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Makam AN. Concerns Regarding Strength of Conclusions in Systematic Review and Meta-Analysis of Neuroradiological Abnormalities in First-Episode Psychosis. JAMA Psychiatry 2024; 81:107-108. [PMID: 37966834 DOI: 10.1001/jamapsychiatry.2023.4396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Anil N Makam
- Division of Hospital Medicine, University of California San Francisco at San Francisco General Hospital, San Francisco
- University of California San Francisco Philip R. Lee Institute for Health Policy Studies, San Francisco
- University of California San Francisco Center for Vulnerable Populations, San Francisco
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2
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Blackman G, Neri G, Al-Doori O, Teixeira-Dias M, Mazumder A, Pollak TA, Hird EJ, Koutsouleris N, Bell V, Kempton MJ, McGuire P. Prevalence of Neuroradiological Abnormalities in First-Episode Psychosis: A Systematic Review and Meta-analysis. JAMA Psychiatry 2023; 80:1047-1054. [PMID: 37436735 PMCID: PMC10339221 DOI: 10.1001/jamapsychiatry.2023.2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/08/2023] [Indexed: 07/13/2023]
Abstract
Importance Individuals presenting with first-episode psychosis (FEP) may have a secondary ("organic") etiology to their symptoms that can be identified using neuroimaging. Because failure to detect such cases at an early stage can have serious clinical consequences, it has been suggested that brain magnetic resonance imaging (MRI) should be mandatory for all patients presenting with FEP. However, this remains a controversial issue, partly because the prevalence of clinically relevant MRI abnormalities in this group is unclear. Objective To derive a meta-analytic estimate of the prevalence of clinically relevant neuroradiological abnormalities in FEP. Data Sources Electronic databases Ovid, MEDLINE, PubMed, Embase, PsychINFO, and Global Health were searched up to July 2021. References and citations of included articles and review articles were also searched. Study Selection Magnetic resonance imaging studies of patients with FEP were included if they reported the frequency of intracranial radiological abnormalities. Data Extraction and Synthesis Independent extraction was undertaken by 3 researchers and a random-effects meta-analysis of pooled proportions was calculated. Moderators were tested using subgroup and meta-regression analyses. Heterogeneity was evaluated using the I2 index. The robustness of results was evaluated using sensitivity analyses. Publication bias was assessed using funnel plots and Egger tests. Main Outcomes and Measures Proportion of patients with a clinically relevant radiological abnormality (defined as a change in clinical management or diagnosis); number of patients needed to scan to detect 1 such abnormality (number needed to assess [NNA]). Results Twelve independent studies (13 samples) comprising 1613 patients with FEP were included. Of these patients, 26.4% (95% CI, 16.3%-37.9%; NNA of 4) had an intracranial radiological abnormality, and 5.9% (95% CI, 3.2%-9.0%) had a clinically relevant abnormality, yielding an NNA of 18. There were high degrees of heterogeneity among the studies for these outcomes, 95% to 73%, respectively. The most common type of clinically relevant finding was white matter abnormalities, with a prevalence of 0.9% (95% CI, 0%-2.8%), followed by cysts, with a prevalence of 0.5% (95% CI, 0%-1.4%). Conclusions and Relevance This systematic review and meta-analysis found that 5.9% of patients presenting with a first episode of psychosis had a clinically relevant finding on MRI. Because the consequences of not detecting these abnormalities can be serious, these findings support the use of MRI as part of the initial clinical assessment of all patients with FEP.
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Affiliation(s)
- Graham Blackman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Giulia Neri
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Omar Al-Doori
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Maria Teixeira-Dias
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Asif Mazumder
- Department of Neuroradiology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Department of Radiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Thomas A. Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emily J. Hird
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Nikolaos Koutsouleris
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Max-Planck Institute of Psychiatry, Munich, Germany
| | - Vaughan Bell
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Matthew J. Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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3
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Sefik E, Boamah M, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, Keshavan MS, Mathalon DH, Perkins DO, Stone WS, Tsuang MT, Woods SW, Cannon TD, Walker EF. Sex- and Age-Specific Deviations in Cerebellar Structure and Their Link With Symptom Dimensions and Clinical Outcome in Individuals at Clinical High Risk for Psychosis. Schizophr Bull 2023; 49:350-363. [PMID: 36394426 PMCID: PMC10016422 DOI: 10.1093/schbul/sbac169] [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: 11/18/2022]
Abstract
BACKGROUND The clinical high-risk (CHR) period offers a temporal window into neurobiological deviations preceding psychosis onset, but little attention has been given to regions outside the cerebrum in large-scale studies of CHR. Recently, the North American Prodrome Longitudinal Study (NAPLS)-2 revealed altered functional connectivity of the cerebello-thalamo-cortical circuitry among individuals at CHR; however, cerebellar morphology remains underinvestigated in this at-risk population, despite growing evidence of its involvement in psychosis. STUDY DESIGN In this multisite study, we analyzed T1-weighted magnetic resonance imaging scans obtained from N = 469 CHR individuals (61% male, ages = 12-36 years) and N = 212 healthy controls (52% male, ages = 12-34 years) from NAPLS-2, with a focus on cerebellar cortex and white matter volumes separately. Symptoms were rated by the Structured Interview for Psychosis-Risk Syndromes (SIPS). The outcome by two-year follow-up was categorized as in-remission, symptomatic, prodromal-progression, or psychotic. General linear models were used for case-control comparisons and tests for volumetric associations with baseline SIPS ratings and clinical outcomes. STUDY RESULTS Cerebellar cortex and white matter volumes differed between the CHR and healthy control groups at baseline, with sex moderating the difference in cortical volumes, and both sex and age moderating the difference in white matter volumes. Baseline ratings for major psychosis-risk dimensions as well as a clinical outcome at follow-up had tissue-specific associations with cerebellar volumes. CONCLUSIONS These findings point to clinically relevant deviations in cerebellar cortex and white matter structures among CHR individuals and highlight the importance of considering the complex interplay between sex and age when studying the neuromaturational substrates of psychosis risk.
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Affiliation(s)
- Esra Sefik
- Department of Psychology, Emory University, Atlanta, GA, USA
- Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - Michelle Boamah
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | | | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
- Mental Health Service, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - William S Stone
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ming T Tsuang
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
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4
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Fortea A, Pinzón-Espinosa J, Ilzarbe D, Espinosa L, Lázaro L, Calvo RM, Castro-Fornieles J, de la Serna E, Bargalló N, Baeza I, Sugranyes G. Radiological findings in brain MRI scans in youth with early-onset psychosis: A controlled study. J Psychiatr Res 2022; 156:151-158. [PMID: 36252344 DOI: 10.1016/j.jpsychires.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/08/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022]
Abstract
There is a lack of consensus on whether routine brain magnetic resonance imaging (MRI) should be recommended as part of the initial assessment in patients with psychosis. No study so far has qualitatively assessed brain MRI in patients with early-onset psychosis (EOP), in whom neurodevelopmental factors may play a stronger role. We aimed to determine the prevalence of brain MRI findings in patients with EOP compared to healthy controls, and assess whether these findings were clinically relevant. Retrospective clinical chart review of all patients with EOP in whom a brain MRI scan was acquired during admission to an inpatient child and adolescent psychiatry unit during January 2013-December 2017, compared to age and biologically assigned gender matched healthy controls. Between group analyses tested differences in rates of qualitatively abnormal MRI scans and changes in clinical management as a result of radiological findings. A total of 256 individuals were included (128 patients with EOP and 128 healthy controls). Patients with EOP presented with a significantly higher rate of abnormal MRI scans relative to healthy controls (21.9% vs 11.7%, p = .030; OR = 2.11, [95% CI:1.06-4.17]). Radiological findings in the EOP group triggered clinical referral for further evaluation or management more often than in the healthy control group (7.0% vs 1.6%, p = .030; OR = 4.76, [95% CI:1.01-22.50]). MRI scans in youth with EOP may be characterized by an increased number of radiological abnormalities than in controls. The rates of MRI findings requiring clinical referral suggests that routine MRI acquisition may need to be considered in patients with EOP.
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Affiliation(s)
- Adriana Fortea
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Medicine, School of Medicine, University of Barcelona, 143 Casanova St Barcelona 08036, Spain; Fundació Clínic per a La Recerca Biomèdica (FCRB), 153 Rosselló St., Barcelona, 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain
| | - Justo Pinzón-Espinosa
- Department of Medicine, School of Medicine, University of Barcelona, 143 Casanova St Barcelona 08036, Spain; Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Mental Health, Parc Tauli University Hospital, Sabadell, 1 Parc Taulí, Sabadell, 08208, Barcelona, Spain; Department of Clinical Psychiatry, School of Medicine, University of Panama, Ave. Octavio Méndez Pereira, Panamá, XFJ8+V2Q, Panama
| | - Daniel Ilzarbe
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Medicine, School of Medicine, University of Barcelona, 143 Casanova St Barcelona 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain
| | - Laura Espinosa
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Child and Adolescent Psychiatry, Hospital Sant Joan de Deu, Fundació Althaia, 1-3 Dr. Joan Soler St., Manresa, 08243, Barcelona, Spain
| | - Luisa Lázaro
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Medicine, School of Medicine, University of Barcelona, 143 Casanova St Barcelona 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain
| | - Rosa M Calvo
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Medicine, School of Medicine, University of Barcelona, 143 Casanova St Barcelona 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Medicine, School of Medicine, University of Barcelona, 143 Casanova St Barcelona 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain
| | - Elena de la Serna
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain
| | - Nuria Bargalló
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Department of Radiology, Imaging Diagnosis Center, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Medicine, School of Medicine, University of Barcelona, 143 Casanova St Barcelona 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain
| | - Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Fundació Clínic per a La Recerca Biomèdica (FCRB), 153 Rosselló St., Barcelona, 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain.
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Bellani M, Perlini C, Zovetti N, Rossetti MG, Alessandrini F, Barillari M, Ricciardi GK, Konze A, Sberna M, Zoccatelli G, Lasalvia A, Miceli M, Neri G, Torresani S, Mazzi F, Scocco P, D'Agostino A, Imbesi M, Veronese A, Ruggeri M, Brambilla P. Incidental findings on brain MRI in patients with first-episode and chronic psychosis. Psychiatry Res Neuroimaging 2022; 326:111518. [PMID: 36037703 DOI: 10.1016/j.pscychresns.2022.111518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022]
Abstract
Brain incidental findings (IFs) are unexpected brain abnormalities detected by a structural magnetic resonance (MRI) examination. We conducted a study to assess whether brain IFs are associated with first-episode psychosis (FEP) and chronic psychosis (affective vs. non-affective) compared to healthy controls (HC). Chi-squared analyses were run to compare the frequency of several IFs across groups. Logistic regression analyses were run to explore the association between group and IFs, accounting for sex, age, MRI field strength. We observed a higher frequency of most IFs in both FEP and chronic psychosis groups compared to HC, however most of the chi-squared tests did not reach significance. Patients with FEP and chronic psychosis were 3-4 times more likely to show deep white matter hyperintensities (WMH) than HC. Patients with FEP and affective chronic psychosis were 3-4 times more likely to show ventricular asymmetries than HC. All chronic patients were more likely to show periventricular WMH, liquoral spaces enlargements and ventricular system enlargements respectively. Our results suggest that deep WMH and ventricular asymmetries are associated with both the early and the chronic stages of psychosis, thus representing potential vulnerability factors already present before the onset of the symptoms, possibly due to neurodevelopmental insults.
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Affiliation(s)
- Marcella Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, AOUI Verona, Verona, Italy.
| | - Cinzia Perlini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Niccolò Zovetti
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, AOUI Verona, Verona, Italy
| | - Maria Gloria Rossetti
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Franco Alessandrini
- Neuroradiology Department, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Marco Barillari
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Angela Konze
- Department of Radiology, Azienda USL Toscana Centro, Florence, Italy
| | - Maurizio Sberna
- Department of Neuroradiology, Niguarda Hospital, Milan, Italy
| | - Giada Zoccatelli
- Neuroradiology Department, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Antonio Lasalvia
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, AOUI Verona, Verona, Italy
| | - Maurizio Miceli
- Department of Mental Health and Addiction, Azienda Sanitaria Toscana Centro, Firenze, Italy
| | - Giovanni Neri
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Verona, Italy
| | - Stefano Torresani
- Department of Mental Health, District of Bolzano, Health Service of South Tyrol, Italy
| | | | - Paolo Scocco
- Department of Mental Health, AULSS 6 Euganea, Padua, Italy
| | - Armando D'Agostino
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | | | | | - Mirella Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, AOUI Verona, Verona, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Iftimovici A, Chaumette B, Duchesnay E, Krebs MO. Brain anomalies in early psychosis: From secondary to primary psychosis. Neurosci Biobehav Rev 2022; 138:104716. [PMID: 35661683 DOI: 10.1016/j.neubiorev.2022.104716] [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: 09/28/2021] [Revised: 03/12/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
Abstract
Brain anomalies are frequently found in early psychoses. Although they may remain undetected for many years, their interpretation is critical for differential diagnosis. In secondary psychoses, their identification may allow specific management. They may also shed light on various pathophysiological aspects of primary psychoses. Here we reviewed cases of secondary psychoses associated with brain anomalies, reported over a 20-year period in adolescents and young adults aged 13-30 years old. We considered age at first psychotic symptoms, relevant medical history, the nature of psychiatric symptoms, clinical red flags, the nature of the brain anomaly reported, and the underlying disease. We discuss the relevance of each brain area in light of normal brain function, recent case-control studies, and postulated pathophysiology. We show that anomalies in all regions, whether diffuse, multifocal, or highly localized, may lead to psychosis, without necessarily being associated with non-psychiatric symptoms. This underlines the interest of neuroimaging in the initial workup, and supports the hypothesis of psychosis as a global network dysfunction that involves many different regions.
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Affiliation(s)
- Anton Iftimovici
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, GDR 3557-Institut de Psychiatrie, Paris, France; NeuroSpin, Atomic Energy Commission, Gif-sur Yvette, France; GHU Paris Psychiatrie et Neurosciences, Paris, France.
| | - Boris Chaumette
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, GDR 3557-Institut de Psychiatrie, Paris, France; GHU Paris Psychiatrie et Neurosciences, Paris, France
| | | | - Marie-Odile Krebs
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, GDR 3557-Institut de Psychiatrie, Paris, France; GHU Paris Psychiatrie et Neurosciences, Paris, France
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7
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Borgwardt SJ, Radue EW, Riecher-Rössler A. Cavum septum pellucidum in patients with first episode psychosis and individuals at high risk of psychosis. Eur Psychiatry 2020; 22:264. [PMID: 17227705 DOI: 10.1016/j.eurpsy.2006.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Accepted: 11/19/2006] [Indexed: 11/17/2022] Open
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8
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Schmidt A, Borgwardt S. Implementing MR Imaging into Clinical Routine Screening in Patients with Psychosis? Neuroimaging Clin N Am 2020; 30:65-72. [DOI: 10.1016/j.nic.2019.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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9
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Forbes M, Stefler D, Velakoulis D, Stuckey S, Trudel JF, Eyre H, Boyd M, Kisely S. The clinical utility of structural neuroimaging in first-episode psychosis: A systematic review. Aust N Z J Psychiatry 2019; 53:1093-1104. [PMID: 31113237 DOI: 10.1177/0004867419848035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Australian and US guidelines recommend routine brain imaging, either computed tomography or magnetic resonance imaging, to exclude structural lesions in presentations for first-episode psychosis. The aim of this review was to examine the evidence for the appropriateness and clinical utility of this recommendation by assessing the frequency of abnormal radiological findings in computed tomography and magnetic resonance imaging scans among patients with first-episode psychosis. METHODS PubMed and Embase database were searched from inception to April 2018 using appropriate MeSH or Emtree terms. Studies were included in the review if they reported data on computed tomography or magnetic resonance imaging scan findings of individuals with first-episode psychosis. No restriction on the geographical location of the study or the age of participants was applied. We calculated the percentage of abnormal radiological findings in each study, separately by the two diagnostic methods. RESULTS There were 16 suitable studies published between 1988 and 2017, reporting data on an overall 2312 patients with first-episode psychosis. Most were observational studies with a retrospective design and the majority examined patients with computed tomography. While structural abnormalities were a relatively common finding, these rarely required clinical intervention (range across studies: 0-60.7%; median: 3.5%) and were very rarely the cause of the psychotic symptoms (range: 0-3.3%; median: 0%). Only 2 of the 16 studies concluded that brain imaging should be routinely ordered in first-episode psychosis. CONCLUSION There is insufficient evidence to suggest that brain imaging should be routinely ordered for patients presenting with first-episode psychosis without associated neurological or cognitive impairment. The appropriate screening procedure for structural brain lesions is conventional history-taking, mental status and neurological examination. If intracranial pathology is suspected clinically, a magnetic resonance imaging or computed tomography scan should be performed depending on the clinical signs, the acuity and the suspected pathology. National guidelines should reflect evidence-based data.
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Affiliation(s)
- Malcolm Forbes
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Denes Stefler
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Parkville, VIC, Australia
| | - Stephen Stuckey
- Monash Imaging, Diagnostic Neuroradiology and MRI, Monash Health, Clayton, VIC, Australia.,Department of Imaging, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | | | - Harris Eyre
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia.,Innovation Institute, Texas Medical Centre, Houston, TX, USA
| | - Melinda Boyd
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Steve Kisely
- Innovation Institute, Texas Medical Centre, Houston, TX, USA
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10
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LeBaron DB, Mahjoub Y, Abba-Aji A. Incidental intracranial pathology: a retrospective case review of structural neuroimaging results amongst young adult psychiatric patients. Neuropsychiatr Dis Treat 2019; 15:1557-1562. [PMID: 31354273 PMCID: PMC6580137 DOI: 10.2147/ndt.s192200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/30/2019] [Indexed: 11/23/2022] Open
Abstract
Objective: Given that there continue to be conflicting recommendations on the inclusion of routine structural neuroimaging amongst the investigations ordered in psychiatric patients, our group aimed to add to the data on intracranial pathology amongst, specifically, the young adult psychiatric population. This is a novel study in that it includes all presentations (mania, depression, psychosis, anxiety, substance use disorders) and presents, to the authors' knowledge, the largest cohort of imaging results amongst this group. Method: The neuroimaging (CT and MRI) reports of 224 patients admitted to the Young Adult Assessment, Evaluation and Reintegration Unit (12-A) at the Alberta Hospital Edmonton (AHE) between the years of 2012-2015 were reviewed, and all findings were classified into one of four categories (normal, abnormal/benign, abnormal and unlikely linked to symptoms, and abnormal with possible link to symptoms). This study is largely a review of CT scans, as there were only six MRI reports available in the study population. Results: In total, 86.6% of findings were classified as normal. Amongst the scans with abnormal findings, 10.7% were deemed benign and non-specific. 1.8% of abnormal findings required an outside consultation or follow-up, but were unlikely linked to symptoms; and 0.9% were deemed possibly causally related to symptoms, though follow-up imaging deemed otherwise. The most prevalent findings were cerebral atrophy (n=6), arachnoid cysts (n=5), ventricular asymmetry (n=3), and cavum septum pellucidum (n=3). Conclusions: This study represents the largest cohort of incidental findings in the young adult psychiatric population. These findings do not support the practice of ordering structural imaging tests in the young adult (17-26 years) psychiatric population. This suggestion agrees with recent recommendations on this question, and highlights the need for ongoing review in this area.
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Affiliation(s)
- David B LeBaron
- Faculty of Medicine and Dentistry, Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Yasamin Mahjoub
- Faculty of Medicine and Dentistry, Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Adam Abba-Aji
- Faculty of Medicine and Dentistry, Department of Psychiatry, University of Alberta, Edmonton, Canada.,Young Adult Assessment, Evaluation and Reintegration Alberta Hospital, Edmonton, Canada
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Picchioni MM, Dazzan P. Clinical significance of neurological abnormalities in psychosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.107.004408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryThe neurological deficits in sensory and motor function in schizophrenia have been described using a confusing variety of terms, reflecting their uncertain relevance and significance to psychosis. In this article we explore the nature of neurological abnormalities in psychosis, describe their assessment and suggest their potential relevance for clinician and patient. We propose that the assessment of neurological abnormalities and extrapyramidal side-effects should figure in the assessment of any patient with psychosis, particularly at illness onset. Furthermore, we suggest that neurological abnormalities can inform prognostic predictions and help to identify patients with more complex future care needs.
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Falkenberg I, Benetti S, Raffin M, Wuyts P, Pettersson-Yeo W, Dazzan P, Morgan KD, Murray RM, Marques TR, David AS, Jarosz J, Simmons A, Williams S, McGuire P. Clinical utility of magnetic resonance imaging in first-episode psychosis. Br J Psychiatry 2017; 211:231-237. [PMID: 28473319 DOI: 10.1192/bjp.bp.116.195834] [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] [Received: 04/27/2016] [Revised: 02/04/2017] [Accepted: 02/07/2017] [Indexed: 11/23/2022]
Abstract
BackgroundThere is no consensus as to whether magnetic resonance imaging (MRI) should be used as part of the initial clinical evaluation of patients with first-episode psychosis (FEP).Aims(a) To assess the logistical feasibility of routine MRI; (b) to define the clinical significance of radiological abnormalities in patients with FEP.MethodRadiological reports from MRI scans of two FEP samples were reviewed; one comprised 108 patients and 98 healthy controls recruited to a research study and the other comprised 241 patients scanned at initial clinical presentation plus 66 healthy controls.ResultsIn the great majority of patients, MRI was logistically feasible. Radiological abnormalities were reported in 6% of the research sample and in 15% of the clinical sample (odds ratio (OR)=3.1, 95% CI 1.26-7.57, χ2(1) = 6.63, P = 0.01). None of the findings necessitated a change in clinical management.ConclusionsRates of neuroradiological abnormalities in FEP are likely to be underestimated in research samples that often exclude patients with organic abnormalities. However, the majority of findings do not require intervention.
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Affiliation(s)
- Irina Falkenberg
- Irina Falkenberg, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany; Stefania Benetti, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Marie Raffin, MD, Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Paris, France; Phillipe Wuyts, MD, EDHEC Business School, Nice, France; William Pettersson-Yeo, PhD, Paola Dazzan, MBChB, MSc, MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Kevin D. Morgan, PhD, Department of Psychology, University of Westminster, London, UK; Robin M. Murray, MBChB, MPhil, FRCPsych, Tiago Reis Marques, PhD, Anthony S. David, FRCP, FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Jozef Jarosz, MD, Department of Neuroimaging, South London and Maudsley NHS Foundation Trust, London and Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Andrew Simmons, PhD, Steve Williams, Professor, Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Stefania Benetti
- Irina Falkenberg, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany; Stefania Benetti, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Marie Raffin, MD, Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Paris, France; Phillipe Wuyts, MD, EDHEC Business School, Nice, France; William Pettersson-Yeo, PhD, Paola Dazzan, MBChB, MSc, MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Kevin D. Morgan, PhD, Department of Psychology, University of Westminster, London, UK; Robin M. Murray, MBChB, MPhil, FRCPsych, Tiago Reis Marques, PhD, Anthony S. David, FRCP, FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Jozef Jarosz, MD, Department of Neuroimaging, South London and Maudsley NHS Foundation Trust, London and Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Andrew Simmons, PhD, Steve Williams, Professor, Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Marie Raffin
- Irina Falkenberg, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany; Stefania Benetti, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Marie Raffin, MD, Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Paris, France; Phillipe Wuyts, MD, EDHEC Business School, Nice, France; William Pettersson-Yeo, PhD, Paola Dazzan, MBChB, MSc, MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Kevin D. Morgan, PhD, Department of Psychology, University of Westminster, London, UK; Robin M. Murray, MBChB, MPhil, FRCPsych, Tiago Reis Marques, PhD, Anthony S. David, FRCP, FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Jozef Jarosz, MD, Department of Neuroimaging, South London and Maudsley NHS Foundation Trust, London and Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Andrew Simmons, PhD, Steve Williams, Professor, Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Phillipe Wuyts
- Irina Falkenberg, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany; Stefania Benetti, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Marie Raffin, MD, Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Paris, France; Phillipe Wuyts, MD, EDHEC Business School, Nice, France; William Pettersson-Yeo, PhD, Paola Dazzan, MBChB, MSc, MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Kevin D. Morgan, PhD, Department of Psychology, University of Westminster, London, UK; Robin M. Murray, MBChB, MPhil, FRCPsych, Tiago Reis Marques, PhD, Anthony S. David, FRCP, FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Jozef Jarosz, MD, Department of Neuroimaging, South London and Maudsley NHS Foundation Trust, London and Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Andrew Simmons, PhD, Steve Williams, Professor, Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - William Pettersson-Yeo
- Irina Falkenberg, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany; Stefania Benetti, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Marie Raffin, MD, Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Paris, France; Phillipe Wuyts, MD, EDHEC Business School, Nice, France; William Pettersson-Yeo, PhD, Paola Dazzan, MBChB, MSc, MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Kevin D. Morgan, PhD, Department of Psychology, University of Westminster, London, UK; Robin M. Murray, MBChB, MPhil, FRCPsych, Tiago Reis Marques, PhD, Anthony S. David, FRCP, FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Jozef Jarosz, MD, Department of Neuroimaging, South London and Maudsley NHS Foundation Trust, London and Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Andrew Simmons, PhD, Steve Williams, Professor, Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Paola Dazzan
- Irina Falkenberg, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany; Stefania Benetti, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Marie Raffin, MD, Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Paris, France; Phillipe Wuyts, MD, EDHEC Business School, Nice, France; William Pettersson-Yeo, PhD, Paola Dazzan, MBChB, MSc, MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Kevin D. Morgan, PhD, Department of Psychology, University of Westminster, London, UK; Robin M. Murray, MBChB, MPhil, FRCPsych, Tiago Reis Marques, PhD, Anthony S. David, FRCP, FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Jozef Jarosz, MD, Department of Neuroimaging, South London and Maudsley NHS Foundation Trust, London and Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Andrew Simmons, PhD, Steve Williams, Professor, Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Kevin D Morgan
- Irina Falkenberg, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany; Stefania Benetti, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Marie Raffin, MD, Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Paris, France; Phillipe Wuyts, MD, EDHEC Business School, Nice, France; William Pettersson-Yeo, PhD, Paola Dazzan, MBChB, MSc, MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Kevin D. Morgan, PhD, Department of Psychology, University of Westminster, London, UK; Robin M. Murray, MBChB, MPhil, FRCPsych, Tiago Reis Marques, PhD, Anthony S. David, FRCP, FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Jozef Jarosz, MD, Department of Neuroimaging, South London and Maudsley NHS Foundation Trust, London and Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Andrew Simmons, PhD, Steve Williams, Professor, Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Robin M Murray
- Irina Falkenberg, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany; Stefania Benetti, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Marie Raffin, MD, Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Paris, France; Phillipe Wuyts, MD, EDHEC Business School, Nice, France; William Pettersson-Yeo, PhD, Paola Dazzan, MBChB, MSc, MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Kevin D. Morgan, PhD, Department of Psychology, University of Westminster, London, UK; Robin M. Murray, MBChB, MPhil, FRCPsych, Tiago Reis Marques, PhD, Anthony S. David, FRCP, FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Jozef Jarosz, MD, Department of Neuroimaging, South London and Maudsley NHS Foundation Trust, London and Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Andrew Simmons, PhD, Steve Williams, Professor, Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Tiago Reis Marques
- Irina Falkenberg, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany; Stefania Benetti, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Marie Raffin, MD, Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Paris, France; Phillipe Wuyts, MD, EDHEC Business School, Nice, France; William Pettersson-Yeo, PhD, Paola Dazzan, MBChB, MSc, MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Kevin D. Morgan, PhD, Department of Psychology, University of Westminster, London, UK; Robin M. Murray, MBChB, MPhil, FRCPsych, Tiago Reis Marques, PhD, Anthony S. David, FRCP, FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Jozef Jarosz, MD, Department of Neuroimaging, South London and Maudsley NHS Foundation Trust, London and Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Andrew Simmons, PhD, Steve Williams, Professor, Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Anthony S David
- Irina Falkenberg, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany; Stefania Benetti, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Marie Raffin, MD, Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Paris, France; Phillipe Wuyts, MD, EDHEC Business School, Nice, France; William Pettersson-Yeo, PhD, Paola Dazzan, MBChB, MSc, MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Kevin D. Morgan, PhD, Department of Psychology, University of Westminster, London, UK; Robin M. Murray, MBChB, MPhil, FRCPsych, Tiago Reis Marques, PhD, Anthony S. David, FRCP, FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Jozef Jarosz, MD, Department of Neuroimaging, South London and Maudsley NHS Foundation Trust, London and Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Andrew Simmons, PhD, Steve Williams, Professor, Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Jozef Jarosz
- Irina Falkenberg, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany; Stefania Benetti, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Marie Raffin, MD, Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Paris, France; Phillipe Wuyts, MD, EDHEC Business School, Nice, France; William Pettersson-Yeo, PhD, Paola Dazzan, MBChB, MSc, MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Kevin D. Morgan, PhD, Department of Psychology, University of Westminster, London, UK; Robin M. Murray, MBChB, MPhil, FRCPsych, Tiago Reis Marques, PhD, Anthony S. David, FRCP, FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Jozef Jarosz, MD, Department of Neuroimaging, South London and Maudsley NHS Foundation Trust, London and Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Andrew Simmons, PhD, Steve Williams, Professor, Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Andrew Simmons
- Irina Falkenberg, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany; Stefania Benetti, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Marie Raffin, MD, Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Paris, France; Phillipe Wuyts, MD, EDHEC Business School, Nice, France; William Pettersson-Yeo, PhD, Paola Dazzan, MBChB, MSc, MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Kevin D. Morgan, PhD, Department of Psychology, University of Westminster, London, UK; Robin M. Murray, MBChB, MPhil, FRCPsych, Tiago Reis Marques, PhD, Anthony S. David, FRCP, FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Jozef Jarosz, MD, Department of Neuroimaging, South London and Maudsley NHS Foundation Trust, London and Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Andrew Simmons, PhD, Steve Williams, Professor, Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Steve Williams
- Irina Falkenberg, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany; Stefania Benetti, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Marie Raffin, MD, Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Paris, France; Phillipe Wuyts, MD, EDHEC Business School, Nice, France; William Pettersson-Yeo, PhD, Paola Dazzan, MBChB, MSc, MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Kevin D. Morgan, PhD, Department of Psychology, University of Westminster, London, UK; Robin M. Murray, MBChB, MPhil, FRCPsych, Tiago Reis Marques, PhD, Anthony S. David, FRCP, FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Jozef Jarosz, MD, Department of Neuroimaging, South London and Maudsley NHS Foundation Trust, London and Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Andrew Simmons, PhD, Steve Williams, Professor, Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Philip McGuire
- Irina Falkenberg, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany; Stefania Benetti, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Marie Raffin, MD, Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Paris, France; Phillipe Wuyts, MD, EDHEC Business School, Nice, France; William Pettersson-Yeo, PhD, Paola Dazzan, MBChB, MSc, MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Kevin D. Morgan, PhD, Department of Psychology, University of Westminster, London, UK; Robin M. Murray, MBChB, MPhil, FRCPsych, Tiago Reis Marques, PhD, Anthony S. David, FRCP, FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Jozef Jarosz, MD, Department of Neuroimaging, South London and Maudsley NHS Foundation Trust, London and Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Andrew Simmons, PhD, Steve Williams, Professor, Department of Neuroimaging Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Borgwardt S, Schmidt A. Implementing magnetic resonance imaging into clinical routine screening in patients with psychosis? Br J Psychiatry 2017; 211:192-193. [PMID: 28970300 DOI: 10.1192/bjp.bp.117.199919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/20/2017] [Indexed: 11/23/2022]
Abstract
In this issue, Falkenberg et al explore the practicability of magnetic resonance imaging (MRI) as part of the initial clinical assessment in patients with first-episode psychosis and the prevalence, nature and clinical significance of radiological abnormalities in these patients. They provide evidence for the use of MRI data to detect gross brain abnormalities. In addition, improvements in quantitative analyses makes MRI an indispensable tool to elucidate the neurobiological substrates that might underlie primary (or idiopathic) psychotic illness.
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Affiliation(s)
- Stefan Borgwardt
- Stefan Borgwardt, MD, MBA, Head of Neuropsychiatry and Brain Imaging, Department of Psychiatry, University of Basel, Switzerland; André Schmidt, MSc, PhD, Research Group Leader in the Department of Psychiatry (UPK), University of Basel, Switzerland
| | - André Schmidt
- Stefan Borgwardt, MD, MBA, Head of Neuropsychiatry and Brain Imaging, Department of Psychiatry, University of Basel, Switzerland; André Schmidt, MSc, PhD, Research Group Leader in the Department of Psychiatry (UPK), University of 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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Liu H, Li L, Shen L, Wang X, Hou Y, Zhao Z, Gu L, Mao J. Cavum septum pellucidum and first-episode psychosis: A meta-analysis. PLoS One 2017; 12:e0177715. [PMID: 28545119 PMCID: PMC5435239 DOI: 10.1371/journal.pone.0177715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/02/2017] [Indexed: 02/05/2023] Open
Abstract
Objectives To investigate the prevalence and changes of cavum septum pellucidum (CSP) in first-episode psychosis (FEP) patients. Methods Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify eligible studies comparing FEP patients and healthy controls from inception to Feb 29, 2016. Results Ten cross-sectional studies and three longitudinal studies reported in ten articles met our criteria. Our meta-analysis found no significant differences in the prevalence of either “any CSP” (OR = 1.41; 95% CI 0.90–2.20; p = 0.13; I2 = 52.7%) or “large CSP” (OR = 1.10; 95% CI 0.77–1.58; p = 0.59; I2 = 24.1%) between FEP patients and healthy controls. However, the heterogeneity analysis of the prevalence of “any CSP” suggested bias in outcome reporting. Conclusions The results based on current evidence suggest it is unclear whether “any CSP” is a risk factor for FEP due to the heterogeneity of the studies. There is insufficient evidence to support that “large CSP” is a possible risk factor for FEP.
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Affiliation(s)
- Hanwen Liu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Internal Medicine Unit, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ling Li
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Shen
- Department of Psychosomatic Medicine, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xianliang Wang
- Cardiovascular Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yazhu Hou
- Cardiovascular Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhiqiang Zhao
- Cardiovascular Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lili Gu
- Department of Medical Administration, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jingyuan Mao
- Internal Medicine Unit, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- * E-mail:
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Bernasconi R, Smieskova R, Schmidt A, Harrisberger F, Raschle NM, Lenz C, Walter A, Simon A, Riecher-Rössler A, Radue EW, Lang UE, Fusar-Poli P, Borgwardt SJ. Hippocampal volume correlates with attenuated negative psychotic symptoms irrespective of antidepressant medication. NEUROIMAGE-CLINICAL 2015; 8:230-7. [PMID: 26110110 PMCID: PMC4473852 DOI: 10.1016/j.nicl.2015.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/23/2015] [Accepted: 04/25/2015] [Indexed: 12/18/2022]
Abstract
Background Individuals with at-risk mental state for psychosis (ARMS) often suffer from depressive and anxiety symptoms, which are clinically similar to the negative symptomatology described for psychosis. Thus, many ARMS individuals are already being treated with antidepressant medication. Objectives To investigate clinical and structural differences between psychosis high-risk individuals with or without antidepressants. Methods We compared ARMS individuals currently receiving antidepressants (ARMS-AD; n = 18), ARMS individuals not receiving antidepressants (ARMS-nonAD; n = 31) and healthy subjects (HC; n = 24), in terms of brain structure abnormalities, using voxel-based morphometry. We also performed region of interest analysis for the hippocampus, anterior cingulate cortex, amygdala and precuneus. Results The ARMS-AD had higher ‘depression’ and lower ‘motor hyperactivity’ scores than the ARMS-nonAD. Compared to HC, there was significantly less GMV in the middle frontal gyrus in the whole ARMS cohort and in the superior frontal gyrus in the ARMS-AD subgroup. Compared to ARMS-nonAD, the ARMS-AD group showed more gray matter volume (GMV) in the left superior parietal lobe, but less GMV in the left hippocampus and the right precuneus. We found a significant negative correlation between attenuated negative symptoms and hippocampal volume in the whole ARMS cohort. Conclusion Reduced GMV in the hippocampus and precuneus is associated with short-term antidepressant medication and more severe depressive symptoms. Hippocampal volume is further negatively correlated with attenuated negative psychotic symptoms. Longitudinal studies are needed to distinguish whether hippocampal volume deficits in the ARMS are related to attenuated negative psychotic symptoms or to antidepressant action. We compared brain structure in high-risk patients with/without antidepressants (AD). We found attenuated negative psychotic symptoms (ANS) irrespective of AD. We found a significant correlation between ANS and hippocampal volume. Results indicate relevance of ANS for clinical high-risk studies.
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Affiliation(s)
- Raffaele Bernasconi
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
| | - Renata Smieskova
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
| | - André Schmidt
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Nora Maria Raschle
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
| | - Claudia Lenz
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
| | - Anna Walter
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
| | - Andor Simon
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
| | | | | | - Undine E. Lang
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
| | - Paolo Fusar-Poli
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stefan J. Borgwardt
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Medical Image Analysis Centre, University Hospital, Basel, Switzerland
- Correspondence to: Department of Psychiatry (UPK), University of Basel, Wilhelm Klein-strasse 27, Basel 4056, Switzerland. Tel.: +41 (0)61 325 81 87; fax: +41 (0)61 325 81 80.
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Neurodegenerative Aspects in Vulnerability to Schizophrenia Spectrum Disorders. Neurotox Res 2014; 26:400-13. [DOI: 10.1007/s12640-014-9473-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/21/2014] [Accepted: 04/21/2014] [Indexed: 01/20/2023]
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Sommer IE, de Kort GAP, Meijering AL, Dazzan P, Hulshoff Pol HE, Kahn RS, van Haren NEM. How frequent are radiological abnormalities in patients with psychosis? A review of 1379 MRI scans. Schizophr Bull 2013; 39:815-9. [PMID: 22416264 PMCID: PMC3686442 DOI: 10.1093/schbul/sbs037] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The term psychosis refers to a combination of symptoms, without pointing to the origin of these symptoms. In a subset of psychotic patients, symptoms are attributable to an organic disease. It is important to identify these organic causes of psychosis early, as urgent treatment of the primary disease may be required. Some of these underlying organic disorders can be identified on magnetic resonance imaging (MRI) scans. Whether routine screening for all psychotic patients should therefore include MRI scans is still a matter of debate. METHODS This study investigated the prevalence of clinically relevant abnormalities detected on MRI scans from psychotic patients and a matched control group. We could include MRI scans from 656 psychotic patients and 722 controls. The standard radiological reports of these scans were classified as normal, as a nonrelevant abnormality or as a clinically relevant brain abnormality by means of consensus, blind to diagnosis. RESULTS A normal aspect of the brain was reported in 74.4% of the patients and in 73.4% of the controls. We found clinically relevant pathology in 11.1% of the patients and in 11.8% of the controls. None of the neuropathological findings observed in the patients was interpreted as a possible substrate for organic psychosis. Brain abnormalities that were classified as not clinically relevant were identified in 14.5% of the patients and in 14.8% of the controls. CONCLUSIONS This suggests that MRI brain scans are not an essential part of routine screening for psychotic patients.
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Affiliation(s)
- Iris E. Sommer
- Psychiatry Department University Medical Center Utrecht and Rudolf Magnus Institute for Neuroscience, A01.160, Heidelberglaan 100, 3485CX, the Netherlands,To whom correspondence should be addressed; tel: 31887556370, fax: 31887555443, e-mail:
| | - Gérard A. P. de Kort
- Radiology Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anne Lotte Meijering
- Psychiatry Department University Medical Center Utrecht and Rudolf Magnus Institute for Neuroscience, A01.160, Heidelberglaan 100, 3485CX, the Netherlands
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Hilleke E. Hulshoff Pol
- Psychiatry Department University Medical Center Utrecht and Rudolf Magnus Institute for Neuroscience, A01.160, Heidelberglaan 100, 3485CX, the Netherlands
| | - René S. Kahn
- Psychiatry Department University Medical Center Utrecht and Rudolf Magnus Institute for Neuroscience, A01.160, Heidelberglaan 100, 3485CX, the Netherlands
| | - Neeltje E. M. van Haren
- Psychiatry Department University Medical Center Utrecht and Rudolf Magnus Institute for Neuroscience, A01.160, Heidelberglaan 100, 3485CX, the Netherlands
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Zugman A, Pan PM, Gadelha A, Mansur RB, Asevedo E, Cunha GR, Silva PFR, Brietzke E, Bressan RA. Brain tumor in a patient with attenuated psychosis syndrome. Schizophr Res 2013; 144:151-2. [PMID: 23302302 DOI: 10.1016/j.schres.2012.11.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/28/2012] [Accepted: 11/30/2012] [Indexed: 11/26/2022]
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Hippocampal volume in subjects at high risk of psychosis: a longitudinal MRI study. Schizophr Res 2012; 142:217-22. [PMID: 23123134 DOI: 10.1016/j.schres.2012.10.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 10/09/2012] [Accepted: 10/10/2012] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The hippocampal formation has been studied extensively in schizophrenic psychoses and alterations in hippocampal anatomy have been consistently reported. Chronic schizophrenia seems to be associated with bilateral hippocampal volume (HV) reduction, while in patients with an at-risk mental state (ARMS) there are contradictory results. This is the first region of interest (ROI) based follow-up MRI study of hippocampal volume comparing ARMS individuals with and without transition to psychosis. The aim was to investigate the timing of HV changes in ARMS in the early phase of psychosis. METHODS Magnetic resonance imaging data from 18 antipsychotic-naïve individuals with an ARMS were collected within the FePsy-clinic for early detection of psychoses. During follow-up 8 subjects transitioned to psychosis (ARMS-T) and 10 did not (ARMS-NT). Subjects were re-scanned after the onset of psychosis or at the end of the follow-up if they did not develop psychosis. RESULTS Across both groups there was a significant decrease in HV over time (p<0.05). There was no significant difference in progression between ARMS-T and ARMS-NT. Antipsychotic medication at follow up was associated with increased HV (p<0.05). CONCLUSIONS We found a decrease of HV over time in subjects with an ARMS, independently of clinical outcome. We may speculate that the decrease of HV over time might reflect brain degeneration processes.
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Ziermans TB, Schothorst PF, Schnack HG, Koolschijn PCMP, Kahn RS, van Engeland H, Durston S. Progressive structural brain changes during development of psychosis. Schizophr Bull 2012; 38:519-30. [PMID: 20929968 PMCID: PMC3329986 DOI: 10.1093/schbul/sbq113] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ultra-high risk (UHR) for psychosis has been associated with widespread structural brain changes in young adults. The onset of these changes and their subsequent progression over time are not well understood. METHODS Rate of brain change over time was investigated in 43 adolescents at UHR for psychosis compared with 30 healthy controls. Brain volumes (total brain, gray matter, white matter [WM], cerebellum, and ventricles), cortical thickness, and voxel-based morphometry were measured at baseline and at follow-up (2 y after baseline) and compared between UHR individuals and controls. Post hoc analyses were done for UHR individuals who became psychotic (N = 8) and those who did not (N = 35). RESULTS UHR individuals showed a smaller increase in cerebral WM over time than controls and more cortical thinning in the left middle temporal gyrus. Post hoc, a more pronounced decrease over time in total brain and WM volume was found for UHR individuals who became psychotic relative to controls and a greater decrease in total brain volume than individuals who were not psychotic. Furthermore, UHR individuals with subsequent psychosis displayed more thinning than controls in widespread areas in the left anterior cingulate, precuneus, and temporo-parieto-occipital area. Volume loss in the individuals who developed psychosis could not be attributed to medication use. CONCLUSION The development of psychosis during adolescence is associated with progressive structural brain changes around the time of onset. These changes cannot be attributed to (antipsychotic) medication use and are therefore likely to reflect a pathophysiological process related to clinical manifestation of psychosis.
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Affiliation(s)
- Tim B Ziermans
- Department of Child and Adolescent Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, the Netherlands.
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Rapp C, Bugra H, Riecher-Rössler A, Tamagni C, Borgwardt S. Effects of cannabis use on human brain structure in psychosis: a systematic review combining in vivo structural neuroimaging and post mortem studies. Curr Pharm Des 2012; 18:5070-80. [PMID: 22716152 PMCID: PMC3474956 DOI: 10.2174/138161212802884861] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 04/12/2012] [Indexed: 11/22/2022]
Abstract
It is unclear yet whether cannabis use is a moderating or causal factor contributing to grey matter alterations in schizophrenia and the development of psychotic symptoms. We therefore systematically reviewed structural brain imaging and post mortem studies addressing the effects of cannabis use on brain structure in psychosis. Studies with schizophrenia (SCZ) and first episode psychosis (FEP) patients as well as individuals at genetic (GHR) or clinical high risk for psychosis (ARMS) were included. We identified 15 structural magnetic resonance imaging (MRI) (12 cross sectional / 3 longitudinal) and 4 post mortem studies. The total number of subjects encompassed 601 schizophrenia or first episode psychosis patients, 255 individuals at clinical or genetic high risk for psychosis and 397 healthy controls. We found evidence for consistent brain structural abnormalities in cannabinoid 1 (CB1) receptor enhanced brain areas as the cingulate and prefrontal cortices and the cerebellum. As these effects have not consistently been reported in studies examining nonpsychotic and healthy samples, psychosis patients and subjects at risk for psychosis might be particularly vulnerable to brain volume loss due to cannabis exposure.
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Affiliation(s)
- Charlotte Rapp
- Department of Psychiatry, University of Basel, 4031 Basel, Switzerland
| | - Hilal Bugra
- Department of Psychiatry, University of Basel, 4031 Basel, Switzerland
| | | | - Corinne Tamagni
- Department of Psychiatry, University of Basel, 4031 Basel, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel, 4031 Basel, Switzerland
- Medical Image Analysis Centre, University of Basel, Switzerland
- King’s College London, Department of Psychosis Studies, De Crespigny Park, London SE5 8AF, United Kingdom
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Smieskova R, Allen P, Simon A, Aston J, Bendfeldt K, Drewe J, Gruber K, Gschwandtner U, Klarhoefer M, Lenz C, Scheffler K, Stieglitz RD, Radue EW, McGuire P, Riecher-Rössler A, Borgwardt SJ. Different duration of at-risk mental state associated with neurofunctional abnormalities. A multimodal imaging study. Hum Brain Mapp 2011; 33:2281-94. [PMID: 21922599 DOI: 10.1002/hbm.21360] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 03/22/2011] [Accepted: 04/26/2011] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Neurofunctional alterations are correlates of vulnerability to psychosis, as well as of the disorder itself. How these abnormalities relate to different probabilities for later transition to psychosis is unclear. We investigated vulnerability- versus disease-related versus resilience biomarkers of psychosis during working memory (WM) processing in individuals with an at-risk mental state (ARMS). EXPERIMENTAL DESIGN Patients with "first-episode psychosis" (FEP, n = 21), short-term ARMS (ARMS-ST, n = 17), long-term ARMS (ARMS-LT, n = 16), and healthy controls (HC, n = 20) were investigated with an n-back WM task. We examined functional magnetic resonance imaging (fMRI) and structural magnetic resonance imaging (sMRI) data in conjunction using biological parametric mapping (BPM) toolbox. PRINCIPAL OBSERVATIONS There were no differences in accuracy, but the FEP and the ARMS-ST group had longer reaction times compared with the HC and the ARMS-LT group. With the 2-back > 0-back contrast, we found reduced functional activation in ARMS-ST and FEP compared with the HC group in parietal and middle frontal regions. Relative to ARMS-LT individuals, FEP patients showed decreased activation in the bilateral inferior frontal gyrus and insula, and in the left prefrontal cortex. Compared with the ARMS-LT, the ARMS-ST subjects showed reduced activation in the right inferior frontal gyrus and insula. Reduced insular and prefrontal activation was associated with gray matter volume reduction in the same area in the ARMS-LT group. CONCLUSIONS These findings suggest that vulnerability to psychosis was associated with neurofunctional alterations in fronto-temporo-parietal networks in a WM task. Neurofunctional differences within the ARMS were related to different duration of the prodromal state and resilience factors.
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Affiliation(s)
- Renata Smieskova
- Department of Psychiatry, University of Basel, c/o University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
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Jung WH, Jang JH, Byun MS, An SK, Kwon JS. Structural brain alterations in individuals at ultra-high risk for psychosis: a review of magnetic resonance imaging studies and future directions. J Korean Med Sci 2010; 25:1700-9. [PMID: 21165282 PMCID: PMC2995221 DOI: 10.3346/jkms.2010.25.12.1700] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 10/11/2010] [Indexed: 11/20/2022] Open
Abstract
Individuals at ultra-high-risk (UHR) for psychosis have become a major focus for research designed to explore markers for early detection of and clinical intervention in schizophrenia. In particular, structural magnetic resonance imaging studies in UHR individuals have provided important insight into the neurobiological basis of psychosis and have shown the brain changes associated with clinical risk factors. In this review, we describe the structural brain abnormalities in magnetic resonance images in UHR individuals. The current accumulated data demonstrate that abnormalities in the prefrontal and temporal cortex and anterior cingulate cortex occur before illness onset. These regions are compatible with the regions of structural deficits found in schizophrenia and first-episode patients. In addition, the burgeoning evidence suggests that such structural abnormalities are potential markers for the transition to psychosis. However, most findings to date are limited because they are from cross-sectional rather than longitudinal studies. Recently, researchers have emphasized neurodevelopmental considerations with respect to brain structural alterations in UHR individuals. Future studies should be conducted to characterize the differences in the brain developmental trajectory between UHR individuals and healthy controls using a longitudinal design. These new studies should contribute to early detection and management as well as provide more predictive markers of later psychosis.
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Affiliation(s)
- Wi Hoon Jung
- Interdisciplinary Program in Neuroscience, Seoul National University, Seoul, Korea
- Clinical Cognitive Neuroscience Center, SNU-MRC, Seoul, Korea
| | - Joon Hwan Jang
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Min Soo Byun
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Suk Kyoon An
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Soo Kwon
- Interdisciplinary Program in Neuroscience, Seoul National University, Seoul, Korea
- Clinical Cognitive Neuroscience Center, SNU-MRC, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Brain & Cognitive Sciences-WCU Program, Seoul National University College of Natural Sciences, Seoul, Korea
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Borgwardt SJ, Picchioni MM, Ettinger U, Toulopoulou T, Murray R, McGuire PK. Regional gray matter volume in monozygotic twins concordant and discordant for schizophrenia. Biol Psychiatry 2010; 67:956-64. [PMID: 20006324 DOI: 10.1016/j.biopsych.2009.10.026] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 10/08/2009] [Accepted: 10/11/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Alterations in gray matter volume (GMV) are a robust feature of schizophrenia. However, it is not clear to what extent these abnormalities are correlates of the genetic liability to the disorder, as opposed to environmental factors and the disorder itself. We investigated the influence of genetic and environmental risk on GMV in monozygotic (MZ) twin pairs concordant and discordant for schizophrenia. METHODS Total and regional GMVs were measured from magnetic resonance images of 80 twins: 14 MZ pairs concordant for schizophrenia, 9 pairs discordant for schizophrenia, and 17 healthy MZ twin pairs. RESULTS Total GMV was smaller in twins with schizophrenia (t = -3.17, p = .003) and nonpsychotic cotwins from discordant pairs (t = -2.66, p = .011) than in healthy control twins. Twin pairs concordant for schizophrenia displayed reduced regional GMV in the inferior frontal, medial frontal, and anterior cingulate gyri; the caudate; lingual gyrus; and cerebellum relative to healthy twins (p < .05, corrected). Within discordant pairs, twins with schizophrenia had less GMV than their nonpsychotic cotwins in the insula; superior/medial frontal, pre/postcentral, cingulate, and superior temporal gyri; and the paracentral lobule. There were no significant differences in regional GMV between nonpsychotic cotwins and healthy control subjects. CONCLUSIONS The presence of schizophrenia was specifically related to reduced GMV in frontal, insular, cingulate, medial parietal, and temporal cortex, over and above effects of genetic risk for the disorder. These changes could be related to the pathophysiology of the disorder itself or to unique environmental factors acting etiologically or because of the illness.
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Affiliation(s)
- Stefan J Borgwardt
- Section of Neuroimaging, Institute of Psychiatry, King's College London, London, United Kingdom.
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Buehlmann E, Berger GE, Aston J, Gschwandtner U, Pflueger MO, Borgwardt SJ, Radue EW, Riecher-Rössler A. Hippocampus abnormalities in at risk mental states for psychosis? A cross-sectional high resolution region of interest magnetic resonance imaging study. J Psychiatr Res 2010; 44:447-53. [PMID: 19939408 DOI: 10.1016/j.jpsychires.2009.10.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 09/16/2009] [Accepted: 10/20/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hippocampal volume (HV) reduction is well documented in schizophrenia. However, it is still unclear whether this change is a pre-existing vulnerability factor, a sign of disease progression, a consequence of environmental factors, such as drug use, antipsychotic medication, or malnutrition. The timing of HV changes is not well established, but a lack of macrostructural hippocampal brain abnormalities before disease onset would rather support a neuroprogressive illness model. AIM To investigate the timing of HV changes in emerging psychosis. METHODS A cross-sectional MRI study of manually traced HVs in 37 individuals with an At Risk Mental State (ARMS) for psychosis, 23 individuals with First-Episode Psychosis (FEP), and 22 Healthy Controls (HC) was performed. We compared left and right HVs corrected for whole brain volume across groups using analysis of covariance (ANCOVA) with gender as a covariate. Sixteen of 37 ARMS individuals developed a psychotic disorder during follow up (ARMS-T). The mean duration of follow up in ARMS was 25.1months. RESULTS The overall ANCOVA model comparing left HVs across FEP, ARMS and HC indicated a significant general group effect (p<.05) with largest volumes in ARMS and smallest in FEP. ARMS-T subjects had significantly larger left HVs compared to FE but no HV differences compared to HC (p<0.05). Over all groups, we found an asymmetry between the left and right mean HVs and a strong effect of sex. DISCUSSION The present study suggests that macrostructural hippocampal abnormalities probably occur in the context of the first psychotic breakdown.
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Affiliation(s)
- Eva Buehlmann
- University Hospital Basel, Psychiatric Outpatient Department, Petersgraben 4, CH-4031 Basel, Switzerland
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Smieskova R, Fusar-Poli P, Allen P, Bendfeldt K, Stieglitz RD, Drewe J, Radue EW, McGuire PK, Riecher-Rössler A, Borgwardt SJ. Neuroimaging predictors of transition to psychosis--a systematic review and meta-analysis. Neurosci Biobehav Rev 2010; 34:1207-22. [PMID: 20144653 DOI: 10.1016/j.neubiorev.2010.01.016] [Citation(s) in RCA: 242] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 01/29/2010] [Accepted: 01/31/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In early stage psychosis research the identification of neurobiological correlates of vulnerability to schizophrenia is an important hurdle. METHODS We systematically reviewed the neuroimaging publications on high-risk subjects with subsequent transition to psychosis (HR-T) and conducted a meta-analysis calculating the effect size Cohen's d. RESULTS Out of 30 identified studies 25 met the inclusion criteria. Structural (s)MRI studies showed small to medium effect sizes of decreased prefrontal, cingulate, insular and cerebellar gray matter volume in HR-T compared to high-risk subjects without transition (HR-NT). Meta-analysis revealed relatively larger whole brain volumes in HR-T compared to HR-NT subjects (mean Cohen's d 0.36, 95% CI 0.27-0. 46). Compared to HR-NT, HR-T subjects showed in functional imaging studies reduced brain activation in prefrontal cortex, reduced neuronal density, and increased membrane turnover in frontal and cingulate cortex with medium to large effect sizes. CONCLUSIONS Despite methodological differences between studies, structural and neurochemical abnormalities in prefrontal, anterior cingulate, medial temporal and cerebellar cortex might be predictive for development of psychosis within HR subjects.
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Affiliation(s)
- R Smieskova
- Psychiatric Outpatient Department, Psychiatric University Clinics, Basel, Switzerland
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Price G, Cercignani M, Chu EM, Barnes TRE, Barker GJ, Joyce EM, Ron MA. Brain pathology in first-episode psychosis: magnetization transfer imaging provides additional information to MRI measurements of volume loss. Neuroimage 2009; 49:185-92. [PMID: 19632338 PMCID: PMC2806943 DOI: 10.1016/j.neuroimage.2009.07.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 06/04/2009] [Accepted: 07/13/2009] [Indexed: 12/02/2022] Open
Abstract
Background Loss of brain volume in first-episode psychosis can be detected using conventional magnetic resonance imaging (MRI), but subtle changes – not leading to reduction in volume – that may contribute to clinical and cognitive abnormalities, may go undetected. Magnetization transfer imaging (MTI), a technique more sensitive to subtle neuropathological changes than conventional MRI, could yield important information on the extent and nature of structural abnormalities. Methods Forty-eight patients (33 males) from a population-based sample with first-episode psychosis (41 with schizophrenia and 7 with schizoaffective psychosis) and 47 healthy volunteers (27 males) were studied. Differences in magnetization transfer ratio (MTR) and white and grey matter volumes between groups were investigated. Results In patients, MTR was reduced in right entorhinal cortex, fusiform, dentate and superior frontal gyri and in left superior frontal and inferior/rostral cingulate gyri. Grey matter volume was reduced in right insula, frontal operculum and middle and superior temporal gyri and in left middle temporal gyrus. Grey matter volume increases were seen in patients in the superior frontal gyrus. White matter volume loss was found adjacent to grey matter loss. In patients MTR was lower in all areas of volumetric differences between groups suggesting that both changes may be related. Similar findings were observed when patients with schizoaffective psychosis were removed from the analysis. The correlations between clinical and MRI parameters did not survive correction for multiple comparisons. Conclusions MTI frontal and temporal abnormalities suggesting neuroaxonal and myelin changes were more extensive in our patients than those detected with conventional MRI. Our findings also suggest that there is regional variation in the severity of structural brain abnormalities.
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Affiliation(s)
- Gary Price
- Institute of Neurology, University College London, Queen Square, London, UK.
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Goulet K, Deschamps B, Evoy F, Trudel JF. Use of brain imaging (computed tomography and magnetic resonance imaging) in first-episode psychosis: review and retrospective study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2009; 54:493-501. [PMID: 19660172 DOI: 10.1177/070674370905400711] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify and review available evidence on the diagnostic yield of brain computed tomographies (CTs) and magnetic resonance images (MRIs) in first-episode psychosis, and examine yield in our own institution (Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec). METHOD Using MEDLINE (1966 to October 2007) and EMBASE (1980 to October 2007), we identified and analyzed studies that examined imaging yields in first-episode psychosis; yield being defined as the percentage of scans showing abnormalities that may result in psychosis. We also retrospectively analyzed diagnostic yields in 46 patients hospitalized in our institution between 2001 and 2006 for first-episode psychosis. RESULTS Five studies were deemed relevant. Including our own series, the sample comprised 384 CT and 184 MRI scans. Point estimate for diagnostic yield was 1.3% for CT and 1.1% for MRI scans. These yields likely overestimate clinical usefulness of findings. MRI scans also resulted in a sizeable number of fortuitous, clinically irrelevant findings. CONCLUSIONS In first-episode psychosis, routine CT or MRI scans are of little benefit and should be reserved for situations where history or examination suggests neurological causation, or possibly for people aged 50 years and older.
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Affiliation(s)
- Karine Goulet
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec
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Neuroanatomical differences between familial and sporadic schizophrenia and their parents: an optimized voxel-based morphometry study. Psychiatry Res 2009; 171:71-81. [PMID: 19168334 DOI: 10.1016/j.pscychresns.2008.02.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Revised: 01/24/2008] [Accepted: 02/13/2008] [Indexed: 02/05/2023]
Abstract
Symptomatic differences have been reported between patients with familial and sporadic schizophrenia. The present study examined neuroanatomical differences between the two subgroups and their parents using voxel-based morphometry. High-resolution T1-weighted images were obtained using 3 Tesla magnetic resonance imaging from 20 patients with schizophrenia (familial subgroup, n=10; sporadic subgroup, n=10), 20 of their parents (familial subgroup, n=10; sporadic subgroup, n=10) and 20 healthy volunteers. Gray matter density (GMD) was compared between groups on a voxel-by-voxel basis. Compared with the sporadic patients, the familial patients had significantly reduced GMD in the thalamus bilaterally. Reduction of GMD in bilateral thalami was also found in familial parents in comparison with sporadic parents. Compared with controls, both familial and sporadic patients had lower GMD involving bilateral insula, right temporal lobe, right occipital lobe, left lenticular nucleus and right cerebellum. However, only familial patients showed lower GMD than controls in the right thalamus. Compared with controls, only familial parents showed lower GMD in the right insula extending to the right temporal lobe and the right parietal lobule. The present data suggest that familial schizophrenia is associated with more severe structural abnormalities than sporadic schizophrenia, especially in the thalamus.
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Takahashi T, Yung AR, Yücel M, Wood SJ, Phillips LJ, Harding IH, Soulsby B, McGorry PD, Suzuki M, Velakoulis D, Pantelis C. Prevalence of large cavum septi pellucidi in ultra high-risk individuals and patients with psychotic disorders. Schizophr Res 2008; 105:236-44. [PMID: 18693084 DOI: 10.1016/j.schres.2008.06.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 06/24/2008] [Accepted: 06/30/2008] [Indexed: 10/21/2022]
Abstract
An increased prevalence of large cavum septum pellucidum (CSP), a marker of midline neurodevelopmental abnormality, has been reported in schizophrenia. However, not all studies have been able to replicate this finding and very few studies have been conducted in large samples. In the current study, magnetic resonance imaging was used to assess the presence of an abnormal CSP in 162 patients with first-episode psychosis (FEP), 89 patients with chronic schizophrenia, 135 ultra high-risk (UHR) individuals, and 87 controls. The prevalence of a large CSP (>5.6 mm) did not differ between the groups (9.3% of the FEP patients, 11.2% of the chronic schizophrenia patients, 11.1% of the UHR individuals, and 11.5% of the controls). The length of the CSP was not associated with sulcal morphology of the anterior cingulate cortex (ACC), suggesting different biological processes responsible for the CSP enlargement versus ACC folding. These findings suggest that the CSP is not a neurodevelopmental marker of psychosis and cast doubt over the notion that it plays a major role in the neurobiology of psychosis.
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Affiliation(s)
- Tsutomu Takahashi
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Victoria, Australia.
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Takahashi T, Yücel M, Yung AR, Wood SJ, Phillips LJ, Berger GE, Ang A, Soulsby B, McGorry PD, Suzuki M, Velakoulis D, Pantelis C. Adhesio interthalamica in individuals at high-risk for developing psychosis and patients with psychotic disorders. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1708-14. [PMID: 18675876 DOI: 10.1016/j.pnpbp.2008.07.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 07/09/2008] [Accepted: 07/10/2008] [Indexed: 10/21/2022]
Abstract
Abnormal neurodevelopment in midline structures such as the adhesio interthalamica (AI) has been reported in psychotic disorders, but it is unknown whether individuals at risk for the disorder share the AI findings observed in patients with florid psychosis. Magnetic resonance imaging of 162 patients with first-episode psychosis (FEP), 89 patients with chronic schizophrenia, 135 individuals at ultra high-risk (UHR) of psychosis (of whom 39 later developed psychosis), and 87 healthy controls were used to investigate the length and prevalence of the AI. The relation of the AI length to lateral ventricular enlargement was also explored. The patients with FEP and chronic schizophrenia as well as UHR individuals had a shorter AI than the controls, but there was no difference in the AI findings between the UHR individuals who did and did not subsequently develop psychosis. There was a negative correlation between the AI length and lateral ventricular volume in all the diagnostic groups. The absence of the AI was more common in the chronic schizophrenia patients when compared with all other groups. These results support the notion that the AI absence or shorter length could be a neurodevelopmental marker related to vulnerability to psychopathology, but also suggest that schizophrenia patients may manifest progressive brain changes related to ongoing atrophy of the AI after the onset.
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Affiliation(s)
- Tsutomu Takahashi
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Victoria, Australia.
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Choi JS, Kang DH, Park JY, Jung WH, Choi CH, Chon MW, Jung MH, Lee JM, Kwon JS. Cavum septum pellucidum in subjects at ultra-high risk for psychosis: compared with first-degree relatives of patients with schizophrenia and healthy volunteers. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1326-30. [PMID: 18513845 DOI: 10.1016/j.pnpbp.2008.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Revised: 04/12/2008] [Accepted: 04/15/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The cavum septum pellucidum (CSP) is a space between the two leaflets of the septum pellucidum, and is a putative marker of disturbance in early brain development. We examined whether CSP was present more frequently in subjects at ultra-high risk (UHR) for psychosis compared to first-degree relatives of patients with schizophrenia (genetic high risk, GHR) and healthy controls (HC). METHODS We evaluated CSP in 87 subjects (30 UHR, 23 GHR, and 34 HC) according to a published grading system using high-resolution magnetic resonance imaging (MRI) with 0.45-mm slice thickness. We also assessed two other criteria: presence of CSP on at least one MRI slice, and abnormally large CSP (i.e., > or =6 mm in length). Correlational analysis between CSP measures and clinical symptoms was also examined. RESULTS Based on the grading scale, the UHR group exhibited a significantly higher incidence of abnormal CSP (grades 2, 3, and 4) compared to the HC group, but there were no significant differences in the incidence of abnormal CSP between the UHR and GHR or the GHR and HC groups. There were no significant differences among the groups in the presence of CSP on at least one MRI slice or abnormally large CSP based on the length of CSP. In addition, no significant correlations between CSP measures and clinical symptoms were found. CONCLUSION These findings suggest that abnormal CSP might be associated with susceptibility to psychosis, although the CSP itself might be a normal anatomical variant. Further studies using a larger sample are needed to clarify issues on neurodevelopmental perspective in subjects at high risk for psychosis.
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Affiliation(s)
- Jung-Seok Choi
- Department of Psychiatry, Seoul National University College of Medicine and Clinical Cognitive Neuroscience Center, SNU-MRC, Seoul, Republic of Korea
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Zanetti MV, Schaufelberger MS, de Castro CC, Menezes PR, Scazufca M, McGuire PK, Murray RM, Busatto GF. White-matter hyperintensities in first-episode psychosis. Br J Psychiatry 2008; 193:25-30. [PMID: 18700214 PMCID: PMC2802525 DOI: 10.1192/bjp.bp.107.038901] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND White-matter hyperintensities have been associated with both schizophrenia and mood disorders, particularly bipolar disorder, but results are inconsistent across studies. AIMS To examine whether white-matter hyperintensities are a vulnerability marker for psychosis or are specifically associated with bipolar disorder. METHOD T(2)-weighted magnetic resonance imaging data were acquired in 129 individuals with first-episode psychosis (either affective or non-affective psychoses) and 102 controls who were randomly selected from the same geographical areas. Visual white-matter hyperintensity ratings were used for group and subgroup comparisons. RESULTS There were no statistically significant between-group differences in white-matter hyperintensity frequency or severity scores. No significant correlations were found between white-matter hyperintensity scores and duration of illness, duration of untreated psychosis, or severity of psychotic, manic or depressive symptoms. CONCLUSIONS White-matter hyperintensities are not associated with vulnerability to psychosis in general, or specifically with affective psychoses. Further, first-episode psychosis investigations using more quantitative methods are warranted to confirm these findings.
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Borgwardt SJ, McGuire PK, Aston J, Berger G, Dazzan P, Gschwandtner U, Pflüger M, D'Souza M, Radue EW, Riecher-Rössler A. Structural brain abnormalities in individuals with an at-risk mental state who later develop psychosis. Br J Psychiatry 2008; 51:s69-75. [PMID: 18055941 DOI: 10.1192/bjp.191.51.s69] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Neuroanatomical abnormalities are a well-established feature of schizophrenia. However, the timing of their emergence and the extent to which they are related to vulnerability to the disorder as opposed to psychotic illness itself is unclear. AIMS To assess regional grey matter volume in the at-risk individuals who subsequently developed psychosis. METHOD Magnetic resonance imaging data from at-risk individuals who developed psychosis (n=12) within the following 25 months were compared with data from healthy volunteers (n=22) and people with first-episode psychosis (n=25). RESULTS Compared with healthy volunteers, individuals who subsequently developed psychosis had smaller grey matter volume in the posterior cingulate gyrus, precuneus, and paracentral lobule bilaterally and in the left superior parietal lobule, and greater grey matter volume in a left parietal/posterior temporal region. Compared with first-episode patients, they had relatively greater grey matter volume in the temporal gyrus bilaterally and smaller grey matter volume in the right lentiform nucleus. CONCLUSIONS Some of the structural brain abnormalities in individuals with an at-risk mental state may be related to an increased vulnerability to psychosis, while others are associated with the development of a psychotic illness.
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Affiliation(s)
- Stefan J Borgwardt
- Psychiatric Outpatient Department, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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Neuropsychological deficits in individuals with an at risk mental state for psychosis - working memory as a potential trait marker. Schizophr Res 2007; 97:14-24. [PMID: 17936587 DOI: 10.1016/j.schres.2007.09.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 08/16/2007] [Accepted: 09/06/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the neuropsychological profile of individuals with an at risk mental state for psychosis (ARMS, N=60) compared to healthy controls (HC, N=51) and to identify those cognitive domains which discriminate best between groups. METHOD Study subjects and controls were compared using a neuropsychological test battery covering the domains of intelligence (LPS3, MWT-A), executive functions (ToH, WCST, TAP - Go/NoGo), working memory (Tests for Attentional Performance (TAP) - Working Memory), and attention (CPT-OX). A multivariate analysis of variance (MANOVA) comparing ARMS subjects with HC was conducted. A stepwise logit regression procedure was performed in order to determine the subset of measures which best distinguish ARMS subjects from HC. RESULTS ARMS subjects revealed deficiencies in intelligence, executive functions, working memory and attention. Verbal intelligence, executive functions, and, in particular, working memory discriminated best between the groups. CONCLUSION Individuals with an at risk mental state for psychosis already show impairment of neuropsychological functions prior to the onset of the first psychotic episode and can best be distinguished from healthy controls on the basis of working memory.
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Foster A, Usman M, Stirewalt E, Buckley P. Schizophrenia: from brain morphology to psychopathology. Curr Psychiatry Rep 2007; 9:337-42. [PMID: 17880867 DOI: 10.1007/s11920-007-0042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ten years ago, Velakoulis, the author of a study cited in the present article, was appreciating that the role of functional imaging in schizophrenia research would involve collaboration of clinicians, imaging specialists, and neuropsychologists, and the past year's literature proves his point. Our review shows that structural and functional imaging in schizophrenia is still alive and well. In the past year, it has focused on changes in "at-risk" and first-episode schizophrenia populations and has been used by researchers to characterize phenotypes of patients with schizophrenia prior to including them in genetic research. A decade ago, O'Donovan and Owen were cautiously optimistic about future advances in finding susceptibility genes for schizophrenia, and this year's literature, including their review, proves that the massive efforts of research in the genetics of schizophrenia have started to pay off. An almost-obscure area 10 years ago, pharmacogenetics of schizophrenia is well represented in the past year and gives hope to the practicing clinicians who are eagerly waiting to understand patients' variability in antipsychotic drug response. These and additional areas are included in our review of schizophrenia literature in the past year.
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Affiliation(s)
- Adriana Foster
- Department of Psychiatry, Medical College of Georgia, Augusta, GA 30912, USA
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Pantelis C, Velakoulis D, Wood SJ, Yücel M, Yung AR, Phillips LJ, Sun DQ, McGorry PD. Neuroimaging and emerging psychotic disorders: the Melbourne ultra-high risk studies. Int Rev Psychiatry 2007; 19:371-81. [PMID: 17671870 DOI: 10.1080/09540260701512079] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although the underlying neurobiology of emerging psychotic disorders is not well understood, evidence from structural imaging and other studies support the notion that schizophrenia arises as a consequence of both an 'early neurodevelopmental' disturbance, as well as 'late neurodevelopmental' changes occurring during the initial stages of a psychotic illness, including around the time of transition to illness. In line with this, our longitudinal MRI findings in individuals at ultra-high risk for developing a psychotic illness show that there are excessive neuroanatomical changes in those who convert to psychosis. These aberrant changes are observed most prominently in medial temporal and prefrontal lobe regions. In a further series of longitudinal studies in first-episode psychosis, we have identified changes in prefrontal regions that indicate an accelerated loss of grey matter in patients compared to healthy control subjects. We suggest that the available evidence is consistent with the presence of subtle regionally and temporally specific neurobiological changes through the course of psychosis (Pantelis et al., 2005), including: (1) evidence for early (pre- and peri-natal) neurodevelopmental anomalies, (2) evidence for progressive grey matter loss involving medial temporal and orbital prefrontal regions around the time of transition to illness, and (3) evidence of late (post-pubertal) neurodevelopmental changes soon after the onset of psychosis, involving an acceleration of normal brain maturational processes, associated with significant loss of grey matter in dorsal prefrontal regions. The pathological processes underlying such changes remain unclear and may reflect anomalies in genetic and/or other endogenous mechanisms responsible for brain maturation, the adverse effects of intense or prolonged stress, or other environmental factors. These findings suggest that early markers of impending illness may prove difficult to define, and that brain changes in psychosis may better be conceptualized as anomalous trajectories of brain development. Further, active changes during transition to illness may present the potential to intervene and ameliorate these changes with potential benefit clinically.
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Affiliation(s)
- C Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Royal Melbourne Hospital, Sunshine Hospital, 176 Furlong Road, St Albans, Victoria 3021, Australia.
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Borgwardt SJ, Riecher-Rössler A, Dazzan P, Chitnis X, Aston J, Drewe M, Gschwandtner U, Haller S, Pflüger M, Rechsteiner E, D'Souza M, Stieglitz RD, Radü EW, McGuire PK. Regional gray matter volume abnormalities in the at risk mental state. Biol Psychiatry 2007; 61:1148-56. [PMID: 17098213 DOI: 10.1016/j.biopsych.2006.08.009] [Citation(s) in RCA: 238] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 07/11/2006] [Accepted: 08/04/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Individuals with an At Risk Mental State (ARMS) have a very high risk of developing a psychotic disorder but the basis of this risk is unclear. We addressed this issue by studying gray matter volume in this group with magnetic resonance imaging (MRI). METHODS Thirty-five individuals with an ARMS, 25 patients with first episode schizophrenia, and 22 healthy volunteers were studied using a 1.5T MRI scanner. Twelve (34%) of the ARMS group developed schizophrenia in the 2 years subsequent to scanning. RESULTS There were significant volumetric differences between the three groups in the left insula, superior temporal gyrus, cingulate gyrus and precuneus. In these regions, the volume in the ARMS group was smaller than in volunteers but not significantly different from that in the first episode (FE) group. Direct comparison of the ARMS and control groups revealed additional areas of reduced volume in the left medial temporal cortex. Within the ARMS group, those subjects who later developed psychosis had less gray matter than subjects who did not in the right insula, inferior frontal and superior temporal gyrus. CONCLUSIONS The ARMS was associated with reductions in gray matter volume in areas that are also reduced in schizophrenia, suggesting that these are a correlate of an increased vulnerability to psychosis. Volumetric differences within the ARMS group may be related to the subsequent onset of schizophrenia in a subset of those at high risk.
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Affiliation(s)
- Stefan J Borgwardt
- Psychiatric Outpatient Department, University Hospital Basel, Switzerland.
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Riecher-Rössler A, Gschwandtner U, Aston J, Borgwardt S, Drewe M, Fuhr P, Pflüger M, Radü W, Schindler C, Stieglitz RD. The Basel early-detection-of-psychosis (FEPSY)-study--design and preliminary results. Acta Psychiatr Scand 2007; 115:114-25. [PMID: 17244175 DOI: 10.1111/j.1600-0447.2006.00854.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED Early detection and therapy of schizophrenic psychoses have become broadly accepted aims in psychiatry, recently even in very early stages of the disorder when clear diagnostic criteria are not yet fulfilled. However, reliable and widely applicable methods do not yet exist. This study aims at contributing to the improvement of the early assessment of psychosis. METHOD Individuals potentially at risk are identified by a newly developed stepwise screening procedure. Identified subjects are then examined extensively and followed-up for at least 5 years to detect actual transition to psychosis. RESULTS Of 50 subjects who have been followed up for 1-5 years by now, 16 have progressed to frank psychosis, 12 of them during the first 12 months of follow-up. CONCLUSION At this stage, our approach seems to be promising for the early detection of psychosis. Further results from this ongoing study will hopefully permit us to optimize the assessment procedure.
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Affiliation(s)
- A Riecher-Rössler
- Psychiatric Outpatient Department, University Hospital Basel, Petersgraben 4-6, CH-4031 Basel, Switzerland.
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Abstract
PURPOSE OF REVIEW Psychiatric neuroimaging has made a dramatic impact on the understanding of the brain in mental illness in a relatively brief period of time and continues to be evolving in terms of methodology, analysis and utilization of the combination of techniques. Given the level of sophistication of the techniques and the importance of imaging in current academic psychiatry, it is timely to review its conceptual influence on psychopathology. RECENT FINDINGS The study will review scientific advances in psychiatric neuromaging, around the themes of functional connectivity, diffusion tensor imaging, magnetoencephalography, modality integration, meta-analyses and mega-analyses of data and discuss recent influential findings in contemporary research. We then focus on more conceptual issues relating to biological psychiatry and its relationship with cognitive neuroscience. We discuss the dominant paradigm of scientific psychopathology, namely cognitive neuropsychiatry and how it relates more broadly to imaging and cognitive science and elaborate on the philosophical positions of the paradigm and how it views abnormal mental states. SUMMARY We conclude that despite the advances in biological psychiatry and the power of the cognitive neuropsychiatry paradigm, its findings are logically contingent upon psychopathology and the normatively defined terms employed therein.
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Affiliation(s)
- Paolo Fusar-Poli
- PO 67, Section of Neuroimaging, Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London, UK
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