1
|
Chahine B, Al Souheil F, Yaghi G. Anticholinergic burden in older adults with psychiatric illnesses: A cross-sectional study. Arch Psychiatr Nurs 2023; 44:26-34. [PMID: 37197858 DOI: 10.1016/j.apnu.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/19/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVES We aimed in this study to determine the extent of exposure to anticholinergic drugs in older adults with psychiatric illnesses using the anticholinergic cognitive burden (ACB) scale and to identify the factors associated with anticholinergic drugs use and higher ACB scores. METHODS A cross-sectional study was conducted in the psychogeriatric division of an elderly care hospital. The study sample comprised all inpatients, aged ≥65 years, and diagnosed with psychiatric illness. RESULTS Anticholinergic drugs use was reported in 117 (79.6 %) patients, 76 (51.7 %) had an ACB score ≥ 3. Schizophrenia [OR = 5.4 (95 % CI 1.1-10.2), p = 0.02], anemia [OR = 2.2 (95 % CI 1.54-7.89), p = 0.01], and anticholinergic adverse effects [OR = 2.8 (95 % CI 1.12-7.07), p = 0.04] were significantly associated with a higher likelihood of using anticholinergic drugs. The odds of having an ACB score ≥ 3 over an ACB score = 0 were significantly increased by schizophrenia [OR = 4.9 (95 % CI 1.65-8.02), p = 0.01], anemia [OR = 1.32 (95 % CI 1.90-6.90), p = 0.02], and polypharmacy [OR = 1.74 (95 % CI 1.10-2.40), p = 0.04], while they were significantly decreased by age [OR = 0.86 (95 % CI 0.78-0.96), p < 0.001]. Patients with cognitive impairment were less likely than those without cognitive impairment to have an ACB score ≥ 3 over an ACB score = 0. CONCLUSIONS Our study revealed that older adults with psychiatric illnesses were exposed to high anticholinergic burden.
Collapse
Affiliation(s)
- Bahia Chahine
- PharmD Program, School of Pharmacy, Lebanese International University, Beirut, Lebanon.
| | - Farah Al Souheil
- PharmD Program, School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Gracia Yaghi
- PharmD Program, School of Pharmacy, Lebanese International University, Beirut, Lebanon
| |
Collapse
|
2
|
Wood-Ross C, Tran T, Milanovic M, Jokic R, Milev R, Bowie CR. Neurocognition and Depressive Symptoms have Unique Pathways to Predicting Different Domains of Functioning in Major Depressive Disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:241-248. [PMID: 36411975 PMCID: PMC10037745 DOI: 10.1177/07067437221133375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research has established the independent relationships between depressive symptoms to cognition and functioning in depression; however, little is known about the role of mediators in this relationship. We explored the role of neurocognitive abilities, depressive symptom severity, dysfunctional attitudes, and functional capacity in predicting two dimensions of daily functioning in individuals with major depressive disorder (MDD). METHODS One hundred and twenty-four participants (mean age = 46.26, SD = 12.27; 56% female) with a diagnosis of MDD were assessed on a standard neurocognitive battery, self-reported depressive symptoms, dysfunctional attitudes, and clinician-rated functional impairment. They completed a performance-based assessment of functional competence. RESULTS Confirmatory path analyses were used to model the independent and mediated effects of variables on two domains of functioning: social (relationships and social engagement) and productive (household and community activities). Cognition and depressive symptoms both predicted productive functioning, and dysfunctional attitudes mediated each of these relationships. Functional competence was a significant mediator in the relationship between neurocognition and productive functioning. Depressive symptoms and cognition were direct predictors of social functioning with no significant mediators. CONCLUSIONS There are divergent pathways to different dimensions of daily functioning in MDD. Measurement implications include the consideration of multiple levels of predicting productive activities and more direct relationships with social outcomes. Treatments that directly target depressive symptoms and cognition might not generalize to improvements in everyday functioning if additional pathways to functioning are not addressed.
Collapse
Affiliation(s)
| | - Tanya Tran
- Department of Psychology, Queen's University, Ontario, Canada
| | | | - Ruzica Jokic
- Department of Psychology, Queen's University, Ontario, Canada
- Centre for Neuroscience Studies, Queen's University, Ontario, Canada
| | - Roumen Milev
- Department of Psychology, Queen's University, Ontario, Canada
- Centre for Neuroscience Studies, Queen's University, Ontario, Canada
- Providence Care, Kingston, Ontario, Canada
| | - Christopher R Bowie
- Department of Psychology, Queen's University, Ontario, Canada
- Centre for Addictions and Mental Health, Ontario, Canada
| |
Collapse
|
3
|
Spark DL, Fornito A, Langmead CJ, Stewart GD. Beyond antipsychotics: a twenty-first century update for preclinical development of schizophrenia therapeutics. Transl Psychiatry 2022; 12:147. [PMID: 35393394 PMCID: PMC8991275 DOI: 10.1038/s41398-022-01904-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/02/2022] [Accepted: 03/15/2022] [Indexed: 11/15/2022] Open
Abstract
Despite 50+ years of drug discovery, current antipsychotics have limited efficacy against negative and cognitive symptoms of schizophrenia, and are ineffective-with the exception of clozapine-against any symptom domain for patients who are treatment resistant. Novel therapeutics with diverse non-dopamine D2 receptor targets have been explored extensively in clinical trials, yet often fail due to a lack of efficacy despite showing promise in preclinical development. This lack of translation between preclinical and clinical efficacy suggests a systematic failure in current methods that determine efficacy in preclinical rodent models. In this review, we critically evaluate rodent models and behavioural tests used to determine preclinical efficacy, and look to clinical research to provide a roadmap for developing improved translational measures. We highlight the dependence of preclinical models and tests on dopamine-centric theories of dysfunction and how this has contributed towards a self-reinforcing loop away from clinically meaningful predictions of efficacy. We review recent clinical findings of distinct dopamine-mediated dysfunction of corticostriatal circuits in patients with treatment-resistant vs. non-treatment-resistant schizophrenia and suggest criteria for establishing rodent models to reflect such differences, with a focus on objective, translational measures. Finally, we review current schizophrenia drug discovery and propose a framework where preclinical models are validated against objective, clinically informed measures and preclinical tests of efficacy map onto those used clinically.
Collapse
Affiliation(s)
- Daisy L Spark
- Drug Discovery Biology, Neuroscience & Mental Health Therapeutic Program Area, and Neuromedicines Discovery Centre, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC, 3052, Australia
| | - Alex Fornito
- Turner Institute for Brain and Mental Health, Monash Biomedical Imaging, and School of Psychological Sciences, Monash University, Clayton, VIC, 3800, Australia
| | - Christopher J Langmead
- Drug Discovery Biology, Neuroscience & Mental Health Therapeutic Program Area, and Neuromedicines Discovery Centre, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC, 3052, Australia.
| | - Gregory D Stewart
- Drug Discovery Biology, Neuroscience & Mental Health Therapeutic Program Area, and Neuromedicines Discovery Centre, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC, 3052, Australia.
| |
Collapse
|
4
|
Guo P, Hu S, Jiang X, Zheng H, Mo D, Cao X, Zhu J, Zhong H. Associations of Neurocognition and Social Cognition With Brain Structure and Function in Early-Onset Schizophrenia. Front Psychiatry 2022; 13:798105. [PMID: 35222115 PMCID: PMC8866448 DOI: 10.3389/fpsyt.2022.798105] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cognitive impairment is a core feature of schizophrenia that is more serious in patients with early-onset schizophrenia (EOS). However, the neuroimaging basis of cognitive functions, including neurocognition and social cognition, remains unclear in patients with EOS. METHODS Forty-three patients with EOS underwent structural and resting state functional magnetic resonance imaging scans. Brain structure and function were evaluated through the analysis of brain gray matter volume (GMV) and amplitude of low-frequency fluctuations (ALFF). They underwent comprehensive assessments for neurocognition (verbal memory, verbal expression, attention, and executive function) and social cognition (theory of mind and attributional bias). Correlation analyses were conducted to detect the potential link between cognitive function indices and brain imaging parameters. RESULTS First, neurocognition was linked to brain structure characterized by higher immediate recall scores associated with increased GMV in the left temporal pole, higher verbal fluency scores associated with increased GMV in the left temporal pole: middle temporal gyrus, and higher Stroop-word scores associated with increased GMV in the right middle frontal gyrus. Second, social cognition was related to brain function characterized by lower sense of reality scores associated with increased ALFF in the left precentral gyrus, higher scores of accidental hostility bias associated with increased ALFF in the right middle temporal gyrus, and higher scores of accidental aggression bias associated with increased ALFF in the left precentral gyrus. CONCLUSION These findings may add to the existing knowledge about the cognitive function-brain relationship. They may have clinical significance for studying the mechanism of neurocognitive and social cognitive impairment in patients with EOS and providing potential neural targets for their treatment and intervention.
Collapse
Affiliation(s)
- Pengfei Guo
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Shuwen Hu
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Xiaolu Jiang
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Hongyu Zheng
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Daming Mo
- Department of Child and Adolescent Mental Disorder, Anhui Mental Health Center, Hefei, China
| | - Xiaomei Cao
- Department of Child and Adolescent Mental Disorder, Anhui Mental Health Center, Hefei, China
| | - Jiajia Zhu
- Department of Radiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hui Zhong
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Department of Child and Adolescent Mental Disorder, Anhui Mental Health Center, Hefei, China
| |
Collapse
|
5
|
Stollenwerk TM, Hillard CJ. Adolescent THC Treatment Does Not Potentiate the Behavioral Effects in Adulthood of Maternal Immune Activation. Cells 2021; 10:3503. [PMID: 34944011 PMCID: PMC8700174 DOI: 10.3390/cells10123503] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Both in utero exposure to maternal immune activation and cannabis use during adolescence have been associated with increased risk for the development of schizophrenia; however, whether these exposures exert synergistic effects on brain function is not known. In the present study, mild maternal immune activation (MIA) was elicited in mice with prenatal exposure to polyinosinic-polycytidylic acid (poly(I:C)), and ∆9-tetrahydrocannabinol (THC) was provided throughout adolescence in cereal (3 mg/kg/day for 5 days). Neither THC nor MIA pretreatments altered activity in assays used to characterize hyperdopaminergic states in adulthood: amphetamine hyperlocomotion and prepulse inhibition of the acoustic startle reflex. Adolescent THC treatment elicited deficits in spatial memory and enhanced spatial reversal learning in adult female mice in the Morris water maze, while exposure to MIA elicited female-specific deficits in fear extinction learning in adulthood. There were no effects in these assays in adult males, nor were there interactions between THC and MIA in adult females. While doses of poly(I:C) and THC were sufficient to elicit behavioral effects, particularly relating to cognitive performance in females, there was no evidence that adolescent THC exposure synergized with the risk imposed by MIA to worsen behavioral outcomes in adult mice of either sex.
Collapse
Affiliation(s)
| | - Cecilia J. Hillard
- Neuroscience Research Center, Department of Pharmacology and Toxicology, Medical College of Wisconsin, Wauwatosa, WI 53226, USA;
| |
Collapse
|
6
|
Lerbaek B, Jørgensen R, Buus N, Lauritsen MB, Aagaard J, Nordgaard J, McCloughen A. "Modifying" or "Retreating"- Self-management of physical health among a group of people with schizophrenia. An ethnographic study from Denmark. Int J Ment Health Nurs 2021; 30:1575-1587. [PMID: 34263516 DOI: 10.1111/inm.12907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2022]
Abstract
The aim of this ethnographic study was to explore how a group of nine Danish people with schizophrenia managed physical health issues as they naturally occurred in everyday life. Qualitative methods were used to generate of data. Thematic analysis led to the description of two typical strategies used by participants to manage debilitating physical health issues in everyday life. Modifying everyday life to manage discomfort was a strategy employed to manage potential or actual discomfort associated with ongoing poor physical health, while retreating from everyday life to recover was a strategy used by participants who experienced recurring discrete episodes of poor physical health characterized by fast deterioration. Both management strategies were inexpedient as they failed to produce any positive progress in terms of the participants regaining health. The social context of participants' everyday life was characterized by a lack of interactions with others about their prevailing and ongoing physical health issues. Repeated use of these inexpedient strategies to manage physical health caused potential worsening rather than improvements to physical health. There is a need for future research that explores aspects of beneficial management of physical health issues among people with severe mental illness. Relevant foci of such research include enhancing self-management of physical health, active help-seeking behaviours, and opportunities to engage in interactions with others about physical health issues.
Collapse
Affiliation(s)
- Birgitte Lerbaek
- Clinic for Internal and Emergency Medicine, Aalborg University Hospital, Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Clinic Psychiatry South, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rikke Jørgensen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Buus
- Relationships Australia NSW, Macquarie Park, New South Wales, Australia.,Faculty of Health, Department of Regional Health Research, University of Southern Denmark, Syddanmark, Denmark.,Faculty of Medicine and Health, Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Marlene Briciet Lauritsen
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Julie Nordgaard
- Mental Health Center Amager, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Andrea McCloughen
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
7
|
Sampedro A, Peña J, Sánchez P, Ibarretxe-Bilbao N, Iriarte-Yoller N, Pavón C, Hervella I, Tous-Espelosin M, Ojeda N. The impact of creativity on functional outcome in schizophrenia: a mediational model. NPJ SCHIZOPHRENIA 2021; 7:14. [PMID: 33637749 PMCID: PMC7910291 DOI: 10.1038/s41537-021-00144-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/15/2021] [Indexed: 01/31/2023]
Abstract
Functional impairment remains one of the most challenging issues for treatment in schizophrenia. However, previous studies have mainly focused on the negative impact of symptoms excluding variables that could positively impact functional outcome, such as creativity, which is considered an adaptive capacity for real-life problem-solving. This study analyzed the predictive role of creativity on functional outcome in 96 patients with schizophrenia through a mediational model, including sociodemographic, clinical, neurocognitive, and social cognitive variables. Path analysis revealed that creativity significantly mediated the relationship between neurocognition and functional outcome, and that creativity mediated between negative symptoms and functional outcome. Additionally, neurocognition was directly associated with functional outcome and social functioning was associated with creativity. The involvement of creativity in functional outcome could have relevant implications for the development of new interventions. These findings open up a new field of research on additional personal resources as possible factors of functional outcome in schizophrenia and other diseases.
Collapse
Affiliation(s)
- Agurne Sampedro
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Javier Peña
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain.
| | - Pedro Sánchez
- Refractory Psychosis Unit, Hospital Psiquiátrico de Alava, Vitoria, Spain
- Department of Neuroscience, Psychiatry Section, School of Medicine and Odontology, University of the Basque Country (UPV/EHU), Vizcaya, Spain
| | - Naroa Ibarretxe-Bilbao
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | | | - Cristóbal Pavón
- Refractory Psychosis Unit, Hospital Psiquiátrico de Alava, Vitoria, Spain
| | - Isabel Hervella
- Refractory Psychosis Unit, Hospital Psiquiátrico de Alava, Vitoria, Spain
| | - Mikel Tous-Espelosin
- Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
| | - Natalia Ojeda
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| |
Collapse
|
8
|
Khan WU, Ghazala Z, Brooks HJ, Subramaniam P, Mulsant BH, Kumar S, Voineskos AN, Blumberger DM, Kern RS, Rajji TK. The Impact of Anticholinergic Burden on Functional Capacity in Persons With Schizophrenia Across the Adult Life Span. Schizophr Bull 2021; 47:249-257. [PMID: 32619225 PMCID: PMC7825090 DOI: 10.1093/schbul/sbaa093] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Anticholinergic burden (ACB) from medications impairs cognition in schizophrenia. Cognition is a predictor of functional capacity; however, little is known about ACB effect on functional capacity in this population. This study assesses the relationship between ACB and functional capacity across the life span in individuals with schizophrenia after controlling for ACB effect on cognition. A cross-sectional analysis was performed with data collected from 6 academic tertiary health centers. Two hundred and twenty-three community-dwelling participants with schizophrenia or schizoaffective disorder were included in this study. Main variables were ACB, antipsychotic olanzapine equivalents, functional capacity, cognition, and negative symptoms. Simultaneous linear regression analyses were performed to assess the association between ACB, functional capacity, and cognition and then between ACB and cognition. A mediation analysis was then performed to examine whether cognition mediated ACB effect on functional capacity if there was an association between ACB and cognition. Mean age of participants was 49.0 years (SD = 13.1, range 19-79), and 63.7% of participants had severe ACB, ie, a total score of 3 or above. Regression analyses revealed that ACB, age, education, and cognition independently predicted functional capacity and that ACB predicted cognition among those aged 55 years and older. Mediation analysis showed that cognition did partially mediate the effect of ACB on functional capacity in this older cohort. In conclusion, people with schizophrenia are exposed to severe ACB that can have a direct negative impact on functional capacity after controlling for its impact on cognition. Reducing ACB could improve functional capacity and potentially real-world function in schizophrenia.
Collapse
Affiliation(s)
- Waqas Ullah Khan
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zaid Ghazala
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Ponnusamy Subramaniam
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Robert S Kern
- Department of Psychiatry, University of California–Los Angeles, Los Angeles, CA
- Department of Veterans Affairs, VISN 22 Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Tarek K Rajji
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
9
|
Does Self-Efficacy Predict Functioning in Older Adults with Schizophrenia? A Cross-Sectional and Longitudinal Mediation Analysis. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
10
|
Behavioral abnormalities and phosphorylation deficits of extracellular signal-regulated kinases 1 and 2 in rat offspring of the maternal immune activation model. Physiol Behav 2020; 217:112805. [DOI: 10.1016/j.physbeh.2020.112805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/23/2019] [Accepted: 01/14/2020] [Indexed: 12/31/2022]
|
11
|
Gerritsen C, Maheandiran M, Lepock J, Ahmed S, Kiang M, Bagby RM, Mizrahi R. Negative symptoms in the clinical high-risk state for psychosis: Connection with cognition and primacy in impacting functioning. Early Interv Psychiatry 2020; 14:188-195. [PMID: 31264790 DOI: 10.1111/eip.12843] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/30/2019] [Accepted: 06/09/2019] [Indexed: 12/14/2022]
Abstract
AIM In the clinical high-risk (CHR) state for psychosis, both negative symptoms and lower cognitive function have been associated with poorer daily functioning. Recent evidence suggests that negative symptoms share overlapping variability with cognition and may partially mediate the relationship between cognition and functioning. However, the nature of this overlap is unknown, and the reverse mediation model remains untested leaving the precise nature of these associations unclear. METHODS In order to clarify these relationships, a sample of community-dwelling youth meeting CHR criteria was collected from a specialty CHR clinic (n = 91, mean age = 21, 63% male). Bootstrapping methods were then applied in a mediation analysis to test both negative symptoms and cognition as independent variables and mediating variables predicting social and role functioning in CHR individuals. Canonical correlation analysis was used to characterize the overlapping variability between negative symptoms and cognition. RESULTS Support for a primary role of negative symptoms in predicting functioning and cognition was observed. Canonical correlation revealed a single dimension of overlap between the two symptom types (r = .62), represented by a strong correlation between negative symptoms in general and tasks involving verbal working memory, vigilance and social cognition specifically. A single cognitive factor composed primarily of these tasks was found to predict role functioning (adjusted R 2 = .04). CONCLUSIONS The results highlight the importance of considering specific cognitive mechanisms overlapping with negative symptoms in research and rehabilitative practice in CHR populations, as well as the primary importance of targeting negative symptoms.
Collapse
Affiliation(s)
- Cory Gerritsen
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | | | - Jenny Lepock
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Sarah Ahmed
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Michael Kiang
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Robert Michael Bagby
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Romina Mizrahi
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
12
|
Utility of the MoCA for cognitive impairment screening in long-term psychosis patients. Schizophr Res 2020; 216:429-434. [PMID: 31801676 DOI: 10.1016/j.schres.2019.10.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/25/2019] [Accepted: 10/26/2019] [Indexed: 12/12/2022]
Abstract
Cognitive impairment is a key feature in patients with psychotic disorders. The Montreal Cognitive Assessment (MoCA) is a brief tool that has been shown to be effective in identifying mild cognitive impairment and early dementia. This study explores the usefulness of this instrument to detect cognitive impairment in long-term psychotic disorders. One hundred-forty stabilized patients were re-evaluated more than 15 years after a First Episode of Psychosis (FEP). Patients were psychopathologically assessed, and the MoCA test and MATRICS Consensus Cognitive Battery (MCCB) were administered. Two cut-off scores for cognitive impairment using the MCCB were applied (T score <40 and < 30). Concurrent validation was found between the total scores of the MoCA and MCCB. We also found significant associations between 5 out of 7 MoCA subtests (visuospatial-executive, attention, language, abstraction and delayed recall) and MCCB subtests but not for the naming and orientation MoCA subtests. Receiver operating characteristic (ROC) analysis suggested a <25 cut-off for cognitive impairment instead of the original <26. Our results suggest that the MoCA test is a useful screening instrument for assessing cognitive impairment in psychotic patients and has some advantages over other available instruments, such as its ease-of-use and short administration time.
Collapse
|
13
|
Kraus MS, Gold JM, Barch DM, Walker TM, Chun CA, Buchanan RW, Csernansky JG, Goff DC, Green MF, Jarskog LF, Javitt DC, Kimhy D, Lieberman JA, McEvoy JP, Mesholam-Gately RI, Seidman LJ, Ball MP, Kern RS, McMahon RP, Robinson J, Marder SR, Keefe RSE. The characteristics of cognitive neuroscience tests in a schizophrenia cognition clinical trial: Psychometric properties and correlations with standard measures. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100161. [PMID: 31832342 PMCID: PMC6889798 DOI: 10.1016/j.scog.2019.100161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 07/24/2019] [Accepted: 08/25/2019] [Indexed: 11/28/2022]
Abstract
In comparison to batteries of standard neuropsychological tests, cognitive neuroscience tests may offer a more specific assessment of discrete neurobiological processes that may be aberrant in schizophrenia. However, more information regarding psychometric properties and correlations with standard neuropsychological tests and functional measures is warranted to establish their validity as treatment outcome measures. The N-back and AX-Continuous Performance Task (AX-CPT) are two promising cognitive neuroscience tests designed to measure specific components of working memory and contextual processing respectively. In the current study, we report the psychometric properties of multiple outcome measures from these two tests as well as their correlations with standard neuropsychological measures and functional capacity measures. The results suggest that while the AX-CPT and N-back display favorable psychometric properties, they do not exhibit greater sensitivity or specificity with functional measures than standard neurocognitive tests.
Collapse
Affiliation(s)
- Michael S Kraus
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Deanna M Barch
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States of America
| | - Trina M Walker
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | | | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - John G Csernansky
- Department of Psychiatry, Northwestern Feinberg School of Medicine, Chicago, IL, United States of America
| | - Donald C Goff
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States of America
| | - Michael F Green
- UCLA Semel Institute for Neuroscience and Human Behavior, United States of America.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America
| | - L Fredrik Jarskog
- North Carolina Psychiatric Research Center, Department of Psychiatry, University of North Carolina at Chapel Hill, United States of America
| | - Daniel C Javitt
- Department of Psychiatry, Nathan Kline Institute for Psychiatric Research, New York University School of Medicine, New York, NY, United States of America
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jeffrey A Lieberman
- Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons, Columbia University, United States of America
| | - Joseph P McEvoy
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - Raquelle I Mesholam-Gately
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Larry J Seidman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States of America.,Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - M Patricia Ball
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Robert S Kern
- UCLA Semel Institute for Neuroscience and Human Behavior, United States of America.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America
| | - Robert P McMahon
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - James Robinson
- Department of Psychiatry, Nathan Kline Institute for Psychiatric Research, New York University School of Medicine, New York, NY, United States of America
| | - Stephen R Marder
- UCLA Semel Institute for Neuroscience and Human Behavior, United States of America.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America
| | - Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| |
Collapse
|
14
|
Guercio GD, Thomas ME, Cisneros-Franco JM, Voss P, Panizzutti R, de Villers-Sidani E. Improving cognitive training for schizophrenia using neuroplasticity enhancers: Lessons from decades of basic and clinical research. Schizophr Res 2019; 207:80-92. [PMID: 29730045 DOI: 10.1016/j.schres.2018.04.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 01/29/2023]
Abstract
Mounting evidence indicates that schizophrenia is a disorder that stems from maladaptive plasticity within neural circuits and produces broad cognitive deficits leading to loss of autonomy. A large number of studies have identified abnormalities spanning many neurotransmitter systems in schizophrenia, and as a result, a variety of drugs have been developed to attempt to treat these abnormalities and enhance cognition. Unfortunately, positive results have been limited so far. This may be in part because the scope of abnormalities in the schizophrenic brain requires a treatment capable of engaging many different neurotransmitter systems. One approach to achieving this kind of treatment has been to use neuroplasticity-based computerized cognitive training programs to stimulate the formation of more adaptive circuits. Although the number of studies implementing this approach has increased exponentially in recent years, effect sizes for cognitive gains have been modest and adherence to treatment remains an important challenge in many studies, as patients are often required to train for 40 h or more. In the present paper, we argue that cognitive training protocols will benefit from the addition of cognitive enhancers to produce more robust and longer lasting targeted neuroplasticity. Indeed, recent data from animal studies have provided support for combining plasticity-enhancing drugs with tailored behavioral training paradigms to restore normal function within dysfunctioning neural circuits. The advantages and challenges of applying this approach to patients with schizophrenia will be discussed.
Collapse
Affiliation(s)
- G D Guercio
- Biomedical Sciences Institute, Federal University of Rio de Janeiro, RJ, Brazil; Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
| | - M E Thomas
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - J M Cisneros-Franco
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - P Voss
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - R Panizzutti
- Biomedical Sciences Institute, Federal University of Rio de Janeiro, RJ, Brazil
| | - E de Villers-Sidani
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
| |
Collapse
|
15
|
Kawaguchi T, Matsunaga A, Watanabe A, Suzuki M, Asano E, Shirakihara Y, Shimizu S, Sawayama T, Fukuda M, Miyaoka H. Prediction of changes in functional ability of inpatients with schizophrenia using logarithmic and linear regression modelling. Hong Kong J Occup Ther 2019; 31:76-85. [PMID: 30643495 PMCID: PMC6322114 DOI: 10.1177/1569186118808431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/28/2018] [Indexed: 11/16/2022] Open
Abstract
Background/Objective Few studies have addressed the type of time course regression that can predict changes in functional ability in inpatients with schizophrenia. This study investigated the possibility of predicting changes in functional ability by logarithmic and linear regression modelling when treating schizophrenia. Methods This longitudinal study included two analysis rounds. Analysis 1 comprised 40 inpatients (male/female: 16/24, mean age: 39.7 ± 13.5 years) for the identification of the time course of changes in functional ability based on the Activity Profile Scale for Patients with Psychiatric Disorders score from the group data. Analysis 2 comprised 17 inpatients (male/female: 9/8, mean age: 38.5 ± 9.4 years) to ensure correlation of the group data with the prediction of each individual’s degree of functional ability. Results In Analysis 1, Activity Profile Scale for Patients with Psychiatric Disorders score was assessed at the initial occupational therapy visit, one week and one month thereafter, and at discharge; logarithmic modelling using the scores at the initial visit, one month later and at discharge was more suitable (R2 = .506, p < .001) than the logarithmic and linear regression models using other score combinations. In Analysis 2, the individual’s predicted Activity Profile Scale for Patients with Psychiatric Disorders scores at discharge, as calculated by logarithmic modelling using scores from the initial visit and one month later, correlated moderately with actual Activity Profile Scale for Patients with Psychiatric Disorders scores (R2 = .574, p < .001; ICC = .747, p < .001). Conclusion Logarithmic modelling based on Activity Profile Scale for Patients with Psychiatric Disorders score accurately predicted changes in the functional ability of inpatients with schizophrenia and is sufficiently uncomplicated to be adopted in daily clinical practice.
Collapse
Affiliation(s)
| | | | - Aki Watanabe
- Kitasato University School of Allied Health Sciences, Japan
| | | | | | | | | | | | - Michinari Fukuda
- Kitasato University School of Allied Health Sciences, Japan.,Kitasato University East Hospital, Japan
| | | |
Collapse
|
16
|
Kawaguchi H, Taguchi M, Sukigara M, Sakuragi S, Sugiyama N, Chiba H, Kawasaki T. Evaluation of cognitive and social functioning in patients requiring long-term inpatient psychiatric care using the International Classification of Functioning, Disability, and Health: a large-scale, multi-institutional observational study. Disabil Rehabil 2018; 40:2538-2544. [DOI: 10.1080/09638288.2017.1340980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hideaki Kawaguchi
- Japan Psychiatric Hospitals Association, Tokyo, Japan
- Department of Biomedical Informatics, The University of Tokyo, Tokyo, Japan
| | | | - Masune Sukigara
- Japan Psychiatric Hospitals Association, Tokyo, Japan
- Graduate School of Humanities and Social Sciences, Nagoya City University, Nagoya, Japan
| | | | | | - Hisomu Chiba
- Japan Psychiatric Hospitals Association, Tokyo, Japan
| | | |
Collapse
|
17
|
Stefanatou P, Karatosidi CS, Tsompanaki E, Kattoulas E, Stefanis NC, Smyrnis N. Premorbid adjustment predictors of cognitive dysfunction in schizophrenia. Psychiatry Res 2018; 267:249-255. [PMID: 29940456 DOI: 10.1016/j.psychres.2018.06.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/24/2022]
Abstract
Premorbid adjustment (PA) in academic and social domain is a key-predictor of cognitive performance in schizophrenia. Prior studies provided inconsistent findings regarding the differential relationships of PA domains with post-illness cognition. Multivariate associations of academic and social PA in each developmental stage (childhood, early and late adolescence) with post-onset cognitive variables were explored. Furthermore, possible differential relationships of PA domain deterioration courses with post-onset cognitive dysfunction were investigated. Seventy-five schizophrenia patients were evaluated with Premorbid Adjustment Scale (PAS). General cognitive ability, verbal IQ, verbal memory and learning, processing speed, working memory, executive function and premorbid IQ were assessed. Canonical Correlation Analyses revealed that poorer academic PA across childhood and early adolescence was related to worse post-onset verbal IQ, working memory, verbal learning and executive function, while academic PA deterioration between early and late adolescence was associated with poorer verbal learning and executive function and, as further analysis indicated, predicts IQ decline. Academic PA was exclusively associated with post-onset cognitive impairment. New evidence emerged for the specificity of each developmental period in constructing academic PA in its relation to post-illness cognition. Early premorbid academic maladjustment possibly constitutes the onset of a cognitive dysmaturational process which results to post-diagnosis impaired cognition.
Collapse
Affiliation(s)
- Pentagiotissa Stefanatou
- Psychiatry Department, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - Chrysovalado-Sofia Karatosidi
- Psychiatry Department, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - Evgenia Tsompanaki
- Department of Statistics, School of Information Sciences and Technology, Athens University of Economics and Business, Athens, Greece
| | - Emmanouil Kattoulas
- Psychiatry Department, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - Nicholas C Stefanis
- Psychiatry Department, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece; University Mental Health Research Institute, Athens, Greece
| | - Nikolaos Smyrnis
- Psychiatry Department, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece; University Mental Health Research Institute, Athens, Greece.
| |
Collapse
|
18
|
Qiu L, Yan H, Zhu R, Yan J, Yuan H, Han Y, Yue W, Tian L, Zhang D. Correlations between exploratory eye movement, hallucination, and cortical gray matter volume in people with schizophrenia. BMC Psychiatry 2018; 18:226. [PMID: 30005610 PMCID: PMC6045825 DOI: 10.1186/s12888-018-1806-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Widespread cortical gray matter alternations in people with schizophrenia are correlated with both psychotic symptoms and cognitive/behavioral abnormalities, including the impairments of exploratory eye movement (EEM). Particularly, the loss of gray matter density is specifically related to deficits of the responsive search score (RSS) of EEM in schizophrenia. It is unknown, however, whether the schizophrenia-related RSS deficits are associated with certain psychotic symptoms, such as hallucinations. METHODS In 33 participants with schizophrenia, the measurement of EEM, assessment of the hallucination severity using Positive and Negative Syndrome Scale (PANSS) and a voxel-based morphometric analysis of cortical gray matter volume (GMV) were conducted to investigate the relationships between the RSS of EEM, symptom severity, and GMV. In 29 matched healthy controls, the measurement of EEM and a voxel-based morphometric analysis of cortical GMV were also conducted to investigate the relationship between the RSS of EEM and GMV. RESULTS In participants with schizophrenia, the hallucination severity was significantly negatively correlated with both the RSS and the GMV of a large number of brain regions in the frontal, temporal, parietal, orbitofrontal, calcarine, cingulate, and insular cortices, and rolandic operculum, hippocampus, parahippocampal gyrus, and thalamus. Also in participants with schizophrenia, the RSS was significantly positively correlated with the GMV in the left supplementary motor area (SMA), left superior frontal cortex (SFG), bilateral precentral gyri, bilateral postcentral gyri, and bilateral middle frontal cortices. More importantly, the GMV of the SMA, SFG, and precentral gyrus in the left hemisphere was not only significantly negatively correlated with the hallucination severity but also significantly positively correlated with the RSS. No significant correlation could be revealed between the RSS and the GMV of any brain regions in healthy controls. CONCLUSIONS There was a significantly negative association between the hallucination severity and the RSS of EEM, suggesting that the RSS may be a potential biomarker for predicting the hallucination severity of schizophrenia. Also, the GMV of the left SMA, SFG, and precentral gyrus may be the common substrates underlying both hallucination induction and the RSS in people with schizophrenia.
Collapse
Affiliation(s)
- Linlin Qiu
- 0000 0000 9490 772Xgrid.186775.aDepartment of Medical Psychology, Chaohu Hospital, Anhui Medical University, Hefei, Anhui China ,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders & Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui China ,0000 0004 1798 0615grid.459847.3Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,0000 0004 1769 3691grid.453135.5National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Hao Yan
- 0000 0004 1798 0615grid.459847.3Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,0000 0004 1769 3691grid.453135.5National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Risheng Zhu
- 0000 0004 1798 0615grid.459847.3Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,0000 0004 1769 3691grid.453135.5National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Jun Yan
- 0000 0004 1798 0615grid.459847.3Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,0000 0004 1769 3691grid.453135.5National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Huishu Yuan
- 0000 0004 0605 3760grid.411642.4The Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yonghua Han
- 0000 0004 1798 0615grid.459847.3Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,0000 0004 1769 3691grid.453135.5National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Weihua Yue
- 0000 0004 1798 0615grid.459847.3Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,0000 0004 1769 3691grid.453135.5National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Lin Tian
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China. .,National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China. .,Department of Psychiatry, the Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, Jiangsu, China.
| | - Dai Zhang
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China. .,National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China.
| |
Collapse
|
19
|
Harvey PD, Rosenthal JB. Cognitive and functional deficits in people with schizophrenia: Evidence for accelerated or exaggerated aging? Schizophr Res 2018; 196:14-21. [PMID: 28506706 DOI: 10.1016/j.schres.2017.05.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/05/2017] [Accepted: 05/07/2017] [Indexed: 10/19/2022]
Abstract
Cognitive and functional deficits are commonly seen in people with schizophrenia. The profile of these impairments has a resemblance to the cognitive changes seen in healthy aging. In specific, many of the cognitive ability domains that change the most with aging in healthy people are the most salient of these deficits seen in people with schizophrenia, including prominent deficits in processing speed, working memory, and episodic memory. Functional deficits seen in schizophrenia are also similar to those seen in healthy aging. There is a relationship between multiple psychotic relapses and treatment resistance and longitudinal cognitive and functional changes in schizophrenia, with this relationship starting early in the course of illness. Cognitive performance in people with schizophrenia may be consistent with accelerated or premature aging. People with schizophrenia perform similarly to healthy people who are 3 or more decades older on indices of both cognition and their everyday functional skills. Some people with schizophrenia show exaggerated cognitive changes as well. Cognitive and functional performance worsens at the outset of the illness in schizophrenia compared to premorbid functioning, meaning that these deficits are not due to development disabilities. There are multiple medical and substance abuse comorbidities in schizophrenia and although these comorbidities affect cognitive functioning, they are not completely responsible for age-related changes.
Collapse
Affiliation(s)
- Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA; Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA.
| | | |
Collapse
|
20
|
Aidelbaum R, Labelle A, Baddeley A, Knott V. Assessing the acute effects of CDP-choline on sensory gating in schizophrenia: A pilot study. J Psychopharmacol 2018; 32:541-551. [PMID: 29338621 DOI: 10.1177/0269881117746903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Deficient sensory gating (SG) in schizophrenia is associated with functional outcome and offers a therapeutic target as it is linked to the altered function/expression of the α7 nicotinic acetylcholine receptors (nAChRs). This study analyzed the effects of citicoline (CDP-choline), a supplement with α7 nAChRs agonist properties, on SG in a sample of schizophrenia (SZ) patients. Using a randomized, placebo-controlled, double-blind design the dose-dependent (500 mg, 1000 mg, 2000 mg) and baseline-dependent (deficient versus normal suppressors) effects of CDP-choline on SG were examined using the P50 event-related potential (ERP) index of SG. Overall analysis failed to demonstrate treatment effects but CDP-choline improved SG (500 mg) in the deficient SZ subgroup by increasing suppression of the S2 P50 amplitude. These findings tentatively support α7 nAChR dysfunction in the expression of SG deficits and suggest further trials to assess the effects of sustained α7 nAChR activation on SG with low doses of CDP-choline.
Collapse
Affiliation(s)
- Robert Aidelbaum
- 1 Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, ON, Canada.,2 Department of Psychology, Carleton University, ON, Canada
| | - Alain Labelle
- 3 Schizophrenia Program, Royal Ottawa Mental Health Centre, ON, Canada
| | - Ashley Baddeley
- 1 Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, ON, Canada
| | - Verner Knott
- 1 Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, ON, Canada
| |
Collapse
|
21
|
Guercio GD, Panizzutti R. Potential and Challenges for the Clinical Use of d-Serine As a Cognitive Enhancer. Front Psychiatry 2018; 9:14. [PMID: 29459833 PMCID: PMC5807334 DOI: 10.3389/fpsyt.2018.00014] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/17/2018] [Indexed: 12/16/2022] Open
Abstract
After 25 years of its discovery in the rat brain, d-serine is a recognized modulator of synaptic plasticity and cognitive processes through its actions on the NMDA-glutamate receptor. Importantly, cognitive impairment is a core feature of conditions, such as schizophrenia, Alzheimer's disease, depression, and aging, and is associated to disturbances in NMDA-glutamate receptors. The d-serine pathway has been associated with cognitive deficits and these conditions, and, for this reason, d-serine signaling is subject of intense research to probe its role in aiding diagnosis and therapy. Nevertheless, this has not resulted in new therapies being incorporated into clinical practice. Therefore, in this review we will address many questions that need to be solved by future studies, regarding d-serine pharmacokinetics, possible side effects, other strategies to modulate its levels, and combination with other therapies to increase its efficacy.
Collapse
Affiliation(s)
- Gerson D. Guercio
- Instituto de Ciencias Biomedicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogerio Panizzutti
- Instituto de Ciencias Biomedicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
22
|
Locked in and Growing Old: The Psychiatric, Forensic, and Cognitive Correlates of 30 Years of Psychiatric Hospitalization. Am J Geriatr Psychiatry 2018; 26:188-197. [PMID: 29122420 DOI: 10.1016/j.jagp.2017.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE As the number of older adults in the United States continues to grow, the population of older adults with severe mental illness in institutional settings (OASIS) is expected to place a significant demand on healthcare resources. This study presents an update to research regarding the clinical characteristics of OASIS inpatients with histories of extensive hospitalization through the use of a newly developed psychiatric measure: the Clinician-Rated Dimension of Psychosis Symptom Severity. METHODS We investigated an OASIS sample (N = 55) with an average of nearly 30 continuous years of hospitalization at a forensic state psychiatric hospital. RESULTS The average OASIS patient exhibited the most prominent psychiatric symptoms via delusions and negative symptoms, received psychotropic medications at substantially higher doses than recommended therapeutic levels, rarely committed acts of institutional violence (IV), and performed more than two standard deviations below the normative mean on cognitive testing. More severe hallucination symptoms were associated with higher psychotropic medication dosage, and more severe depressive symptoms were associated with more IV incidents. OASIS inpatients performed moderately worse than general psychiatric inpatients in the areas of overall cognition, immediate memory, and delayed memory; older age was associated with poorer language and attention. No psychiatric or cognitive factors predicted IV incidents. CONCLUSION These results highlight the continued importance of understanding the psychiatric, forensic, and cognitive factors associated with aging in an institutional setting and how these factors among OASIS inpatients may vary from general psychiatric inpatients.
Collapse
|
23
|
Collet J, de Vugt ME, Verhey FRJ, Engelen NJJA, Schols JMGA. Characteristics of double care demanding patients in a mental health care setting and a nursing home setting: results from the SpeCIMeN study. Aging Ment Health 2018; 22:33-39. [PMID: 27367644 DOI: 10.1080/13607863.2016.1202891] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Older patients suffering from a combination of psychiatric disorders and physical illnesses and/or dementia are called Double Care Demanding patients (DCDs). Special wards for DCDs within Dutch nursing homes (NHs) and mental health care institutions (MHCIs) offer a unique opportunity to obtain insight into the characteristics and needs of this challenging population. METHODS This observational cross-sectional study collected data from 163 DCDs admitted to either a NH or a MHCI providing specialized care for DCDs. Similarities and differences between both DCD groups are described. RESULTS Neuropsychiatric symptoms were highly prevalent in all DCDs but significantly more in MHCI-DCDs. Cognitive disorders were far more present in NH-DCDs, while MHCI-DCDs often suffered from multiple psychiatric disorders. The severity of comorbidities and care dependency were equally high among all DCDs. NH-DCDs expressed more satisfaction in overall quality of life. CONCLUSIONS The institutionalized elderly DCD population is very heterogeneous. Specific care arrangements are necessary because the severity of a patient's physical illness and the level of functional impairment seem to be equally important as the patient's behavioural, psychiatric and social problems. Further research should assess the adequacy of the setting assignment and the professional skills needed to provide adequate care for elderly DCDs.
Collapse
Affiliation(s)
- Janine Collet
- a Department of Family Medicine/Elderly Care Medicine and Department Health Services Research, School for Public Health and Primary Care (CAPHRI) , Maastricht University , Maastricht , The Netherlands.,c Department of Elderly , Mondriaan Mental Health Care , Heerlen , The Netherlands
| | - Marjolein E de Vugt
- b Department of Psychiatry and Psychology, School of Mental Health and Neuroscience , Maastricht University Medical Centre+, Alzheimer Centre Limburg , Maastricht , The Netherlands
| | - Frans R J Verhey
- b Department of Psychiatry and Psychology, School of Mental Health and Neuroscience , Maastricht University Medical Centre+, Alzheimer Centre Limburg , Maastricht , The Netherlands
| | - Noud J J A Engelen
- c Department of Elderly , Mondriaan Mental Health Care , Heerlen , The Netherlands
| | - Jos M G A Schols
- a Department of Family Medicine/Elderly Care Medicine and Department Health Services Research, School for Public Health and Primary Care (CAPHRI) , Maastricht University , Maastricht , The Netherlands
| |
Collapse
|
24
|
Wu C, Zheng Y, Li J, She S, Peng H, Li L. Cortical Gray Matter Loss, Augmented Vulnerability to Speech-on-Speech Masking, and Delusion in People With Schizophrenia. Front Psychiatry 2018; 9:287. [PMID: 30022955 PMCID: PMC6040158 DOI: 10.3389/fpsyt.2018.00287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/12/2018] [Indexed: 11/13/2022] Open
Abstract
People with schizophrenia exhibit impairments in target-speech recognition (TSR) against multiple-talker-induced informational speech masking. Up to date, the underlying neural mechanisms and its relationships with psychotic symptoms remain largely unknown. This study aimed to investigate whether the schizophrenia-associated TSR impairment contribute to certain psychotic symptoms by sharing underlying alternations in cortical gray-matter volume (GMV) with the psychotic symptoms. Participants with schizophrenia (N = 34) and their matched healthy controls (N = 29) were tested for TSR against a two-talker-speech masker. Psychotic symptoms of participants with schizophrenia were evaluated using the Positive and Negative Syndrome Scale. The regional GMV across various cortical regions was assessed using the voxel-based morphometry. The results of partial-correlation and mediation analyses showed that in participants with schizophrenia, the TSR was negatively correlated with the delusion severity, but positively with the GMV in the bilateral superior/middle temporal cortex, bilateral insular, left medial orbital frontal gyrus, left Rolandic operculum, left mid-cingulate cortex, left posterior fusiform, and left cerebellum. Moreover, the association between GMV and delusion was based on the mediating role played by the TSR performance. Thus, in people with schizophrenia, both delusions and the augmented vulnerability of TSR to informational masking are associated with each other and share the underlying cortical GMV reduction, suggesting that the origin of delusion in schizophrenia may be related to disorganized or limited informational processing (e.g., the incapability of adequately filtering information from multiple sources at the perceptual level). The TSR impairment can be a potential marker for predicting delusion severity.
Collapse
Affiliation(s)
- Chao Wu
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Yingjun Zheng
- Guangzhou Brain Hospital, Guangzhou Medical University, Guangzhou, China
| | - Juanhua Li
- Guangzhou Brain Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shenglin She
- Guangzhou Brain Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hongjun Peng
- Guangzhou Brain Hospital, Guangzhou Medical University, Guangzhou, China
| | - Liang Li
- School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, Key Laboratory on Machine Perception, Ministry of Education, Peking University, Beijing, China.,Beijing Institute for Brain Disorder, Capital Medical University, Beijing, China
| |
Collapse
|
25
|
Zheng Y, Ning Y, She S, Deng Y, Chen Y, Yi W, Lu X, Chen X, Li J, Li R, Zhang J, Xiao D, Wu H, Wu C. Psychotic Symptoms and Attitudes toward Medication Mediate the Effect of Insight on Personal-Social Functions in Patients with Schizophrenia: One-Year Randomized Controlled Trial and Follow-Up. Psychopathology 2018; 51:167-176. [PMID: 29444522 DOI: 10.1159/000486558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 12/26/2017] [Indexed: 01/26/2023]
Abstract
AIMS This study aimed to investigate the mediating pathway of 3 factors (psychotic symptoms, attitude toward medication, and cognitive processing speed) on the effect of insight on personal-social functioning in patients with schizophrenia. METHODS Chinese inpatients with schizophrenia (n = 168; mean age 18 ± 50 years) diagnosed according to the DSM-IV were randomly assigned to treatment with antipsychotic medication alone or combined treatment. Positive and Negative Syndrome Scale (PANSS), Drug Attitude Inventory (DAI), Assessment of Insight (SAI), and Social-Personal Performance Scale (PSPS) scores were evaluated at baseline and at 3, 6, and 12 months. Cognitive function was assessed at baseline. Multiple mediation analyses were conducted with baseline data, end point data, and changes-in-scale scores between baseline and the end point, respectively. RESULTS At baseline and at 12 months, only psychotic symptoms mediated the effect of insight on personal-social functioning. For changes-in-scale scores over the 12-month follow-up, in patients receiving treatment with medication alone, the effect of improved insight on improved personal-social function was mediated by psychotic symptoms only; in patients receiving a combined treatment, the effect of improved insight on improved personal-social functioning was mediated by both psychotic symptoms and attitudes toward medication, independently. CONCLUSIONS The link between insight and personal-social functions is mainly mediated by psychotic symptoms. Psychosocial intervention improves the predicting effect of insight on personal-social function by improving both the attitude toward medication and psychotic symptoms independently.
Collapse
Affiliation(s)
- Yingjun Zheng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yuping Ning
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Shenglin She
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yongjie Deng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yuwei Chen
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Wenying Yi
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xiaodan Lu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xinrui Chen
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Juanhua Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Ruikeng Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Jie Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Di Xiao
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Haibo Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Chao Wu
- Faculty of Psychology, Beijing Normal University, Beijing, China
| |
Collapse
|
26
|
Arime Y, Akiyama K. Abnormal neural activation patterns underlying working memory impairment in chronic phencyclidine-treated mice. PLoS One 2017; 12:e0189287. [PMID: 29253020 PMCID: PMC5734723 DOI: 10.1371/journal.pone.0189287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/23/2017] [Indexed: 11/18/2022] Open
Abstract
Working memory impairment is a hallmark feature of schizophrenia and is thought be caused by dysfunctions in the prefrontal cortex (PFC) and associated brain regions. However, the neural circuit anomalies underlying this impairment are poorly understood. The aim of this study is to assess working memory performance in the chronic phencyclidine (PCP) mouse model of schizophrenia, and to identify the neural substrates of working memory. To address this issue, we conducted the following experiments for mice after withdrawal from chronic administration (14 days) of either saline or PCP (10 mg/kg): (1) a discrete paired-trial variable-delay task in T-maze to assess working memory, and (2) brain-wide c-Fos mapping to identify activated brain regions relevant to this task performance either 90 min or 0 min after the completion of the task, with each time point examined under working memory effort and basal conditions. Correct responses in the test phase of the task were significantly reduced across delays (5, 15, and 30 s) in chronic PCP-treated mice compared with chronic saline-treated controls, suggesting delay-independent impairments in working memory in the PCP group. In layer 2-3 of the prelimbic cortex, the number of working memory effort-elicited c-Fos+ cells was significantly higher in the chronic PCP group than in the chronic saline group. The main effect of working memory effort relative to basal conditions was to induce significantly increased c-Fos+ cells in the other layers of prelimbic cortex and the anterior cingulate and infralimbic cortex regardless of the different chronic regimens. Conversely, this working memory effort had a negative effect (fewer c-Fos+ cells) in the ventral hippocampus. These results shed light on some putative neural networks relevant to working memory impairments in mice chronically treated with PCP, and emphasize the importance of the layer 2-3 of the prelimbic cortex of the PFC.
Collapse
Affiliation(s)
- Yosefu Arime
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
- * E-mail:
| | - Kazufumi Akiyama
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| |
Collapse
|
27
|
Geng CH, Wang C, Yang J, Wang H, Ma RQ, Liu X, Wang CH. Arginine vasopressin improves the memory deficits in Han Chinese patients with first-episode schizophrenia. Peptides 2017; 97:8-15. [PMID: 28882471 DOI: 10.1016/j.peptides.2017.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 08/29/2017] [Accepted: 09/02/2017] [Indexed: 11/18/2022]
Abstract
The memory impairment is a core deficit in the first-episode schizophrenia patients. Arginine vasopressin (AVP) in the brain can improve learning and memory. We performed multicentre, randomized, double-blind, placebo-controlled, parallel-group clinical trial to study the cognitive functioning in Han Chinese first-episode schizophrenic patients in a 12-week treatment regime with the intranasal administration of AVP (128 cases) or placebo (131 cases) in addition to the conventional treatment. The methods of positive and negative syndrome scale (PANSS), Wechsler memory scale-4th edition (WMS-IV) and event-related potential (ERP) were used to study the effects of AVP on the cognitive function. The results showed that (1) AVP concentration decreased in cerebrospinal fluid (CSF) of the right-handed Han Chinese first-episode schizophrenic patients comparing with that of the health volunteers (7.1±1.5pg/ml vs 13.3±1.9pg/ml, p<0.01), and did not change in plasma; (2) AVP significantly improved PANSS scores including total scores, positive symptoms, negative symptoms and general psychopathology comparing with those of the placebo group; (3) AVP elevated WMS-IV scores including the long-term memory (accumulation), short-term memory (recognition, comprehension), immediate memory (number recitation) and memory quotient 4, 8 and 12 weeks after treatment; and (4) AVP did not influence the latency and wave amplitude of target stimulus of P300 of right-handed Han Chinese first-episode schizophrenic patients. The data suggested that AVP might improve cognitive process, such as memorizing and extraction of the information although there were many changes of cognitive functions in the right-handed Han Chinese first-episode schizophrenic patients.
Collapse
Affiliation(s)
- Cai-Hong Geng
- The Second Affiliated Hospital of Xinxiang Medical University and Henan Province Mental Hospital, Xinxiang, Henan 453002, China
| | - Chao Wang
- The Second Affiliated Hospital of Xinxiang Medical University and Henan Province Mental Hospital, Xinxiang, Henan 453002, China
| | - Jun Yang
- Xinxiang Institute for New Medicine, Xinxing, Henan 453003, China; Xinjiang Hongda Food & Beverage Ltd., Xinjiang, Shanxi 043110, China.
| | - Hua Wang
- Xinxiang Institute for New Medicine, Xinxing, Henan 453003, China; Xinjiang Hongda Food & Beverage Ltd., Xinjiang, Shanxi 043110, China
| | - Rui-Qing Ma
- Xinxiang Institute for New Medicine, Xinxing, Henan 453003, China
| | - Xu Liu
- The Second Affiliated Hospital of Xinxiang Medical University and Henan Province Mental Hospital, Xinxiang, Henan 453002, China
| | - Chang-Hong Wang
- The Second Affiliated Hospital of Xinxiang Medical University and Henan Province Mental Hospital, Xinxiang, Henan 453002, China
| |
Collapse
|
28
|
Joseph J, Kremen WS, Franz CE, Glatt SJ, van de Leemput J, Chandler SD, Tsuang MT, Twamley EW. Predictors of current functioning and functional decline in schizophrenia. Schizophr Res 2017; 188:158-164. [PMID: 28139356 PMCID: PMC5529271 DOI: 10.1016/j.schres.2017.01.038] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 12/19/2022]
Abstract
Positive, negative, and cognitive symptoms of schizophrenia may affect functional outcomes. However, these factors alone do not account for a large percentage of variance in outcomes. We investigated demographic, cognitive, symptom, and functional capacity predictors of current functional status in 280 outpatients with schizophrenia or schizoaffective disorder. Functional decline over the lifespan was also examined in a subset of participants. Stepwise regressions modeled predictors of current functional status and functional decline as measured by the Assessment of Lifespan Functioning Attainment (ALFA). ALFA functional domains included paid employment, independence in living situation, romantic relationships, close friendships, and recreational engagement. More severe depressive symptoms were consistently associated with worse current community integration (lower levels of close friendships and recreational engagement). Better working memory performance was associated with higher rates of current paid employment. There were no consistent modifiable predictors of decline in functioning, but women reported less functional decline in the domains of employment and close friendships than men. Better cognitive performance was associated with less decline in living independence and romantic relationships, but more decline in paid employment and recreational engagement. Increased assessment and treatment of comorbid depressive symptoms may improve functional outcomes in people with schizophrenia.
Collapse
Affiliation(s)
- Jamie Joseph
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - William S Kremen
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
| | - Carol E Franz
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Stephen J Glatt
- Psychiatric Genetic Epidemiology & Neurobiology Laboratory, Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, 3710 Neuroscience Research Building, Syracuse, NY 13210, USA
| | - Joyce van de Leemput
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Sharon D Chandler
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Ming T Tsuang
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA; Institute for Genomic Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Elizabeth W Twamley
- Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
| |
Collapse
|
29
|
Molinari V, Hobday JV, Roker R, Kunik ME, Kane R, Kaas MJ, Mehrotra C, Williams CL, Robbins JC, Dobbs D. Impact of serious mental illness online training for certified nursing assistants in long term care. GERONTOLOGY & GERIATRICS EDUCATION 2017; 38:359-374. [PMID: 28632071 PMCID: PMC6192676 DOI: 10.1080/02701960.2016.1188811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Certified nurse assistants (CNAs) spend the most staff time with nursing home residents, yet they receive little training in addressing the mental health needs of residents with serious mental illness (SMI). Forty CNAs from four long-term-care facilities took the online interactive CARES-® Serious Mental Illness™ training consisting of two modules guided by the Recovery Movement philosophy of care. Responses from pre-post testing, Likert-type items, and open-ended questions indicated that CNAs gained information, changed their perspectives, and had more confidence in dealing with SMI. Although there were minor concerns regarding length, clarity of content, and technical issues, CNAs found the online format acceptable and easy to use, and many said they would recommend the training. CARES Serious Mental Illness online training appears to be a viable way of helping CNAs address the mental health needs of long term care residents. Additional testing on CARES Serious Mental Illness is planned.
Collapse
Affiliation(s)
- Victor Molinari
- a University of South Florida , School of Aging Studies , Tampa , Florida USA
| | - John V Hobday
- b HealthCare Interactive, Inc. , Minneapolis , Minnesota USA
| | - Rosalyn Roker
- a University of South Florida , School of Aging Studies , Tampa , Florida USA
| | - Mark E Kunik
- c Michael E. DeBakey VA Medical Center, Houston, Texas USA and Baylor College of Medicine , Houston , Texas USA
| | - Rosalie Kane
- d University of Minnesota , Center on Aging , Minneapolis , Minnesota USA
| | - Merrie J Kaas
- e University of Minnesota , School of Nursing , Minneapolis , Minnesota USA
| | | | | | - Joyce C Robbins
- h HealthCare Interactive, Inc. , Minneapolis , Minnesota USA
| | - Debra Dobbs
- i University of South Florida , Tampa , Florida USA
| |
Collapse
|
30
|
Synthesis and biological investigation of tetrahydropyridopyrimidinone derivatives as potential multireceptor atypical antipsychotics. Bioorg Med Chem 2017; 25:4904-4916. [DOI: 10.1016/j.bmc.2017.07.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/21/2017] [Accepted: 07/23/2017] [Indexed: 12/25/2022]
|
31
|
Kumar S, Mulsant BH, Tsoutsoulas C, Ghazala Z, Voineskos AN, Bowie CR, Rajji TK. An optimal combination of MCCB and CANTAB to assess functional capacity in older individuals with schizophrenia. Int J Geriatr Psychiatry 2016; 31:1116-23. [PMID: 27428251 DOI: 10.1002/gps.4547] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/08/2016] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Cognitive deficits predict functional capacity in patients with schizophrenia including in late life. The MATRICS Consensus Cognitive Battery (MCCB) and the Cambridge Neuropsychological Test Automated Battery (CANTAB) are widely used to assess cognition in this population. The aim of this study was to determine a minimal set of subtests across the two batteries that would be strongly associated with functional capacity in older patients with schizophrenia. METHODS Sixty participants age 50 years or older with a diagnosis of schizophrenia or schizoaffective disorder and 30 control participants were enrolled. Cognition was assessed using the MCCB and the CANTAB. Functional capacity was assessed using the USCD Performance-based Skills Assessment (UPSA). Stepwise linear regressions were performed to determine the best set of cognitive tests associated with functional capacity. RESULTS UPSA total score was negatively correlated with age and positively correlated with education and the MCCB global score. Most of the MCCB domains and subtests, and several of the CANTAB subtests correlated with UPSA total score. In the regression model, MCCB global score accounted for 42.5% of UPSA variance. In contrast, a combination of only four subtests (processing speed and verbal learning from the MCCB, and affective information processing and working memory from the CANTAB) accounted for 60% of UPSA variance. CONCLUSIONS Performance on MCCB and CANTAB is strongly associated with functional capacity in older patients with schizophrenia. A selective combination of MCCB and CANTAB subtests may be as effective in assessing functional capacity in late life schizophrenia. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Sanjeev Kumar
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada. .,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Benoit H Mulsant
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Zaid Ghazala
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Aristotle N Voineskos
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Christopher R Bowie
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, Queens University, Kingston, ON, Canada
| | - Tarek K Rajji
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Canada
| |
Collapse
|
32
|
Choy KHC, Shackleford DM, Malone DT, Mistry SN, Patil RT, Scammells PJ, Langmead CJ, Pantelis C, Sexton PM, Lane JR, Christopoulos A. Positive Allosteric Modulation of the Muscarinic M1 Receptor Improves Efficacy of Antipsychotics in Mouse Glutamatergic Deficit Models of Behavior. J Pharmacol Exp Ther 2016; 359:354-365. [PMID: 27630144 DOI: 10.1124/jpet.116.235788] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/13/2016] [Indexed: 12/14/2022] Open
Abstract
Current antipsychotics are effective in treating the positive symptoms associated with schizophrenia, but they remain suboptimal in targeting cognitive dysfunction. Recent studies have suggested that positive allosteric modulation of the M1 muscarinic acetylcholine receptor (mAChR) may provide a novel means of improving cognition. However, very little is known about the potential of combination therapies in extending coverage across schizophrenic symptom domains. This study investigated the effect of the M1 mAChR positive allosteric modulator BQCA [1-(4-methoxybenzyl)-4-oxo-1,4-dihydroquinoline-3-carboxylic acid], alone or in combination with haloperidol (a first-generation antipsychotic), clozapine (a second-generation atypical antipsychotic), or aripiprazole (a third-generation atypical antipsychotic), in reversing deficits in sensorimotor gating and spatial memory induced by the N-methyl-d-aspartate receptor antagonist, MK-801 [(5R,10S)-(+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine]. Sensorimotor gating and spatial memory induction are two models that represent aspects of schizophrenia modeled in rodents. In prepulse inhibition (an operational measure of sensorimotor gating), BQCA alone had minimal effects but exhibited different levels of efficacy in reversing MK-801-induced prepulse inhibition disruptions when combined with a subeffective dose of each of the three (currently prescribed) antipsychotics. Furthermore, the combined effect of BQCA and clozapine was absent in M1-/- mice. Interestingly, although BQCA alone had no effect in reversing MK-801-induced memory impairments in a Y-maze spatial test, we observed a reversal upon the combination of BQCA with atypical antipsychotics, but not with haloperidol. These findings provide proof of concept that a judicious combination of existing antipsychotics with a selective M1 mAChR positive allosteric modulator can extend antipsychotic efficacy in glutamatergic deficit models of behavior.
Collapse
Affiliation(s)
- Kwok H C Choy
- Drug Discovery Biology (K.H.C.C., D.T.M, C.J.L, P.M.S, J.R.L, A.C.), Centre for Drug Candidate Optimization (D.M.S., R.T.P.), and Medicinal Chemistry (S.N.M, P.J.S.), Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia; and Melbourne Neuropsychiatry Centre, Department of Psychiatry and Centre for Neural Engineering, University of Melbourne, Melbourne, Australia (C.P.)
| | - David M Shackleford
- Drug Discovery Biology (K.H.C.C., D.T.M, C.J.L, P.M.S, J.R.L, A.C.), Centre for Drug Candidate Optimization (D.M.S., R.T.P.), and Medicinal Chemistry (S.N.M, P.J.S.), Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia; and Melbourne Neuropsychiatry Centre, Department of Psychiatry and Centre for Neural Engineering, University of Melbourne, Melbourne, Australia (C.P.)
| | - Daniel T Malone
- Drug Discovery Biology (K.H.C.C., D.T.M, C.J.L, P.M.S, J.R.L, A.C.), Centre for Drug Candidate Optimization (D.M.S., R.T.P.), and Medicinal Chemistry (S.N.M, P.J.S.), Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia; and Melbourne Neuropsychiatry Centre, Department of Psychiatry and Centre for Neural Engineering, University of Melbourne, Melbourne, Australia (C.P.)
| | - Shailesh N Mistry
- Drug Discovery Biology (K.H.C.C., D.T.M, C.J.L, P.M.S, J.R.L, A.C.), Centre for Drug Candidate Optimization (D.M.S., R.T.P.), and Medicinal Chemistry (S.N.M, P.J.S.), Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia; and Melbourne Neuropsychiatry Centre, Department of Psychiatry and Centre for Neural Engineering, University of Melbourne, Melbourne, Australia (C.P.)
| | - Rahul T Patil
- Drug Discovery Biology (K.H.C.C., D.T.M, C.J.L, P.M.S, J.R.L, A.C.), Centre for Drug Candidate Optimization (D.M.S., R.T.P.), and Medicinal Chemistry (S.N.M, P.J.S.), Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia; and Melbourne Neuropsychiatry Centre, Department of Psychiatry and Centre for Neural Engineering, University of Melbourne, Melbourne, Australia (C.P.)
| | - Peter J Scammells
- Drug Discovery Biology (K.H.C.C., D.T.M, C.J.L, P.M.S, J.R.L, A.C.), Centre for Drug Candidate Optimization (D.M.S., R.T.P.), and Medicinal Chemistry (S.N.M, P.J.S.), Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia; and Melbourne Neuropsychiatry Centre, Department of Psychiatry and Centre for Neural Engineering, University of Melbourne, Melbourne, Australia (C.P.)
| | - Christopher J Langmead
- Drug Discovery Biology (K.H.C.C., D.T.M, C.J.L, P.M.S, J.R.L, A.C.), Centre for Drug Candidate Optimization (D.M.S., R.T.P.), and Medicinal Chemistry (S.N.M, P.J.S.), Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia; and Melbourne Neuropsychiatry Centre, Department of Psychiatry and Centre for Neural Engineering, University of Melbourne, Melbourne, Australia (C.P.)
| | - Christos Pantelis
- Drug Discovery Biology (K.H.C.C., D.T.M, C.J.L, P.M.S, J.R.L, A.C.), Centre for Drug Candidate Optimization (D.M.S., R.T.P.), and Medicinal Chemistry (S.N.M, P.J.S.), Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia; and Melbourne Neuropsychiatry Centre, Department of Psychiatry and Centre for Neural Engineering, University of Melbourne, Melbourne, Australia (C.P.)
| | - Patrick M Sexton
- Drug Discovery Biology (K.H.C.C., D.T.M, C.J.L, P.M.S, J.R.L, A.C.), Centre for Drug Candidate Optimization (D.M.S., R.T.P.), and Medicinal Chemistry (S.N.M, P.J.S.), Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia; and Melbourne Neuropsychiatry Centre, Department of Psychiatry and Centre for Neural Engineering, University of Melbourne, Melbourne, Australia (C.P.)
| | - Johnathan R Lane
- Drug Discovery Biology (K.H.C.C., D.T.M, C.J.L, P.M.S, J.R.L, A.C.), Centre for Drug Candidate Optimization (D.M.S., R.T.P.), and Medicinal Chemistry (S.N.M, P.J.S.), Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia; and Melbourne Neuropsychiatry Centre, Department of Psychiatry and Centre for Neural Engineering, University of Melbourne, Melbourne, Australia (C.P.)
| | - Arthur Christopoulos
- Drug Discovery Biology (K.H.C.C., D.T.M, C.J.L, P.M.S, J.R.L, A.C.), Centre for Drug Candidate Optimization (D.M.S., R.T.P.), and Medicinal Chemistry (S.N.M, P.J.S.), Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia; and Melbourne Neuropsychiatry Centre, Department of Psychiatry and Centre for Neural Engineering, University of Melbourne, Melbourne, Australia (C.P.)
| |
Collapse
|
33
|
Olsson AK, Hjärthag F, Helldin L. Predicting real-world functional milestones in schizophrenia. Psychiatry Res 2016; 242:1-6. [PMID: 27235985 DOI: 10.1016/j.psychres.2016.05.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 03/13/2016] [Accepted: 05/10/2016] [Indexed: 11/24/2022]
Abstract
Schizophrenia is a severe disorder that often causes impairments in major areas of functioning, and most patients do not achieve expected real-world functional milestones. The aim of this study was to identify which variables of demography, illness activity, and functional capacity predict patients' ability to attain real-world functional milestones. Participants were 235 outpatients, 149 men and 86 women, diagnosed with schizophrenia spectrum disorder. Our results showed that younger patients managed to achieve a higher level of functioning in educational level, marital status, and social contacts. Patients' functional capacity was primarily associated with educational level and housing situation. We also found that women needed less support regarding housing and obtained a higher level of marital status as compared with men. Our findings demonstrate the importance of considering current symptoms, especially negative symptoms, and remission stability over time, together with age, duration of illness, gender, educational level, and current functional capacity, when predicting patients' future real-world functioning. We also conclude that there is an advantage in exploring symptoms divided into positive, negative, and general domains considering their probable impact on functional achievements.
Collapse
Affiliation(s)
- Anna-Karin Olsson
- Department of Psychiatry, NU Health Care, Trollhättan, Sweden; Department of Psychology, Karlstad University, Karlstad, Sweden.
| | | | - Lars Helldin
- Department of Psychiatry, NU Health Care, Trollhättan, Sweden; Department of Psychology, Karlstad University, Karlstad, Sweden
| |
Collapse
|
34
|
Chiang SK, Ni CH, Tsai CP, Lin KC. Validation of the cognitively normal range and below normal range subtypes in chronically hospitalized patients with schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2016; 5:28-34. [PMID: 28740814 PMCID: PMC5514302 DOI: 10.1016/j.scog.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/26/2016] [Accepted: 06/20/2016] [Indexed: 12/29/2022]
Abstract
Background Many studies have found a substantial minority of patients whose performance puts them within the normal range of neuropsychological functioning. Recently, a study has seen the delineation of two neurocognitive subtypes of schizophrenia –‘cognitively normal range’ (CNR) and ‘below normal range’ (BNR) – based on neurocognitive performance across multiple domains. Methods The participants were from two studies that collected neurocognitive, psychopathology and social function data between 2008 and 2015. In total the complete data from one hundred and thirty one patients of Han Chinese ethnicity with schizophrenia were collected on 21 neurocognitive indexes (assessing the domains of processing speed, attention, working memory, verbal memory, visual memory, reasoning and problem solving and IQ). Fifty-five patients of the one hundred and thirty one participants received additional ratings on their psychopathology and social functions. An exploratory graphic analysis was conducted on the neurocognitive measures for the entire sample. Difference analyses were also performed according to the aims of the study using the Independent t test, Chi-square test, and Cohen's d effect size. Results Analyses revealed the existence of two patients subtypes. The post hoc tests showed that there were significant differences on all of their neurocognitive measures and on most of the psychopathology and social functions between the two subtypes. These two subtypes could be referred to as the CNR subtype and the BNR subtype respectively. Conclusions There are neurocognitive subtypes of schizophrenia with differential illness characteristics comparable with the CNR and the BNR in patients of Han Chinese ethnicity with schizophrenia.
Collapse
Affiliation(s)
- Shih-Kuang Chiang
- Department of Counseling and Clinical Psychology, National Dong Hwa University, No. 1, Sec. 2, Da Hsueh Rd., Shoufeng, Hualien, 97401, Taiwan (R.O.C)
| | - Ching-Huan Ni
- Department of Counseling and Clinical Psychology, National Dong Hwa University, No. 1, Sec. 2, Da Hsueh Rd., Shoufeng, Hualien, 97401, Taiwan (R.O.C)
| | - Chih-Pu Tsai
- Department of Psychiatry, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st. Rd., Lingya District, Kaohsiung City 80284, Taiwan (R.O.C)
| | - Keng-Chang Lin
- Department of Clinical Psychology, Kaohsiung, Municipal Kai-Syuan Psychiatric Hospital, No.130, Kaisyuan 2nd Rd., Lingya Dist., Kaohsiung City 80276, Taiwan (R.O.C)
| |
Collapse
|
35
|
Goozee R, Reinders AATS, Handley R, Marques T, Taylor H, O'Daly O, McQueen G, Hubbard K, Mondelli V, Pariante C, Dazzan P. Effects of aripiprazole and haloperidol on neural activation during the n-back in healthy individuals: A functional MRI study. Schizophr Res 2016; 173:174-181. [PMID: 25778615 DOI: 10.1016/j.schres.2015.02.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 02/23/2015] [Accepted: 02/25/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Antipsychotic drugs target neurotransmitter systems that play key roles in working memory. Therefore, they may be expected to modulate this cognitive function via their actions at receptors for these neurotransmitters. However, the precise effects of antipsychotic drugs on working memory function remain unclear. Most studies have been carried out in clinical populations, making it difficult to disentangle pharmacological effects from pathology-related brain activation. In this study, we aim to investigate the effects of two antipsychotic compounds on brain activation during working memory in healthy individuals. This would allow elucidation of the effects of current antipsychotic treatments on brain function, independently of either previous antipsychotic use or disease-related pathology. METHODS We carried out a fully counterbalanced, randomised within-subject, double-blinded and placebo-controlled, cross-over study of the effects of two antipsychotic drugs on working memory function in 17 healthy individuals, using the n-back task. Participants completed the functional MRI task on three separate occasions (in randomised order): following placebo, haloperidol, and aripiprazole. For each condition, working memory ability was investigated, and maps of neural activation were entered into a random effects general linear regression model to investigate main working memory function and linear load. Voxel-wise and region of interest analyses were conducted to attain regions of altered brain activation for each intervention. RESULTS Aripiprazole did not lead to any changes in neural activation compared with placebo. However, reaction time to a correct response was significantly increased following aripiprazole compared to both placebo (p=0.046) and haloperidol (p=0.02). In contrast, compared to placebo, haloperidol dampened activation in parietal (BA 7/40; left: FWE-corr. p=0.005; FWE-corr. right: p=0.007) and frontal (including prefrontal; BA 9/44/46; left: FWE-corr. p=0.009; right: FWE-corr. p=0.014) cortices and the left putamen (FWE-corr. p=0.004). Compared with aripiprazole, haloperidol dampened activation in parietal cortex (BA7/40; left: FWE-corr. p=0.034; right: FWE-corr. p=0.045) and the left putamen (FWE-corr.p=0.015). Haloperidol had no effect on working memory performance compared with placebo. CONCLUSION Cognitive functions are known to be impaired in schizophrenia and as such are an important target of treatments. Elucidating the mechanisms by which antipsychotic medications alter brain activation underlying cognition is essential to advance pharmacological treatment of this disorder. Studies in healthy individuals can help elucidate some of these mechanisms, whilst limiting the confounding effect of the underlying disease-related pathology. Our study provides evidence for immediate and differential effects of single-dose haloperidol and aripiprazole on brain activation during working memory in healthy individuals. We propose that these differences likely reflect their different receptor affinity profiles, although the precise mechanisms underlying these differences remain unclear.
Collapse
Affiliation(s)
- Rhianna Goozee
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK.
| | - Antje A T S Reinders
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | | | - Tiago Marques
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - Heather Taylor
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - Owen O'Daly
- Centre for Neuroimaging Sciences (CNS), King's College London, UK
| | - Grant McQueen
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - Kathryn Hubbard
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK; NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Carmine Pariante
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK; NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK; NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| |
Collapse
|
36
|
Schulz S, Bolz M, Bär KJ, Voss A. Central- and autonomic nervous system coupling in schizophrenia. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2016; 374:rsta.2015.0178. [PMID: 27044986 PMCID: PMC4822441 DOI: 10.1098/rsta.2015.0178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 05/03/2023]
Abstract
The autonomic nervous system (ANS) dysfunction has been well described in schizophrenia (SZ), a severe mental disorder. Nevertheless, the coupling between the ANS and central brain activity has been not addressed until now in SZ. The interactions between the central nervous system (CNS) and ANS need to be considered as a feedback-feed-forward system that supports flexible and adaptive responses to specific demands. For the first time, to the best of our knowledge, this study investigates central-autonomic couplings (CAC) studying heart rate, blood pressure and electroencephalogram in paranoid schizophrenic patients, comparing them with age-gender-matched healthy subjects (CO). The emphasis is to determine how these couplings are composed by the different regulatory aspects of the CNS-ANS. We found that CAC were bidirectional, and that the causal influence of central activity towards systolic blood pressure was more strongly pronounced than such causal influence towards heart rate in paranoid schizophrenic patients when compared with CO. In paranoid schizophrenic patients, the central activity was a much stronger variable, being more random and having fewer rhythmic oscillatory components. This study provides a more in-depth understanding of the interplay of neuronal and autonomic regulatory processes in SZ and most likely greater insights into the complex relationship between psychotic stages and autonomic activity.
Collapse
Affiliation(s)
- Steffen Schulz
- Institute of Innovative Health Technologies, University of Applied Sciences, Jena, Germany
| | - Mathias Bolz
- Department of Child and Adolescent Psychiatry, Pain and Autonomics-Integrative Research, University Hospital, Jena, Germany
| | - Karl-Jürgen Bär
- Department of Psychiatry and Psychotherapy, Pain and Autonomics-Integrative Research, University Hospital, Jena, Germany
| | - Andreas Voss
- Institute of Innovative Health Technologies, University of Applied Sciences, Jena, Germany
| |
Collapse
|
37
|
Hernandez K, Swiatkowski P, Patel MV, Liang C, Dudzinski NR, Brzustowicz LM, Firestein BL. Overexpression of Isoforms of Nitric Oxide Synthase 1 Adaptor Protein, Encoded by a Risk Gene for Schizophrenia, Alters Actin Dynamics and Synaptic Function. Front Cell Neurosci 2016; 10:6. [PMID: 26869880 PMCID: PMC4735351 DOI: 10.3389/fncel.2016.00006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 01/11/2016] [Indexed: 11/13/2022] Open
Abstract
Proper communication between neurons depends upon appropriate patterning of dendrites and correct distribution and structure of spines. Schizophrenia is a neuropsychiatric disorder characterized by alterations in dendrite branching and spine density. Nitric oxide synthase 1 adaptor protein (NOS1AP), a risk gene for schizophrenia, encodes proteins that are upregulated in the dorsolateral prefrontal cortex (DLPFC) of individuals with schizophrenia. To elucidate the effects of NOS1AP overexpression observed in individuals with schizophrenia, we investigated changes in actin dynamics and spine development when a long (NOS1AP-L) or short (NOS1AP-S) isoform of NOS1AP is overexpressed. Increased NOS1AP-L protein promotes the formation of immature spines when overexpressed in rat cortical neurons from day in vitro (DIV) 14 to DIV 17 and reduces the amplitude of miniature excitatory postsynaptic currents (mEPSCs). In contrast, increased NOS1AP-S protein increases the rate of actin polymerization and the number of immature and mature spines, which may be attributed to a decrease in total Rac1 expression and a reduction in the levels of active cofilin. The increase in the number of mature spines by overexpression of NOS1AP-S is accompanied by an increase in the frequency of mEPSCs. Our findings show that overexpression of NOS1AP-L or NOS1AP-S alters the actin cytoskeleton and synaptic function. However, the mechanisms by which these isoforms induce these changes are distinct. These results are important for understanding how increased expression of NOS1AP isoforms can influence spine development and synaptic function.
Collapse
Affiliation(s)
- Kristina Hernandez
- Department of Cell Biology and Neuroscience, Human Genetics Institute of New Jersey, Rutgers—The State University of New JerseyPiscataway, NJ, USA
| | - Przemyslaw Swiatkowski
- Department of Cell Biology and Neuroscience, Rutgers—The State University of New JerseyPiscataway, NJ, USA
| | - Mihir V. Patel
- Department of Cell Biology and Neuroscience, Rutgers—The State University of New JerseyPiscataway, NJ, USA
| | - Chen Liang
- Department of Cell Biology and Neuroscience, Rutgers—The State University of New JerseyPiscataway, NJ, USA
| | - Natasha R. Dudzinski
- Department of Cell Biology and Neuroscience, Rutgers—The State University of New JerseyPiscataway, NJ, USA
| | - Linda M. Brzustowicz
- Department of Genetics, Human Genetics Institute of New Jersey, Rutgers—The State University of New JerseyPiscataway, NJ, USA
| | - Bonnie L. Firestein
- Department of Cell Biology and Neuroscience, Human Genetics Institute of New Jersey, Rutgers—The State University of New JerseyPiscataway, NJ, USA
| |
Collapse
|
38
|
Kim SJ, Shim JC, Kong BG, Kang JW, Moon JJ, Jeon DW, Jung SS, Seo BJ, Jung DU. The Relationship between Language Ability and Cognitive Function in Patients with Schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2015; 13:288-95. [PMID: 26598588 PMCID: PMC4662174 DOI: 10.9758/cpn.2015.13.3.288] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/30/2015] [Accepted: 07/27/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Cognitive dysfunction is common in people with schizophrenia, and language disability is one of the most notable cognitive deficits. This study assessed the use and comprehension ability of the Korean language in patients with schizophrenia and the correlations between language ability and cognitive function. METHODS Eighty-six patients with schizophrenia and a group of 29 healthy controls were recruited. We assessed both clinical symptoms and cognitive functions including Korean language ability. For clinical symptoms, the Positive and Negative Syndrome Scale, Clinical Global Impression-Schizophrenia Scale, and Social and Occupational Functioning Assessment Scale were used. For the Korean language ability assessment, a portion of the Korean Broadcasting System (KBS) Korean Language Test was used. The Short-form of Korean-Wechsler Adult Intelligence Scale, the Korean version of the University of California San Diego (UCSD) Performance-based Skills Assessment (K-UPSA), and the Wisconsin Card Sorting Test (WCST) were used to assess cognitive functions. RESULTS Schizophrenic patients had significantly lower scores in the language and cognitive function tests both in the total and subscale scores. Various clinical scores had negative correlations with reading comprehension ability of the KBS Korean Language Test. The WCST and a part of the K-UPSA had positive correlations with multiple domains of the language test. CONCLUSION A significant difference was found between schizophrenic patients and controls in language ability. Correlations between Korean language ability and several clinical symptoms and cognitive functions were demonstrated in patients with schizophrenia. Tests of cognitive function had positive correlations with different aspects of language ability.
Collapse
Affiliation(s)
- Sung-Jin Kim
- Department of Psychiatry, Inje University Busan Paik Hospital, Busan, Korea
| | | | - Bo-Geum Kong
- Department of Psychiatry, Inje University Busan Paik Hospital, Busan, Korea
| | - Je-Wook Kang
- Department of Psychiatry, Inje University Busan Paik Hospital, Busan, Korea
| | - Jung-Joon Moon
- Department of Psychiatry, Inje University Busan Paik Hospital, Busan, Korea
| | - Dong-Wook Jeon
- Department of Psychiatry, Inje University Busan Paik Hospital, Busan, Korea
| | - Sung-Soo Jung
- Department of Psychiatry, Sharing and Happiness Hospital, Busan, Korea
| | - Beom-Joo Seo
- Department of Psychiatry, Busan Metropolitan Mental Hospital, Busan, Korea
| | - Do-Un Jung
- Department of Psychiatry, Inje University Busan Paik Hospital, Busan, Korea
| |
Collapse
|
39
|
Laurenson C, Gorwood P, Orsat M, Lhuillier JP, Le Gall D, Richard-Devantoy S. Cognitive control and schizophrenia: The greatest reliability of the Stroop task. Psychiatry Res 2015; 227:10-6. [PMID: 25800118 DOI: 10.1016/j.psychres.2015.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 02/16/2015] [Accepted: 03/03/2015] [Indexed: 02/02/2023]
Abstract
Three components of cognitive inhibition were compared in patients with schizophrenia and healthy controls. Nineteen patients with schizophrenia were compared to 30 healthy controls, matched for age, sex, and educational level. Cognitive inhibition was examined by (i) access to relevant information (Reading with distraction task), (ii) suppression of no longer relevant information (Trail Making Test B), and (iii) restraint of cognitive resources to relevant information (Stroop Test, Hayling Sentence Completion Test, Go/No-Go Test). Beck Depression Inventory, and Positive and Negative Syndrome Scale were also used. Compared to healthy controls, patients with schizophrenia and stabilized for at least 6 months were slower in the inhibition condition at the Stroop task, read more distractors at the RWD, and made more perseverative errors at the TMT, even after controlling for age, Mini-Mental State Examination score, information speed processing, and accuracy. This difference remained significant after taking into account the level of depressive symptoms and the severity of psychotic symptoms. In multivariate analyses, only the Stroop interference index explained cognitive inhibition deficit in patients with schizophrenia. The abnormal cognitive inhibition process observed in patients with schizophrenia could therefore concerns the ability to restraint, rather than the access or the suppression processes.
Collapse
Affiliation(s)
- Charlotte Laurenson
- Laboratoire de Psychologie des Pays de la Loire, UPRES EA 4638, Université d׳Angers, Angers, France
| | - Philip Gorwood
- CMME (Groupe Hospitalier Sainte-Anne), Université Paris Descartes, et INSERM U894, Center of Psychiatry and Neurosciences, Paris 75014, France
| | - Manuel Orsat
- Pôle 1-6, Center Hospitalier Spécialisé de la Sarthe, 20 avenue du 19 mars 1962, 72703 Allonnes Cédex, France
| | - Jean-Paul Lhuillier
- Secteur 7, CESAME, CHS, Ste Gemmes sur Loire, 27 route de Bouchemaine, 49050 Les Ponts-de-cé, France
| | - Didier Le Gall
- Laboratoire de Psychologie des Pays de la Loire, UPRES EA 4638, Université d׳Angers, Angers, France
| | - Stéphane Richard-Devantoy
- Laboratoire de Psychologie des Pays de la Loire, UPRES EA 4638, Université d׳Angers, Angers, France; McGill University, Department of Psychiatry & Douglas Mental Health University Institute McGill Group for Suicide Studies, Montréal (Québec), Canada.
| |
Collapse
|
40
|
Moore RC, Fazeli PL, Patterson TL, Depp CA, Moore DJ, Granholm E, Jeste DV, Mausbach BT. UPSA-M: Feasibility and initial validity of a mobile application of the UCSD Performance-Based Skills Assessment. Schizophr Res 2015; 164:187-92. [PMID: 25790903 PMCID: PMC4409538 DOI: 10.1016/j.schres.2015.02.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/17/2015] [Accepted: 02/22/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to develop and validate a tablet mobile application version of the UCSD Performance-Based Skills Assessment (UPSA-M), a widely used test for assessing functional capacity in schizophrenia and other neurocognitively impaired patient populations. METHODS The UPSA-M was developed for an iPad platform. Twenty-one middle-aged and older adults with schizophrenia and 13 healthy comparison (HC) participants completed a brief iPad tutorial, followed by the UPSA-M (full version, which includes all components of Brief UPSA-M) and a computer usage questionnaire. During a separate visit, patients with schizophrenia and HC participants completed the Brief UPSA (UPSA-B), and patients with schizophrenia completed a symptom inventory and brief neuropsychological screening battery. RESULTS The UPSA-M was feasible for use among middle aged and older adults with schizophrenia with no prior history of tablet usage. The UPSA-M was able to differentiate between schizophrenia and HC participants 80% of the time, and this differential ability increased to 87% with the UPSA-M Brief. Traditional UPSA scores, UPSA-B scores, and neuropsychological performance were related to UPSA-M scores, whereas symptoms of psychopathology, experience with tablet technology, or difficulties operating the device were not significantly associated with UPSA-M. CONCLUSIONS The UPSA-M performed just as well as the standard-of-practice version. These preliminary results indicate that the UPSA-M Brief has greater sensitivity than the full version of the UPSA-M, and carries the advantage of a shorter administration time. Overall, the UPSA-M appears to be a promising mobile tool to assess functional capacity.
Collapse
Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA; The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Pariya L Fazeli
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA; The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA; VA San Diego Healthcare System, San Diego, CA, 92161, USA.
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Eric Granholm
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA; VA San Diego Healthcare System, San Diego, CA, 92161, USA.
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA; The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Brent T Mausbach
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA.
| |
Collapse
|
41
|
Rowe AR, Mercer L, Casetti V, Sendt KV, Giaroli G, Shergill SS, Tracy DK. Dementia praecox redux: a systematic review of the nicotinic receptor as a target for cognitive symptoms of schizophrenia. J Psychopharmacol 2015; 29:197-211. [PMID: 25567553 DOI: 10.1177/0269881114564096] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most individuals with schizophrenia suffer some cognitive dysfunction: such deficits are predictive of longer-term functioning; and current dopamine-blocking antipsychotics have made little impact on this domain. There is a pressing need to develop novel pharmacological agents to tackle this insidious but most disabling of problems. The acetylcholinergic system is involved in cognitive and attentional processing, and its metabotropic and nicotinic receptors are widespread throughout the brain. Deficits in acetylcholinergic functioning occur in schizophrenia, and high rates of tobacco smoking have been posited to represent a form of self-medication. The nicotinic acetylcholine receptor (nAChR) has emerged as a putative target to improve cognitive deficits in schizophrenia, and this study systematically reviewed the emerging data. Nineteen studies were identified, covering three compound classes: agonists at the α7 and α 4β2 nAChRs, and positive allosteric modulators. Overall data are underwhelming: some studies showed significant improvements in cognition but as many studies had negative findings. It remains unclear if this represents drug limitations or nascent study methodology problems. The literature is particularly hindered by variability in inclusion of smokers, generally small sample sizes, and a lack of consensus on cognitive test batteries. Future work should evaluate longer-term outcomes, and, particularly, the effects of concomitant cognitive training.
Collapse
Affiliation(s)
- Arann R Rowe
- The Institute of Psychiatry, King's College London, London, UK
| | - Louise Mercer
- The Institute of Psychiatry, King's College London, London, UK
| | - Valentina Casetti
- The Institute of Psychiatry, King's College London, London, UK Oxleas NHS Foundation Trust, London, UK
| | | | | | - Sukhwinder S Shergill
- The Institute of Psychiatry, King's College London, London, UK South London and Maudsley NHS Foundation Trust, London, UK
| | - Derek K Tracy
- The Institute of Psychiatry, King's College London, London, UK Oxleas NHS Foundation Trust, London, UK
| |
Collapse
|
42
|
Neurocognition in schizophrenia: from prodrome to multi-episode illness. Psychiatry Res 2014; 220:129-34. [PMID: 25149131 DOI: 10.1016/j.psychres.2014.07.067] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 06/24/2014] [Accepted: 07/27/2014] [Indexed: 11/20/2022]
Abstract
Individuals with schizophrenia present a neuropsychological deficit throughout the course of the disorder. Few studies have addressed the progression of the deficit since the prodromal phase of the disorder. This investigation explored neurocognition in accordance with the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus recommendations. The aim of the study was to explore the presence of neurocognitive impairment in ultra-high-risk individuals and the stage of this impairment in samples at different phases of illness. Thirty-six individuals with a prodromal syndrome, 53 first-episode and 44 multi-episode schizophrenia patients were assessed to examine neuropsychological performance. ANCOVA analysis adjusted for possible confounder factors and planned contrasts with healthy controls were undertaken. The results revealed deficits in speed-of-processing, visual-learning and social-cognition in prodromal individuals, and of all other neuropsychological domains in both first-episode and multi-episode patients. Furthermore impairment was found in the first-episode and in the multi-episode group, respectively on working-memory and attention. Within the framework of the neurodevelopmental model of schizophrenia, our results suggest the presence of neuropsychological impairment before the onset of full-blown psychosis. Moreover, the deficits are larger in the more chronic groups, according to the theory of an ongoing neurodevelopmental alteration.
Collapse
|
43
|
Abstract
After over 100 years of research without clarifying the aetiology of schizophrenia, a look at the current state of knowledge in epidemiology, genetics, precursors, psychopathology, and outcome seems worthwhile. The disease concept, created by Kraepelin and modified by Bleuler, has a varied history. Today, schizophrenia is considered a polygenic disorder with onset in early adulthood, characterized by irregular psychotic episodes and functional impairment, but incident cases occur at all ages with marked differences in symptoms and social outcome. Men’s and women’s lifetime risk is nearly the same. At young age, women fall ill a few years later and less severely than men, men more rarely and less severely later in life. The underlying protective effect of oestrogen is antagonized by genetic load. The illness course is heterogeneous and depressive mood the most frequent symptom. Depression and schizophrenia are functionally associated, and affective and nonaffective psychoses do not split neatly. Most social consequences occur at the prodromal stage. Neither schizophrenia as such nor its main symptom dimensions regularly show pronounced deterioration over time. Schizophrenia is neither a residual state of a neurodevelopmental disorder nor a progressing neurodegenerative process. It reflects multifactorial CNS instability, which leads to cognitive deficits and symptom exacerbations.
Collapse
|
44
|
Stouten LH, Veling W, Laan W, van der Helm M, van der Gaag M. Psychotic symptoms, cognition and affect as predictors of psychosocial problems and functional change in first-episode psychosis. Schizophr Res 2014; 158:113-9. [PMID: 25008791 DOI: 10.1016/j.schres.2014.06.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 06/16/2014] [Accepted: 06/19/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To enable further understanding of how cognitive deficits and psychopathology impact psychosocial functioning in first-episode psychosis patients, we investigated how psychopathology and cognitive deficits are associated with psychosocial problems at baseline, and how these predict psychosocial functioning at 12 months follow-up. Also, we tested whether the effect of baseline psychopathology on psychosocial functioning decreases between baseline and 12 months and the effect of baseline cognition increases. METHODS Eight neurocognitive and four social cognitive subdomains and psychopathology (positive and negative symptoms, depression and anxiety) were assessed at baseline in 153 non-affective first-episode psychosis (FEP) patients. Psychosocial functioning (work/study, relationships, self-care, disturbing behavior and general psychosocial functioning) was assessed at baseline and 12 months. Spearman correlations were examined and backward regression models were computed to test our hypotheses. RESULTS At baseline, psychosocial functioning was associated strongest with positive and negative symptoms of all assessed clinical domains, followed by neurocognition and social cognition. In contrast, psychosocial functioning at 12 months was not predicted by psychotic symptoms, but rather by neurocognition, social cognition and depression. Change in social functioning in the first 12 months after baseline was predicted by positive and negative symptoms, but to a similar degree by neurocognition and social cognition. CONCLUSIONS Whereas psychotic symptoms show marked impact on psychosocial functioning at illness onset, cognitive deficits appear to be more accurate longitudinal predictors of psychosocial problems and functional recovery in the early course of psychosis.
Collapse
Affiliation(s)
- Luyken H Stouten
- Parnassia Psychiatric Institute, Center for Early Psychosis, The Hague, The Netherlands.
| | - Wim Veling
- Parnassia Psychiatric Institute, Center for Early Psychosis, The Hague, The Netherlands; Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Winfried Laan
- Parnassia Psychiatric Institute, Center for Early Psychosis, The Hague, The Netherlands
| | - Mischa van der Helm
- Parnassia Psychiatric Institute, Center for Early Psychosis, The Hague, The Netherlands
| | - Mark van der Gaag
- Parnassia Psychiatric Institute, Center for Early Psychosis, The Hague, The Netherlands; Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| |
Collapse
|
45
|
Matsuda Y, Sato S, Iwata K, Furukawa S, Hatsuse N, Watanabe Y, Anzai N, Kishimoto T, Ikebuchi E. Effects of risperidone and aripiprazole on neurocognitive rehabilitation for schizophrenia. Psychiatry Clin Neurosci 2014; 68:425-31. [PMID: 24506576 DOI: 10.1111/pcn.12147] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 08/29/2013] [Accepted: 12/12/2013] [Indexed: 11/28/2022]
Abstract
AIM Methods to improve neurocognitive impairments are of important research interest. This study sought to examine the synergistic effects of neurocognitive rehabilitation and antipsychotics for schizophrenia. METHODS Subjects were 43 patients diagnosed with schizophrenia or schizoaffective disorder in a randomized trial of the effects of neurocognitive rehabilitation or a quasi-randomized experimental trial of supported employment with neurocognitive rehabilitation. We compared the effects of risperidone and aripiprazole in neurocognitive rehabilitation for schizophrenia. Subjects were divided into the following groups: (i) the control-risperidone group (CR group) (n = 13); (ii) the rehabilitation-risperidone group (RR group) (n = 9); (iii) the control-aripiprazole group (CA group) (n = 10); and (iv) the rehabilitation-aripiprazole group (RA group) (n = 11). Subjects in the rehabilitation group were engaged in computer-based cognitive exercises (24 sessions) with bridging group (12 sessions) over 12 weeks. Psychiatric symptoms, neurocognitive functioning and social functioning assessments were evaluated at baseline and at 12 weeks. RESULTS A two-way anova with neurocognitive rehabilitation and antipsychotic medication as factors revealed a significant interaction effect on motor speed. Working memory and motor speed significantly improved in the RA group compared with the CA group. We found no significant improvements between the CR group and the RR group. CONCLUSION A synergistic effect of neurocognitive rehabilitation and aripiprazole was observed as improvement of motor speed. In patients treated with aripiprazole, neurocognitive rehabilitation appeared to improve working memory and motor speed. Further studies of synergistic effects of neurocognitive rehabilitation and antipsychotic medication are necessary to verify these findings.
Collapse
Affiliation(s)
- Yasuhiro Matsuda
- Department of Psychiatry, Nara Medical University School of Medicine, Nara, Japan; Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Stability and change in symptoms, cognition, and community outcome in schizophrenia. Schizophr Res 2014; 152:435-9. [PMID: 24080456 DOI: 10.1016/j.schres.2013.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/03/2013] [Accepted: 09/11/2013] [Indexed: 11/22/2022]
Abstract
It has been well established that neurocognitive deficits are a core feature in schizophrenia and predict difficulties in functional independence. However, few studies have assessed the longitudinal stability of cognition and key aspects of functional outcome concurrently. Even less attention has been directed at the contingency of cognitive change on real world outcome changes. Accordingly, this study will assess the extent to which significant changes in cognition and community status are independent or related. As a point of comparison, the stability of clinical symptom status and the relationship between symptom and outcome change are evaluated. Symptoms, cognitive abilities, and community outcome was assessed in 128 patients with schizophrenia at baseline and again one year later. Intraclass correlation coefficients were used to index stability and reliable change index analyses quantified the prevalence of significant improvement or deterioration in each of the three illness features. Results from these analyses revealed that symptom status, cognitive functioning, and community outcome are similarly stable in treated schizophrenia outpatients. A small proportion of the sample demonstrated significant improvement or deterioration in these domains, with only weak evidence that such change was predicted by changes in symptoms or cognition. Further, there was no strong evidence of a preferential relationship for cognition relative to symptoms in relation to functional outcome. These results shed light on the strength and nature of the cognition-real world outcome relationship in schizophrenia and have implications for pharmacological and behavioral interventions aimed at improving real world outcome.
Collapse
|
47
|
Holshausen K, Bowie CR, Mausbach BT, Patterson TL, Harvey PD. Neurocognition, functional capacity, and functional outcomes: the cost of inexperience. Schizophr Res 2014; 152:430-4. [PMID: 23978775 DOI: 10.1016/j.schres.2013.08.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/06/2013] [Accepted: 08/08/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurocognitive impairments are the strongest predictor of functional deficits in schizophrenia, but adaptive (i.e., functional) capacity, typically measured with performance-based assessments, yields an objective index of current abilities, whereas real-world functional performance relies on observations of community activity. However, limited experiences in the community may limit the acquisition, retention, or expression of these skills. METHODS We examined the frequency of engagement in behaviors that are assessed in the current "gold standard" in person functional capacity assessment. The UCSD Performance-Based Skills Assessment (i.e., UPSA) examines skills associated with recreational engagement, handling money, scheduling appointments, and navigating public transportation. We used neurocognition, experience, and UPSA performance as predictors of the relationships among cognition and real-world functioning variables. RESULTS Neurocognition was a significant correlate of UPSA scores regardless of whether it was forced into the model before or after prior experience, whereas experience was only a significant predictor of UPSA scores when entered before neurocognition. Further, functional capacity, neurocognition, and experience were significant predictors of real-world outcomes and experience remained a significant predictor regardless of the order it was entered into the model. CONCLUSIONS The amount of current experience with functional tasks is not a rate-limiter of the relationships between neurocognition and functional capacity but does account for some previously unexplained variance in the functional capacity-everyday functioning relationship. These findings underscore the importance of neurocognitive deficits as they relate to functional capacity in schizophrenia, and suggest an incremental functional cost of limited experience with independent living.
Collapse
Affiliation(s)
| | | | - Brent T Mausbach
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA; Research Service, Miami VA Medical Center, USA
| |
Collapse
|
48
|
Ogino S, Miyamoto S, Miyake N, Yamaguchi N. Benefits and limits of anticholinergic use in schizophrenia: focusing on its effect on cognitive function. Psychiatry Clin Neurosci 2014; 68:37-49. [PMID: 24102938 DOI: 10.1111/pcn.12088] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 04/25/2013] [Accepted: 05/26/2013] [Indexed: 12/17/2022]
Abstract
All currently available antipsychotic drugs are the dopamine D2 receptor antagonists and are capable of producing extrapyramidal side-effects (EPS). Anticholinergic drugs are primarily used to treat EPS or prevent EPS induced by antipsychotics in the treatment of psychosis and schizophrenia. However, they can cause a variety of distressing peripheral side-effects (e.g. dry mouth, urinary disturbances, and constipation) and central adverse effects (e.g. cognitive impairment, worsening of tardive dyskinesia, and delirium). Disturbances in cognitive abilities are cardinal features of schizophrenia from its earliest phases and account for much of the functional disability associated with the illness. It is likely that long-term concomitant administration of anticholinergics exacerbates the underlying cognitive impairment in patients with schizophrenia and subsequently affects patients' quality of life. Thus, current treatment guidelines for schizophrenia generally do not recommend the prophylactic and long-term use of anticholinergics. However, the high use of long-term anticholinergic drugs with antipsychotics has been identified as an important issue in the treatment of schizophrenia in several countries. To assess the benefits and limits of anticholinergic use in psychosis and schizophrenia, this article will provide a brief review of the pharmacology and clinical profiles of anticholinergic drugs and will focus on their effects on cognitive function in schizophrenia, particularly during the course of the early phase of the illness. In addition, we will address the effects of discontinuation of anticholinergics on cognitive function in patients with schizophrenia and provide a strategy for adjunctive anticholinergic use in patients treated with long-acting injectable antipsychotics.
Collapse
Affiliation(s)
- Shin Ogino
- Department of Neuropsychiatry, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | | | | |
Collapse
|
49
|
Moreno-Granados JM, Ferrín M, Salcedo-Marín DM, Ruiz-Veguilla M. Evaluación neuropsicológica de la memoria en un grupo de niños y adolescentes con un primer episodio de psicosis: consumo de Cannabis y «efecto paradójico». REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2014; 7:13-24. [DOI: 10.1016/j.rpsm.2013.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 04/09/2013] [Accepted: 04/26/2013] [Indexed: 11/28/2022]
|
50
|
Zawadzki JA, Girard TA, Foussias G, Rodrigues A, Siddiqui I, Lerch JP, Grady C, Remington G, Wong AHC. Simulating real world functioning in schizophrenia using a naturalistic city environment and single-trial, goal-directed navigation. Front Behav Neurosci 2013; 7:180. [PMID: 24324418 PMCID: PMC3840323 DOI: 10.3389/fnbeh.2013.00180] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/11/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To develop a virtual reality platform that would serve as a functionally meaningful measure of cognition in schizophrenia and that would also complement standard batteries of cognitive tests during clinical trials for cognitive treatments in schizophrenia, be amenable to human neuroimaging research, yet lend itself to neurobiological comparison with rodent analogs. METHOD Thirty-three patients with schizophrenia and 33 healthy controls matched for age, sex, video gaming experience, and education completed eight rapid, single-trial virtual navigation tasks within a naturalistic virtual city. Four trials tested their ability to find different targets seen during the passive viewing of a closed path that led them around different city blocks. Four subsequent trials tested their ability to return to four different starting points after viewing a path that took them several blocks away from the starting position. RESULTS Individuals with schizophrenia had difficulties in way-finding, measured as distance travelled to find targets previously encountered within the virtual city. They were also more likely not to notice the target during passive viewing, less likely to find novel shortcuts to targets, and more likely to become lost and fail completely in finding the target. Total travel distances across all eight trials strongly correlated (negatively) with neurocognitive measures and, for 49 participants who completed the Quality of Life Scale, psychosocial functioning. CONCLUSION Single-trial, goal-directed navigation in a naturalistic virtual environment is a functionally meaningful measure of cognitive functioning in schizophrenia.
Collapse
Affiliation(s)
- John A. Zawadzki
- Institute of Medical Science, University of TorontoON, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research InstituteToronto, ON, Canada
| | - Todd A. Girard
- Department of Psychology, Ryerson UniversityToronto, ON, Canada
| | - George Foussias
- Institute of Medical Science, University of TorontoON, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research InstituteToronto, ON, Canada
- Department of Psychiatry, University of TorontoON, Canada
| | - Alicia Rodrigues
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research InstituteToronto, ON, Canada
- Collaborative Program in Neuroscience, University of TorontoON, Canada
| | - Ishraq Siddiqui
- Institute of Medical Science, University of TorontoON, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research InstituteToronto, ON, Canada
| | - Jason P. Lerch
- Department of Medical Biophysics, University of TorontoON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick ChildrenToronto, ON, Canada
| | - Cheryl Grady
- Departments of Psychology and Psychiatry, University of TorontoON, Canada
- Rotman Research Institute at BaycrestToronto, ON, Canada
| | - Gary Remington
- Institute of Medical Science, University of TorontoON, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research InstituteToronto, ON, Canada
- Department of Psychiatry, University of TorontoON, Canada
| | - Albert H. C. Wong
- Institute of Medical Science, University of TorontoON, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research InstituteToronto, ON, Canada
- Department of Psychiatry, University of TorontoON, Canada
| |
Collapse
|