerging psychosis. Schizophr Res 2018; 199:257-265. [PMID: 29605160 DOI: 10.1016/j.schres.2018.03.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/27/2018] [Accepted: 03/18/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND In schizophrenic psychoses, the normal sexual dimorphism of the brain has been shown to be disrupted or even reversed. Little is known, however, at what time point in emerging psychosis this occurs. We have therefore examined, if these alterations are already present in the at-risk mental state (ARMS) for psychosis and in first episode psychosis (FEP) patients. METHODS Data from 65 ARMS (48 (73.8%) male; age=25.1±6.32) and 50 FEP (37 (74%) male; age=27±6.56) patients were compared to those of 70 healthy controls (HC; 27 (38.6%) male; age=26±4.97). Structural T1-weighted images were acquired using a 3 Tesla magnetic resonance imaging (MRI) scanner. Linear mixed effects models were used to investigate whether subcortical brain volumes are dependent on sex. RESULTS We found men to have larger total brain volumes (p<0.001), and smaller bilateral caudate (p=0.008) and hippocampus volume (p<0.001) than women across all three groups. Older subjects had more GM and WM volume than younger subjects. No significant sex×group interaction was found. CONCLUSIONS In emerging psychosis there still seem to exist patterns of normal sexual dimorphism in total brain and caudate volume. The only structure affected by reversed sexual dimorphism was the hippocampus, with women showing larger volumes than men even in HC. Thus, we conclude that subcortical volumes may not be primarily affected by disrupted sexual dimorphism in emerging psychosis.
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Affiliation(s)
- Laura Egloff
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland; University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Basel, Switzerland
| | - Claudia Lenz
- University of Basel, Institute of Forensic Medicine, Basel, Switzerland
| | - Erich Studerus
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland
| | - Fabienne Harrisberger
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland
| | - Renata Smieskova
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland
| | - André Schmidt
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland
| | - Christian Huber
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland
| | - Andor Simon
- University Hospital of Bern, University Hospital of Psychiatry, Bern, Switzerland; Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, Bruderholz, Switzerland
| | - Undine E Lang
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland
| | - Anita Riecher-Rössler
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland
| | - Stefan Borgwardt
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland.
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Uttinger M, Studerus E, Ittig S, Heitz U, Schultze-Lutter F, Riecher-Rössler A. The Frankfurt Complaint Questionnaire for self-assessment of basic symptoms in the early detection of psychosis-Factor structure, reliability, and predictive validity. Int J Methods Psychiatr Res 2018; 27:e1600. [PMID: 29266529 PMCID: PMC6877158 DOI: 10.1002/mpr.1600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/19/2017] [Accepted: 11/06/2017] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Patients with schizophrenia often experience subtle disturbances in several domains of information processing-so-called basic symptoms (BS). BS are already present before onset of frank psychosis and can be assessed by interviews but also by the self-administered Frankfurt Complaint Questionnaire (FCQ). We investigated the factor structure, reliability, and predictive validity for transition to psychosis of the FCQ, comparing previously proposed factor solutions containing 1, 2, 4, and 10 factors. METHODS Confirmatory factor analysis was used in a sample of 117 at-risk mental state and 92 first-episode psychosis participants of the Basel FePsy (early detection of psychosis) study. RESULTS Although all factor models fitted to the data, the 2- or 4-factor solutions performed best among the models that used at least half of the FCQ items, suggesting the covariance between FCQ items is best explained by 2 to 4 underlying factors. No FCQ-scale predicted transition to psychosis. CONCLUSION We could confirm a 2- to 4-factor structure of the FCQ in a sample of at-risk mental state and first-episode psychosis patients using confirmatory factor analysis. Contrary to interview-assessed cognitive-perceptive BS, self-assessed BS do not seem to improve prediction of psychosis. This result reinforces reports of poor correspondence between interview- and questionnaire-assessed BS.
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Affiliation(s)
- Martina Uttinger
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland.,Psychiatric Services Solothurn, Olten, Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
| | - Sarah Ittig
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
| | - Ulrike Heitz
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
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Evaluating verbal learning and memory in patients with an at-risk mental state or first episode psychosis using structural equation modelling. PLoS One 2018; 13:e0196936. [PMID: 29746524 PMCID: PMC5944996 DOI: 10.1371/journal.pone.0196936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 04/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Verbal learning and memory are impaired not only in patients with a first episode of psychosis (FEP) but also-to a lower extent-in those with an at-risk mental state for psychosis (ARMS). However, little is known about the specific nature of these impairments. Hence, we aimed to study learning and memory processes in ARMS and FEP patients by making use of structural equation modelling. METHODS Verbal learning was assessed with the California Verbal Learning Test (CVLT) in 98 FEP patients, 126 ARMS patients and 68 healthy controls (HC) as part of the Basel early detection of psychosis (FePsy) study. The four-factorial CFA model of Donders was used to estimate test performance on latent variables of the CVLT and growth curve analysis was used to model the learning curve. The latter allows disentangling initial recall, which is strongly determined by attentional processes, from the learning rate. RESULTS The CFA model revealed that ARMS and FEP patients were impaired in Attention Span, Learning Efficiency and Delayed Memory and that FEP patients were additionally impaired in Inaccurate Memory. Additionally, ARMS-NT, but not ARMS-T, performed significantly worse than HC on Learning Efficiency. The growth curve model indicated that FEP patients were impaired in both initial recall and learning rate and that ARMS patients were only impaired in the learning rate. CONCLUSIONS Since impairments were more pronounced in the learning rate than the initial recall, our results suggest that the lower scores in the CVLT reported in previous studies are more strongly driven by impairments in the rate of learning than by attentional processes.
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Pflueger MO, Calabrese P, Studerus E, Zimmermann R, Gschwandtner U, Borgwardt S, Aston J, Stieglitz RD, Riecher-Rössler A. The neuropsychology of emerging psychosis and the role of working memory in episodic memory encoding. Psychol Res Behav Manag 2018; 11:157-168. [PMID: 29785144 PMCID: PMC5953273 DOI: 10.2147/prbm.s149425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Episodic memory encoding and working memory (WM) deficits are among the first cognitive signs and symptoms in the course of schizophrenia spectrum disorders. However, it is not clear whether the deficit pattern is generalized or specific in nature. We hypothesized that encoding deficits at an early stage of the disease might be due to the more fundamental WM deficits. Methods We examined episodic memory encoding and WM by administering the California Verbal Learning Test, a 2-back task, and the Wisconsin Card Sorting Test in 90 first-episode psychosis (FE) patients and 116 individuals with an at-risk mental state for psychosis (ARMS) compared to 57 healthy subjects. Results Learning progress, but not span of apprehension, was diminished to a similar extent in both the ARMS and the FE. We showed that this was due to WM impairment by applying a structural equation approach. Conclusion Thus, we conclude that verbal memory encoding deficits are secondary to primary WM impairment in emerging psychosis.
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Affiliation(s)
- Marlon O Pflueger
- Department of Forensic Psychiatry, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Ronan Zimmermann
- Department of Neurology and Neurosurgery, Hospital of the University of Basel, Basel, Switzerland
| | - Ute Gschwandtner
- Department of Neurology and Neurosurgery, Hospital of the University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Jacqueline Aston
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Rolf-Dieter Stieglitz
- Division of Clinical Psychology and Psychiatry, University of Basel, Basel, Switzerland
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
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Hunter SA, Lawrie SM. Imaging and Genetic Biomarkers Predicting Transition to Psychosis. Curr Top Behav Neurosci 2018; 40:353-388. [PMID: 29626338 DOI: 10.1007/7854_2018_46] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The search for diagnostic and prognostic biomarkers in schizophrenia care and treatment is the focus of many within the research community. Longitudinal cohorts of patients presenting at elevated genetic and clinical risk have provided a wealth of data that has informed our understanding of the development of schizophrenia and related psychotic disorders.Imaging follow-up of high-risk cohorts has demonstrated changes in cerebral grey matter of those that eventually transition to schizophrenia that predate the onset of symptoms and evolve over the course of illness. Longitudinal follow-up studies demonstrate that observed grey matter changes can be employed to differentiate those who will transition to schizophrenia from those who will not prior to the onset of the disorder.In recent years our understanding of the genetic makeup of schizophrenia has advanced significantly. The development of modern analysis techniques offers researchers the ability to objectively quantify genetic risk; these have been successfully applied within a high-risk paradigm to assist in differentiating between high-risk individuals who will subsequently become unwell and those who will not.This chapter will discuss the application of imaging and genetic biomarkers within high-risk groups to predict future transition to schizophrenia and related psychotic disorders. We aim to provide an overview of current approaches focussing on grey matter changes that are predictive of future transition to illness, the developing field of genetic risk scores and other methods being developed to aid clinicians in diagnosis and prognosis.
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Affiliation(s)
- Stuart A Hunter
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK.
| | - Stephen M Lawrie
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
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Spitz A, Studerus E, Koranyi S, Rapp C, Ramyead A, Ittig S, Heitz U, Uttinger M, Riecher-Rössler A. Correlations between self-rating and observer-rating of psychopathology in at-risk mental state and first-episode psychosis patients: influence of disease stage and gender. Early Interv Psychiatry 2017; 11:461-470. [PMID: 26376725 DOI: 10.1111/eip.12270] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/17/2015] [Indexed: 01/25/2023]
Abstract
AIM Research findings on the correlations between self-rating and observer-rating of schizophrenic psychopathology are inconsistent and have rarely considered first-episode psychosis (FEP) and at-risk mental state (ARMS) for psychosis patients. This study investigates these correlations in ARMS and FEP patients and how they are moderated by disease stage and gender. METHODS In the Basel Früherkennung von Psychosen (FePsy) study, positive and negative psychotic and affective symptoms were rated in 126 ARMS and 94 FEP patients using two observer- and three self-rating scales. The agreement between self-rating and observer-rating and the moderating influence of disease stage and gender was quantified using Pearson correlation and multiple regression models. RESULTS Correlations between self- and observer-rated subscales covering the same symptom dimension were low and mostly non-significant except for one correlation of positive and one of negative symptoms. There was no moderating influence of disease stage and gender on the correlations between self-rating and observer-rating except for one higher association in positive symptoms in FEP compared to ARMS and in women compared to men. However, these significant interaction effects did not withstand correction for multiple testing. CONCLUSIONS This study suggests that the agreement between self-rating and observer-rating in FEP and ARMS patients is rather low, similar across symptom dimensions, and only partially dependent on disease stage and gender. However, low correlations between self-rating and observer-rating do not necessarily indicate that these patients have difficulties reporting their symptoms. They could also have occurred because the scales did not exactly cover the same symptom dimensions.
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Affiliation(s)
- Andrea Spitz
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Erich Studerus
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Susan Koranyi
- University of Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Charlotte Rapp
- Psychiatric Services, Treatment Center for Psychosis, Solothurn, Switzerland
| | - Avinash Ramyead
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Sarah Ittig
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Ulrike Heitz
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Martina Uttinger
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Anita Riecher-Rössler
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
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Ittig S, Studerus E, Heitz U, Menghini-Müller S, Beck K, Egloff L, Leanza L, Andreou C, Riecher-Rössler A. Sex differences in prolactin levels in emerging psychosis: Indication for enhanced stress reactivity in women. Schizophr Res 2017; 189:111-116. [PMID: 28214176 DOI: 10.1016/j.schres.2017.02.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hyperprolactinemia is a known side effect of antipsychotics. In recent reports it has also been shown in antipsychotic-naïve at-risk mental state (ARMS) and first-episode psychosis (FEP) patients. Prolactin is not only involved in reproduction and lactation, but is also synthesized in response to stress. As stress is thought to play an important role in the onset and relapse of schizophrenia, the aim of this study was to further elucidate the influence of prolactin in emerging psychosis. METHODS The data analysed in this study were collected within the prospective Früherkennung von Psychosen (FePsy) study. Blood sample collection took place under standardized conditions between 8 and 10am after an overnight fast and 30minutes of rest. All patients were antipsychotic-naïve and did not take any prolactin influencing medication. RESULTS Our sample consisted of 116 antipsychotic-naïve ARMS and 49 FEP patients. Hyperprolactinemia was shown in 32% of ARMS and 35% of FEP patients. After correction for the normal biological variation between the sexes, we still found higher average prolactin levels in female than in male patients (β=0.42; t=2.47; p=0.01) but no difference in prolactin levels between ARMS and FEP patients (β=-0.05; t=-0.30; p=0.76). The survival analysis revealed no significant predictive value for prolactin levels to predict transition to psychosis. CONCLUSION Our findings support a possible role of prolactin in emerging psychosis and it could be speculated that stress, which can induce hyperprolactinemia, has a stronger effect on women than on men in emerging psychosis.
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Affiliation(s)
- Sarah Ittig
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Ulrike Heitz
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Stephanie Menghini-Müller
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Katharina Beck
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Laura Egloff
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Letizia Leanza
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Christina Andreou
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland.
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Rapp C, Canela C, Studerus E, Walter A, Aston J, Borgwardt S, Riecher-Rössler A. Duration of untreated psychosis/illness and brain volume changes in early psychosis. Psychiatry Res 2017; 255:332-337. [PMID: 28601717 DOI: 10.1016/j.psychres.2017.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 03/17/2017] [Accepted: 06/02/2017] [Indexed: 01/10/2023]
Abstract
The time period during which patients manifest psychotic or unspecific symptoms prior to treatment (duration of untreated psychosis, DUP, and the duration of untreated illness, DUI) has been found to be moderately associated with poor clinical and social outcome. Equivocal evidence exists of an association between DUP/DUI and structural brain abnormalities, such as reduced hippocampus volume (HV), pituitary volume (PV) and grey matter volume (GMV). Thus, the goal of the present work was to examine if DUP and DUI are associated with abnormalities in HV, PV and GMV. Using a region of interest (ROI) based approach, we present data of 39 patients from the Basel FePsy (Früherkennung von Psychosen, early detection of psychosis) study for which information about DUP, DUI and HV, PV and GMV data could be obtained. Twenty-three of them were first episode psychosis (FEP) and 16 at-risk mental state (ARMS) patients who later made the transition to frank psychosis. In unadjusted analyses, we found a significant positive correlation between DUP and PV in FEP patients. However, when adjusted for covariates, we found no significant correlation between DUP or DUI and HV, PV or GMV anymore. There only was a trend for decreasing GMV with increasing DUI in FEP. Our results do not comprehensively support the hypothesis of a "toxic" effect of the pathogenic mechanism underlying untreated psychosis on brain structure. If there is any effect, it might rather occur very early in the disease process, during which patients experience only unspecific symptoms.
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Affiliation(s)
- Charlotte Rapp
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Kornhausgasse 7, CH-4051 Basel, Switzerland
| | - Carlos Canela
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Erich Studerus
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Kornhausgasse 7, CH-4051 Basel, Switzerland
| | - Anna Walter
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Kornhausgasse 7, CH-4051 Basel, Switzerland
| | - Jacqueline Aston
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Kornhausgasse 7, CH-4051 Basel, Switzerland
| | - Stefan Borgwardt
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Kornhausgasse 7, CH-4051 Basel, Switzerland
| | - Anita Riecher-Rössler
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Kornhausgasse 7, CH-4051 Basel, Switzerland.
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Dukart J, Smieskova R, Harrisberger F, Lenz C, Schmidt A, Walter A, Huber C, Riecher-Rössler A, Simon A, Lang UE, Fusar-Poli P, Borgwardt S. Age-related brain structural alterations as an intermediate phenotype of psychosis. J Psychiatry Neurosci 2017; 42:307-319. [PMID: 28459416 PMCID: PMC5573573 DOI: 10.1503/jpn.160179] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is only limited agreement with respect to location, directionality and functional implications of brain structural alterations observed in patients with schizophrenia. Additionally, their link to occurrence of psychotic symptoms remains unclear. A viable way of addressing these questions is to examine populations in an at-risk mental state (ARMS) before the transition to psychosis. METHODS We tested for structural brain alterations in individuals in an ARMS compared with healthy controls and patients with first-episode psychosis (FEP) using voxel-based morphometry and measures of cortical thickness. Furthermore, we evaluated if these alterations were modified by age and whether they were linked to the observed clinical symptoms. RESULTS Our sample included 59 individuals with ARMS, 26 healthy controls and 59 patients with FEP. We found increased grey matter volume and cortical thickness in individuals with ARMS and a similar pattern of structural alterations in patients with FEP. We further found stronger age-related reductions in grey matter volume and cortical thickness in both patients with FEP and individuals with ARMS, linking these alterations to observed clinical symptoms. LIMITATIONS The ARMS group comprised subgroups with heterogeneous levels of psychosis risk and medication status. Furthermore, the cross-sectional nature of our study and the reduced number of older patients limit conclusions with respect to observed interactions with age. CONCLUSION Our findings on consistent structural alterations in individuals with ARMS and patients with FEP and their link to clinical symptoms have major implications for understanding their time of occurrence and relevance to psychotic symptoms. Interactions with age found for these alterations may explain the heterogeneity of findings reported in the literature.
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Affiliation(s)
- Juergen Dukart
- Correspondence to: J. Dukart, Biomarkers & Clinical Imaging, NORD DTA, F. Hoffmann-La Roche, Grenzacherstrasse 170, 4070 Basel, Switzerland;
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Ramyead A, Kometer M, Studerus E, Baumeler D, von Rotz R, Riecher-Rössler A. Alpha oscillations underlie working memory abnormalities in the psychosis high-risk state. Biol Psychol 2017; 126:12-18. [PMID: 28385625 DOI: 10.1016/j.biopsycho.2017.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 03/17/2017] [Accepted: 04/02/2017] [Indexed: 11/17/2022]
Abstract
Working memory (WM) functioning, known to be modulated by neural oscillations, is impaired in schizophrenic psychoses. It remains unclear whether in the psychosis high-risk state, WM encoding is altered or whether patients are impaired at shielding their WM against distractors. We employed single-trial analyses of neurophysiological and behavioral data recorded during a WM paradigm, designed to include predictable distractors, on 18 patients with an at-risk mental state for psychosis (ARMS, 26.1±5.45 years) and 21 healthy controls (HCs, 25.5±3.95 years). Strong distractors were associated with reduced WM accuracy (p=0.036), but only ARMS patients required more processing time for strong distractors (p=0.002). Increased parieto-occipital alpha amplitude preceding distractor presentations was associated with enhanced accuracy only in HCs (p=0.009). During encoding, increased intertrial alpha phase locking values were associated with increased performance. Reduced shielding mechanisms against distractors in ARMS patients could lead to defective WM maintenance, which may result in significant confusion that may contribute to the formation of psychotic symptoms.
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Affiliation(s)
- Avinash Ramyead
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Michael Kometer
- Neuropsychopharmacology and Brain Imaging Research Unit, Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Switzerland
| | - Erich Studerus
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Denise Baumeler
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Robin von Rotz
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Anita Riecher-Rössler
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland.
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Walter A, Suenderhauf C, Harrisberger F, Lenz C, Smieskova R, Chung Y, Cannon TD, Bearden CE, Rapp C, Bendfeldt K, Borgwardt S, Vogel T. Hippocampal volume in subjects at clinical high-risk for psychosis: A systematic review and meta-analysis. Neurosci Biobehav Rev 2016; 71:680-690. [DOI: 10.1016/j.neubiorev.2016.10.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/09/2016] [Accepted: 10/11/2016] [Indexed: 01/16/2023]
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Harrisberger F, Buechler R, Smieskova R, Lenz C, Walter A, Egloff L, Bendfeldt K, Simon AE, Wotruba D, Theodoridou A, Rössler W, Riecher-Rössler A, Lang UE, Heekeren K, Borgwardt S. Alterations in the hippocampus and thalamus in individuals at high risk for psychosis. NPJ SCHIZOPHRENIA 2016; 2:16033. [PMID: 27738647 PMCID: PMC5040554 DOI: 10.1038/npjschz.2016.33] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 02/04/2023]
Abstract
Reduction in hippocampal volume is a hallmark of schizophrenia and already present in the
clinical high-risk state. Nevertheless, other subcortical structures, such as the
thalamus, amygdala and pallidum can differentiate schizophrenia patients from controls. We
studied the role of hippocampal and subcortical structures in clinical high-risk
individuals from two cohorts. High-resolution T1-weighted structural MRI brain
scans of a total of 91 clinical high-risk individuals and 64 healthy controls were
collected in two centers. The bilateral volume of the hippocampus, the thalamus, the
caudate, the putamen, the pallidum, the amygdala, and the accumbens were automatically
segmented using FSL-FIRST. A linear mixed-effects model and a prospective meta-analysis
were applied to assess group-related volumetric differences. We report reduced hippocampal
and thalamic volumes in clinical high-risk individuals compared to healthy controls. No
volumetric alterations were detected for the caudate, the putamen, the pallidum, the
amygdala, or the accumbens. Moreover, we found comparable medium effect sizes for
group-related comparison of the thalamus in the two analytical methods. These findings
underline the relevance of specific alterations in the hippocampal and subcortical volumes
in the high-risk state. Further analyses may allow hippocampal and thalamic volumes to be
used as biomarkers to predict psychosis.
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Affiliation(s)
| | - Roman Buechler
- The Zurich Program for Sustainable Development of Mental Health Services, Psychiatric Hospital, University of Zurich , Zurich, Switzerland
| | - Renata Smieskova
- Department of Psychiatry, University of Basel, Basel, Switzerland; Medical Image Analysis Centre, University of Basel, Basel, Switzerland
| | - Claudia Lenz
- Department of Psychiatry, University of Basel , Basel, Switzerland
| | - Anna Walter
- Department of Psychiatry, University of Basel , Basel, Switzerland
| | - Laura Egloff
- Department of Psychiatry, University of Basel , Basel, Switzerland
| | - Kerstin Bendfeldt
- Medical Image Analysis Centre, University of Basel , Basel, Switzerland
| | - Andor E Simon
- Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry , Bruderholz, Switzerland
| | - Diana Wotruba
- The Zurich Program for Sustainable Development of Mental Health Services, Psychiatric Hospital, University of Zurich , Zurich, Switzerland
| | - Anastasia Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services, Psychiatric Hospital, University of Zurich , Zurich, Switzerland
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services, Psychiatric Hospital, University of Zurich , Zurich, Switzerland
| | | | - Undine E Lang
- Department of Psychiatry, University of Basel , Basel, Switzerland
| | - Karsten Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services, Psychiatric Hospital, University of Zurich , Zurich, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel, Basel, Switzerland; Medical Image Analysis Centre, University of Basel, Basel, Switzerland; Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
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Petrikis P, Tigas S, Tzallas AT, Archimandriti DT, Skapinakis P, Mavreas V. Prolactin levels in drug-naïve patients with schizophrenia and other psychotic disorders. Int J Psychiatry Clin Pract 2016; 20:165-9. [PMID: 27334805 DOI: 10.1080/13651501.2016.1197274] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Hyperprolactinaemia as a side effect of dopamine receptor blockers is common in patients with schizophrenia and other psychotic disorders and may lead to amenorrhoea, galactorrhoea, hypogonadism, subfertility and osteoporosis. The aim of our study was to determine whether hyperprolactinaemia occurs also in patients with schizophrenia and other psychotic disorders prior to any antipsychotic treatment. METHODS Serum prolactin, thyroid-stimulating hormone (TSH), triiodothyronine (T3), free tetraiodothyronine (FT4) and cortisol levels were measured in 40 newly diagnosed, drug naïve, patients with schizophrenia and other psychotic disorders and in 40 age and gender matched healthy subjects. RESULTS The median prolactin value was 12.5 ng/ml (range: 2-38 ng/ml) for patients and 8.6 ng/ml (range: 4-17.6 ng/ml) for healthy subjects (p = 0.011). Patients had lower levels of T3 compared to healthy controls (mean: 1.08 ng/ml, SD: 0.16 vs. 1.18 ng/ml, 0.18, respectively; p = 0.008). Serum TSH, FT4 and cortisol levels were similar between the two groups. Multiple regression analysis revealed that the difference in serum prolactin values was independent of thyroid function (TSH, FT4, T3) and serum cortisol levels. CONCLUSIONS A higher serum prolactin level was found in drug naïve, newly diagnosed patients with schizophrenia and other psychotic disorders compared to healthy controls, prior to starting any antipsychotic treatment.
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Affiliation(s)
- Petros Petrikis
- a Psychiatric Clinic, Medical School, University of Ioannina (UOI) , Ioannina , Greece
| | - Stelios Tigas
- b Department of Endocrinology , Medical School, University of Ioannina (UOI) , Ioannina , Greece
| | - Alexandros T Tzallas
- c Department of Computer Engineering, School of Applied Technology , Technological Educational Institute of Epirus (TEIEP) , Arta , Greece
| | - Dimitra T Archimandriti
- d Rheumatology Clinic, Department of Internal Medicine , Medical School, University of Ioannina (UOI) , Ioannina , Greece
| | - Petros Skapinakis
- a Psychiatric Clinic, Medical School, University of Ioannina (UOI) , Ioannina , Greece
| | - Venetsanos Mavreas
- a Psychiatric Clinic, Medical School, University of Ioannina (UOI) , Ioannina , Greece
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Harrisberger F, Smieskova R, Vogler C, Egli T, Schmidt A, Lenz C, Simon AE, Riecher-Rössler A, Papassotiropoulos A, Borgwardt S. Impact of polygenic schizophrenia-related risk and hippocampal volumes on the onset of psychosis. Transl Psychiatry 2016; 6:e868. [PMID: 27505231 PMCID: PMC5022088 DOI: 10.1038/tp.2016.143] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/25/2016] [Accepted: 06/05/2016] [Indexed: 12/12/2022] Open
Abstract
Alterations in hippocampal volume are a known marker for first-episode psychosis (FEP) as well as for the clinical high-risk state. The Polygenic Schizophrenia-related Risk Score (PSRS), derived from a large case-control study, indicates the polygenic predisposition for schizophrenia in our clinical sample. A total of 65 at-risk mental state (ARMS) and FEP patients underwent structural magnetic resonance imaging. We used automatic segmentation of hippocampal volumes using the FSL-FIRST software and an odds-ratio-weighted PSRS based on the publicly available top single-nucleotide polymorphisms from the Psychiatric Genomics Consortium genome-wide association study (GWAS). We observed a negative association between the PSRS and hippocampal volumes (β=-0.42, P=0.01, 95% confidence interval (CI)=(-0.72 to -0.12)) across FEP and ARMS patients. Moreover, a higher PSRS was significantly associated with a higher probability of an individual being assigned to the FEP group relative to the ARMS group (β=0.64, P=0.03, 95% CI=(0.08-1.29)). These findings provide evidence that a subset of schizophrenia risk variants is negatively associated with hippocampal volumes, and higher values of this PSRS are significantly associated with FEP compared with the ARMS. This implies that FEP patients have a higher genetic risk for schizophrenia than the total cohort of ARMS patients. The identification of associations between genetic risk variants and structural brain alterations will increase our understanding of the neurobiology underlying the transition to psychosis.
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Affiliation(s)
- F Harrisberger
- Division of Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland,Psychiatric University Clinics, University of Basel, Basel, Switzerland,Division of Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), Psychiatric University Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, Basel 4012, Switzerland. E-mail:
| | - R Smieskova
- Division of Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland,Psychiatric University Clinics, University of Basel, Basel, Switzerland,Medical Image Analysis Centre, University Hospital Basel, Basel, Switzerland
| | - C Vogler
- Psychiatric University Clinics, University of Basel, Basel, Switzerland,Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - T Egli
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - A Schmidt
- King's College London, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - C Lenz
- Division of Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland,Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - A E Simon
- Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, Bruderholz, Switzerland
| | - A Riecher-Rössler
- Division of Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland,Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - A Papassotiropoulos
- Psychiatric University Clinics, University of Basel, Basel, Switzerland,Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland,Transfaculty Research Platform, University of Basel, Basel, Switzerland,Department Biozentrum, Life Sciences Training Facility, University of Basel, Basel, Switzerland
| | - S Borgwardt
- Division of Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland,Psychiatric University Clinics, University of Basel, Basel, Switzerland,Medical Image Analysis Centre, University Hospital Basel, Basel, Switzerland,King's College London, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, London, UK
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Ramyead A, Studerus E, Kometer M, Heitz U, Gschwandtner U, Fuhr P, Riecher-Rössler A. Neural oscillations in antipsychotic-naïve patients with a first psychotic episode. World J Biol Psychiatry 2016; 17:296-307. [PMID: 26899507 DOI: 10.3109/15622975.2016.1156742] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES In chronic schizophrenic psychoses, oscillatory abnormalities predominantly occur in prefrontal cortical regions and are associated with reduced communication across cortical areas. Nevertheless, it remains unclear whether similar alterations can be observed in patients with a first episode of psychosis (FEP), a state characterised by pathological features occurring in both late prodromal patients and initial phases of frank schizophrenic psychoses. METHODS We assessed resting-state electroencephalographic data of 31 antipsychotic-naïve FEP patients and 29 healthy controls (HC). We investigated the three-dimensional (3D) current source density (CSD) distribution and lagged phase synchronisation (LPS) of oscillations across small-scale and large-scale brain networks. We additionally investigated LPS relationships with clinical symptoms using linear mixed-effects models. RESULTS Compared to HC, FEP patients demonstrated abnormal CSD distributions in frontal areas of the brain; while decreased oscillations were found in the low frequencies, an increase was reported in the high frequencies (P < 0.01). Patients also exhibited deviant LPS in the high frequencies, whose dynamics changed over increasing 3D cortico-cortical distances and increasing psychotic symptoms. CONCLUSIONS These results indicate that in addition to prefrontal cortical abnormalities, altered synchronised neural oscillations are also present, suggesting possible disruptions in cortico-cortical communications. These findings provide new insights into the pathophysiological mechanisms of emerging schizophrenic psychoses.
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Affiliation(s)
- Avinash Ramyead
- a University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection , Basel , Switzerland
| | - Erich Studerus
- a University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection , Basel , Switzerland
| | - Michael Kometer
- b Neuropsychopharmacology and Brain Imaging Research Unit, Department of Psychiatry, Psychotherapy and Psychosomatics , Hospital of Psychiatry, University of Zurich , Switzerland
| | - Ulrike Heitz
- a University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection , Basel , Switzerland
| | - Ute Gschwandtner
- c Department of Neurology , University Hospital Basel , Basel , Switzerland
| | - Peter Fuhr
- c Department of Neurology , University Hospital Basel , Basel , Switzerland
| | - Anita Riecher-Rössler
- a University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection , Basel , Switzerland
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