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Mansueto G, Tosato S, Brondino N, Bonetto C, Tomassi S, Politi P, Lasalvia A, Fioravanti G, Casale S, De Santi K, Bertani M, Bellani M, Brambilla P, Ruggeri M, Faravelli C. Childhood adversity, symptoms, and cortisol in first episode psychosis: a cross-sectional, secondary, observational analysis of a subsample of FEP patients. Nord J Psychiatry 2022:1-8. [PMID: 36398909 DOI: 10.1080/08039488.2022.2137846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although it has been proposed that childhood adversities (CAs) may affect the hypothalamic-pituitary-adrenal (HPA) axis activity and psychotic symptoms severity, these associations have not been fully confirmed in first-episode psychosis (FEP). This study explored the association between CA, cortisol and psychotic symptoms in FEP patients. METHODS 81 FEP patients were enrolled. CAs were evaluated by the Childhood Experience of Care and Abuse Questionnaire and a semi-structured interview. Psychotic symptoms were evaluated by the Positive and Negative Syndrome Scale. Cortisol level was collected using saliva samples. ANCOVA and partial correlation analyses were run. RESULTS FEP patients with childhood abuse reported severe positive symptoms than those without CA. FEP patients with at least one CA had higher levels of cortisol awaking, cortisol at 12 a.m., and cortisol at 8 p.m. Morning cortisol levels were negatively correlated with the severity of negative symptoms and positively correlated with the severity of general psychopathology. Evening cortisol levels were positively correlated with severity of general psychopathology. CONCLUSION FEP patients with CAs, compared with those without CA, might report more severe positive symptoms and higher cortisol, even though these findings as prone to bias due to the small sample size, and should be seen in the larger perspective of conflicting evidence in the field.
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Affiliation(s)
- Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Natascia Brondino
- Section of Psychiatry, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Chiara Bonetto
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | | | - Pierluigi Politi
- Section of Psychiatry, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Giulia Fioravanti
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Silvia Casale
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Katia De Santi
- UOC Psichiatria B, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Mariaelena Bertani
- UOC Psichiatria B, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Marcella Bellani
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation at the University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | | | - Carlo Faravelli
- Department of Health Sciences, University of Florence, Florence, Italy
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2
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Remberk B, Niwiński P, Brzóska-Konkol E, Borowska A, Papasz-Siemieniuk A, Brągoszewska J, Bażyńska AK, Szostakiewicz Ł, Herman A. Ectodermal disturbance in development shared by anorexia and schizophrenia may reflect neurodevelopmental abnormalities. Brain Behav 2021; 11:e2281. [PMID: 34510800 PMCID: PMC8553323 DOI: 10.1002/brb3.2281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/25/2021] [Accepted: 06/27/2021] [Indexed: 12/25/2022] Open
Abstract
Minor physical abnormalities (MPA) are subtle dysmorphic features of bodily structures that have little or no impact on function. Most MPA develop during the first gestational trimester and are considered as important indicators of neuroectodermal deficiencies emerging during early brain development. A higher frequency of MPA was confirmed in schizophrenia patients and their relatives, when compared to controls. These findings are consistent with the neurodevelopmental model of schizophrenia. A neurodevelopmental component amongst other risk factors has also been recently proposed for anorexia nervosa (AN). The current study aimed to assess MPA frequency in adolescent inpatients with either schizophrenia spectrum disorders (SSD) or AN as compared to healthy controls (HC). The Waldrop Scale was used for assessing MPA. The mean MPA total score and mean head subscore was significantly higher in both test groups than in HC. There were no statistically significant differences between SSD and AN groups. The MPA profile (not frequency) was similar in all three groups. This finding is consistent both with widely acknowledged neurodevelopmental schizophrenia hypothesis as well as with more recent neurodevelopmental model of AN. Nevertheless, the findings should not be overgeneralized and further studies are warranted.
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Affiliation(s)
| | - Piotr Niwiński
- Psychological and Pedagogical Counselling Centre no 7, Warsaw, Poland
| | | | - Anna Borowska
- Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | | | | | | | - Anna Herman
- Medical University of Warsaw, Warsaw, Poland
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3
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Katz-Barber MW, Hollins SL, Cuskelly A, Leong AJW, Dunn A, Harms L, Hodgson DM. Investigating the gut-brain axis in a neurodevelopmental rodent model of schizophrenia. Brain Behav Immun Health 2020; 3:100048. [PMID: 34589838 PMCID: PMC8474551 DOI: 10.1016/j.bbih.2020.100048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 02/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background Although the aetiology of schizophrenia remains unknown, it has been suggested that it might occur in response to alterations in the gut-brain axis (GBA), the bi-directional communication system between the gut and the brain. The current study aimed to determine whether the “two-hit” animal model of neuropsychopathology (maternal immune activation combined with adolescent cannabinoid exposure), produced abnormalities in the GBA Method Pregnant Wistar rats were administered the viral mimetic polyI:C on gestational day 19 and offspring were administered the synthetic cannabinoid HU210 from postnatal days 35–48. Evidence of GBA activation was assessed in the hypothalamus, colon and fecal samples from male and female offspring at adolescence and adulthood Results Findings were sex-specific with adolescent female offspring exhibiting an increased hypothalamic inflammatory profile, increased hypothalamic CRHR1 mRNA, and decreased fecal expression of Bifidobacterium longum, however, no changes were detected in colonic inflammation or integrity. Conclusion These results indicate that the rat two-hit model, documented to produce behavioural and neuroanatomical abnormalities, also produces hypothalamic and microbiota abnormalities. The results also demonstrate significant sex differences, suggesting that this model may be useful for investigating the role of the GBA in the aetiology of neurodevelopmental disorders such as schizophrenia. Combined MIA and ACE induces sex-specific alterations in hypothalamic inflammation. Combined MIA and ACE increases hypothalamic CRHR1 expression. Combined MIA and ACE decreases fecal expression of Bifidobacterium longum.
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Affiliation(s)
- Max W Katz-Barber
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Sharon L Hollins
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Annalisa Cuskelly
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Angeline J W Leong
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Ariel Dunn
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, Australia
| | - Lauren Harms
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Deborah M Hodgson
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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4
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Pituitary volume in individuals at elevated risk for psychosis: A systematic review and meta-analysis. Schizophr Res 2019; 213:23-31. [PMID: 30600112 DOI: 10.1016/j.schres.2018.12.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/13/2018] [Accepted: 12/16/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pituitary volume (PV) abnormalities, representing one of several markers of hypothalamic-pituitary-adrenal (HPA) axis dysregulation, have been observed in psychosis, with variable patterns across illness stages. Typically, enlargements characterise first-episode patients, with reductions observed in those with chronic illness relative to healthy controls. Findings in high-risk populations have been inconsistent, highlighting the need for an updated review of the evidence. METHODS We searched PubMed, PsycINFO, and EMBASE for studies examining PV in high-risk [clinical high-risk (CHR), family history of psychosis (FHx), schizotypal personality disorder (SPD), and psychotic-experiences (PEs)] and healthy individuals. Random effects models were used to examine group differences in PV (Hedges g) with stratified analyses and meta-regression employed to investigate the effect of high-risk category, transition status, age, sex, and antipsychotic medication. RESULTS Ten studies, yielding 11 effect sizes, were eligible for inclusion. Overall, high-risk individuals had significantly larger PV relative to healthy controls (g = 0.16 [95% CI: 0.01 to 0.32] p = 0.04), despite showing a reduction in whole brain volume (g = -0.17, [95% CI. -0.30 to -0.03] p = 0.020). Individual sub-group analyses for CHR and FHx groups showed no significant differences relative to controls; however, larger PV increases characterised those who later transitioned to psychosis (g = 0.55, [95% CI. 0.06 to 1.04] p = 0.028). Larger effect sizes were positively associated with the proportion of high-risk individuals receiving antipsychotic medication. CONCLUSIONS PV enlargements characterise high-risk individuals and are more pronounced among those who later develop psychosis. We provide recommendations for future studies.
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5
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Clinical correlates of hypothalamic-pituitary-adrenal axis measures in individuals at risk for psychosis and with first-episode psychosis. Psychiatry Res 2018; 265:284-291. [PMID: 29775885 DOI: 10.1016/j.psychres.2018.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/21/2018] [Accepted: 05/05/2018] [Indexed: 01/05/2023]
Abstract
Hypothalamic-pituitary-adrenal (HPA) axis alterations in at-risk mental states (ARMS) resemble those observed in established psychosis but are less consistent. We aimed to explore HPA axis abnormalities in both first-episode psychosis (FEP) and ARMS patients, while controlling for psychopathological symptoms. We studied 21 ARMS, 34 FEP patients and 34 healthy subjects. Clinical assessment included psychopathological symptoms (positive, negative, disorganized, excited and depressive symptoms) and stress measures. Saliva cortisol levels were determined at awakening, 30' and 60' post-awakening, 10:00 h, 23:00 h and 10:00 h on the day after the administration of 0.25 mg of dexamethasone, which occurred at 23:00 h. Three HPA axis measures were calculated: cortisol awakening response (CAR), cortisol diurnal slope and cortisol suppression ratio of the dexamethasone suppression test (DST). There were no significant differences between groups in HPA axis measures. However, when exploring the relationship between HPA axis measures and psychopathological symptoms, in ARMS subjects (but not FEP patients), a flatter cortisol slope was associated with more prominent negative symptoms, whereas a blunted CAR was associated with excited symptoms. Although no significant differences in HPA axis measures were found between diagnostic groups, subtle abnormalities in the CAR or circadian cortisol rhythmicity might be important for the phenotype of ARMS individuals.
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Madhushanthi HJ, Wimalasekera SW, Goonewardena CSE, Amarasekara AATD, Lenora J. Socioeconomic status is a predictor of neurocognitive performance of early female adolescents. Int J Adolesc Med Health 2018; 32:/j/ijamh.ahead-of-print/ijamh-2018-0024/ijamh-2018-0024.xml. [PMID: 29897881 DOI: 10.1515/ijamh-2018-0024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 05/08/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Previous studies have shown that high socioeconomic status (SES) is significantly associated with inhibitory control, working memory, verbal comprehension and IQ. However, in the Asian setting, with its prevailing poverty, information about the influence of SES on cognitive development of female adolescents is limited. This study was aimed to investigate the association between SES and neurocognitive performance of early female adolescents in Sri Lanka. METHODS Female adolescents aged 11-14 years (n = 200) of low and middle SES were studied to assess neurocognitive function. After obtaining baseline data, eight subtests of the Wechsler Intelligence Scale for Children (WISC - IV), Test Of Nonverbal Intelligence (TONI-3) and two computer-based executive function tests (inhibition and visuo-spatial working memory) were administered to assess neurocognitive measures of the above adolescents. The results were compiled into a data base and analyzed using SPSS version 20 statistical software. RESULTS Higher SES was associated with higher performance in all neurocognitive tests. Low SES adolescents obtained significantly poor test scores for executive function test (inhibitory control: p < 0.0001) and for WISC [verbal comprehension index (VCI): p < 0.0001), working memory index (WMI): p < 0.0001 and estimated full scale IQ (EFSIQ): p < 0.0001)] when compared with middle SES adolescents. Maternal education alone significantly predicts VCI and EFSIQ than the combined influence of parental education, occupation and income. Psychosocial adversities of adolescents were inversely correlated with VCI (r = -0.30; p < 0.001) and EFSIQ (r = -0.20; p < 0.001) of WISC and mathematics performance (r = -0.34; p < 0.001) at examination in school. CONCLUSION Findings of the study revealed the importance of upliftment of SES of the society to improve the cognitive and academic outcomes of low SES individuals.
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Affiliation(s)
- H J Madhushanthi
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka
| | - Savithri W Wimalasekera
- Department of Physiology, Faculty of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - C Sampatha E Goonewardena
- Department of Community Medicine, Faculty of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - A A Thamara D Amarasekara
- Department of Allied Health Sciences, Faculty of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Janaka Lenora
- Department of Physiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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7
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DeVylder JE, Koyanagi A, Unick J, Oh H, Nam B, Stickley A. Stress Sensitivity and Psychotic Experiences in 39 Low- and Middle-Income Countries. Schizophr Bull 2016; 42:1353-1362. [PMID: 27109925 PMCID: PMC5049526 DOI: 10.1093/schbul/sbw044] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Stress has a central role in most theories of psychosis etiology, but the relation between stress and psychosis has rarely been examined in large population-level data sets, particularly in low- and middle-income countries. We used data from 39 countries in the World Health Survey (n = 176 934) to test the hypothesis that stress sensitivity would be associated with psychotic experiences, using logistic regression analyses. Respondents in low-income countries reported higher stress sensitivity (P < .001) and prevalence of psychotic experiences (P < .001), compared to individuals in middle-income countries. Greater stress sensitivity was associated with increased odds for psychotic experiences, even when adjusted for co-occurring anxiety and depressive symptoms: adjusted odds ratio (95% CI) = 1.17 (1.15-1.19) per unit increase in stress sensitivity (range 2-10). This association was consistent and significant across nearly every country studied, and translated into a difference in psychotic experience prevalence ranging from 6.4% among those with the lowest levels of stress sensitivity up to 22.2% among those with the highest levels. These findings highlight the generalizability of the association between psychosis and stress sensitivity in the largest and most globally representative community-level sample to date, and support the targeting of stress sensitivity as a potential component of individual- and population-level interventions for psychosis.
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Affiliation(s)
- Jordan E. DeVylder
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD;,*To whom correspondence should be addressed; School of Social Work, University of Maryland, Baltimore, 525 W Redwood St, Baltimore, MD 21201, US; tel: 410-706-6234, fax: 410-706-6046, e-mail:
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain;,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Jay Unick
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD
| | - Hans Oh
- School of Public Health, University of California Berkeley, Berkeley, CA;,Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA
| | - Boyoung Nam
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD
| | - Andrew Stickley
- The Stockholm Centre for Health and Social Change (SCOHOST), Södertörn University, Stockholm, Sweden
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8
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Russak ODF, Ives L, Mittal VA, Dean DJ. Fluctuating dermatoglyphic asymmetries in youth at ultrahigh-risk for psychotic disorders. Schizophr Res 2016; 170:301-3. [PMID: 26723845 PMCID: PMC4740197 DOI: 10.1016/j.schres.2015.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/17/2015] [Accepted: 12/19/2015] [Indexed: 11/15/2022]
Abstract
Fluctuating dermatoglyphic asymmetry represents one specific class of minor physical anomaly that has been proposed to reflect prenatal insult and vulnerability to psychosis. However, very little is known about fluctuating dermatoglyphic asymmetry in youth showing symptoms of ultrahigh risk (UHR) for psychosis. Using high-resolution photographs of fingerprints and clinical interviews, the UHR group in this study showed greater fluctuating dermatoglyphic asymmetry compared to controls; however, this was not further linked to symptomatology. The results of this study provide an important perspective on potential biomarkers and support neurodevelopmental conceptions of psychosis.
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Affiliation(s)
- Olivia Diane Fern Russak
- University of California Los Angeles, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - Lindsay Ives
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, United States
| | - Vijay A Mittal
- Northwestern University, Department of Psychology, Evanston, IL, United States
| | - Derek J Dean
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, United States; University of Colorado Boulder, Center for Neuroscience, Boulder, CO, United States.
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9
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Barrantes-Vidal N, Grant P, Kwapil TR. The role of schizotypy in the study of the etiology of schizophrenia spectrum disorders. Schizophr Bull 2015; 41 Suppl 2:S408-16. [PMID: 25810055 PMCID: PMC4373635 DOI: 10.1093/schbul/sbu191] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Schizotypy provides a useful construct for understanding the development of schizophrenia spectrum disorders. As research on the epidemiology of psychotic symptoms and clinical risk for psychosis has expanded, conceptual challenges have emerged to comprehend the nature and borders of the space comprised between personality variation and psychosis. Schizotypy is considered in light of these more recent constructs. It is suggested that rather than being superseded by them due to their higher specificity and predictive power for transition to psychosis, schizotypy integrates them as it constitutes a dynamic continuum ranging from personality to psychosis. The advantages of schizotypy for studying schizophrenia etiology are discussed (eg, it facilitates a developmental approach and the identification of causal, resilience, and compensating factors and offers a multidimensional structure that captures etiological heterogeneity). An overview of putative genetic, biological, and psychosocial risk factors is presented, focusing on communalities and differences between schizotypy and schizophrenia spectrum disorders. The found notable overlap supports etiological continuity, and, simultaneously, differential findings appear that are critical to understanding resilience to schizophrenia. For example, discrepant findings in genetic studies might be interpreted as suggestive of sets of independent genetic factors playing a differential role in schizotypy and schizophrenia: some would influence variation specifically on schizotypy dimensions (ie, high vs low schizotypy, thereby increasing proneness to psychosis), some would confer unspecific liability to disease by impacting neural properties and susceptibility to environmental factors (ie, high vs low resilience to disorder) and some might contribute to disease-specific characteristics. Finally, schizotypy's promise for studying gene-environment interactions is considered.
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Affiliation(s)
- Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain; University of North Carolina at Greensboro, Greensboro, NC; Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Sant Pere Claver - Fundació Sanitària, Barcelona, Spain;
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Abstract
Psychotic disorders continue to be among the most disabling and scientifically challenging of all mental illnesses. Accumulating research findings suggest that the etiologic processes underlying the development of these disorders are more complex than had previously been assumed. At the same time, this complexity has revealed a wider range of potential options for preventive intervention, both psychosocial and biological. In part, these opportunities result from our increased understanding of the dynamic and multifaceted nature of the neurodevelopmental mechanisms involved in the disease process, as well as the evidence that many of these entail processes that are malleable. In this article, we review the burgeoning research literature on the prodrome to psychosis, based on studies of individuals who meet clinical high risk criteria. This literature has examined a range of factors, including cognitive, genetic, psychosocial, and neurobiological. We then turn to a discussion of some contemporary models of the etiology of psychosis that emphasize the prodromal period. These models encompass the origins of vulnerability in fetal development, as well as postnatal stress, the immune response, and neuromaturational processes in adolescent brain development that appear to go awry during the prodrome to psychosis. Then, informed by these neurodevelopmental models of etiology, we turn to the application of new research paradigms that will address critical issues in future investigations. It is expected that these studies will play a major role in setting the stage for clinical trials aimed at preventive intervention.
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11
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Pelletier-Baldelli A, Dean DJ, Lunsford-Avery JR, Smith Watts AK, Orr JM, Gupta T, Millman ZB, Mittal VA. Orbitofrontal cortex volume and intrinsic religiosity in non-clinical psychosis. Psychiatry Res 2014; 222:124-30. [PMID: 24746701 PMCID: PMC4073495 DOI: 10.1016/j.pscychresns.2014.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 02/16/2014] [Accepted: 03/26/2014] [Indexed: 11/30/2022]
Abstract
Research indicates that religiosity plays a complex role in mental illness. Despite this link, little work has been done to clarify the role of religiosity in persons exhibiting non-clinical psychosis (NCP, individuals experiencing fleeting psychotic-like symptoms in the absence of a formal psychotic disorder). Further, there are no NCP investigations into whether abnormalities exist in brain structures that are associated with religiosity. Understanding these relationships in NCP is important to clarify the role of religiosity and brain structural anomalies in psychosis. Twenty individuals experiencing NCP and twenty controls were assessed for intrinsic religiosity (IR; motivation/commitment to religious beliefs and/or practices) using a well-validated self-report scale. Structural magnetic resonance imaging was used to determine volumes of the orbitofrontal cortex (OFC), a critical region that has been associated with increased religiosity. Results indicate that IR is elevated in the NCP group, and that these individuals exhibit bilateral volume reduction in both the lateral and medial OFC. Sample-wide correlations are non-significant, but show notable relationships between smaller OFC regions and increased IR. Significant negative relationships were found between OFC volume and depressive and negative symptoms. Overall, results suggest that brain abnormalities associated with NCP may also confer a heightened susceptibility for religiosity.
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Affiliation(s)
- Andrea Pelletier-Baldelli
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA,Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA,Corresponding Author: Andrea Pelletier-Baldelli, Department of Psychology and Neuroscience, University of Colorado at Boulder, 345 UCB, Boulder, Colorado 80309-0345, Phone: 252.670.2571
| | - Derek J. Dean
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | | | - Ashley K. Smith Watts
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA,Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - Joseph M. Orr
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA,Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Tina Gupta
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Zachary B. Millman
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Vijay A. Mittal
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA,Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA
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12
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Orr JM, Turner JA, Mittal VA. Widespread brain dysconnectivity associated with psychotic-like experiences in the general population. Neuroimage Clin 2014; 4:343-51. [PMID: 24501703 PMCID: PMC3913833 DOI: 10.1016/j.nicl.2014.01.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/20/2013] [Accepted: 01/09/2014] [Indexed: 11/19/2022]
Abstract
It is becoming increasingly clear that psychosis occurs along a continuum. At the high end are formal psychotic disorders such as schizophrenia, and at the low-end are individuals who experience occasional psychotic symptoms, but are otherwise healthy (non-clinical psychosis, NCP). Schizophrenia has been shown to be marked by altered patterns of connectivity between brain regions, but it is not known if such dysconnectivity exists in NCP. In the current study we used functional magnetic resonance imaging (fMRI) to compare resting-state functional connectivity in NCP individuals (n = 25) and healthy controls (n = 27) for four brain networks of interest (fronto-parietal, cingulo-opercular, default mode, and cerebellar networks). NCP individuals showed reduced connectivity compared to controls between regions of the default mode network and frontal regions, and between regions in all of the networks and the thalamus. NCP individuals showed greater connectivity compared to controls within regions of frontal control networks. Further, positive symptom scores in NCP individuals were positively correlated with connectivity between the cingulo-opercular network and the visual cortex, and were negatively correlated with connectivity between the cerebellar network and the posterior parietal cortex and dorsal premotor cortex. Connectivity was not correlated with positive symptom scores in controls. Taken together, these findings demonstrate that a spectrum of abnormal connectivity underlies the psychosis continuum, and that individuals with sub-clinical psychotic experiences represent a key population for understanding pathogenic processes.
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Affiliation(s)
- Joseph M. Orr
- University of Colorado Boulder, Institute for Cognitive Science, USA
| | - Jessica A. Turner
- Mind Research Network, Translational Neuroscience Department, USA
- Georgia State University, Department of Psychology and Neuroscience Institute, USA
| | - Vijay A. Mittal
- University of Colorado Boulder, Department of Psychology and Neuroscience, USA
- University of Colorado Boulder, Center for Neuroscience, USA
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Zhang J, Wang W, Tan Z, Wu Q, Xiao W, Shang L, Zhang Y, Peng J, Miao D. Spatial analysis of schizotypal personality traits in Chinese male youths: evidence from a GIS-based analysis of Sichuan. Int J Ment Health Syst 2014; 8:3. [PMID: 24423022 PMCID: PMC3904416 DOI: 10.1186/1752-4458-8-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/08/2014] [Indexed: 11/21/2022] Open
Abstract
Background Schizotypal personality traits are associated with schizophrenia spectrum disorders, stating that schizotypal traits may represent a “prodrome” or other developmental precursor of schizophrenia. Genetic and environmental factors both play importanxt roles in the development of schizotypal traits. Different levels of schizotypal traits across regions may be indicative of similar differences in the incidence of schizophrenia. Aim The present study identifying where in a given region, schizotypal personality traits are more or less level of schizotypal personality scores in Chinese male youth of Sichuan province. Not only for research purposes but also for the evaluation of new draft and allocation policy initiatives intended to aid recruitment of mental health employees. Methods Data from the Psychological Selection Systems for Chinese Recruits, a mental health screening system used in China, collected in 2011 (67,558 copies) were used to map spatial distribution of schizotypal personality traits using geostatistics and geographic information system (GIS) techniques. Correlation analyses were conducted to explore the effects of years of education and illiterate rate on schizotypal personality traits. Results Maps for three schizotypal personality clinical scales (dissociative, Dit; neurotic, Net and sensitive, Set) showed similar geographical trends. The highest T scores were distributed mainly in the eastern and northern counties of Sichuan, with scores decreasing successively from east to west, with the eastern counties generally showing higher scores. Correlation analysis showed that t-scores of Set were negatively correlated with years of education, whereas t-scores of Net were negatively correlated with illiteracy rate. Conclusions Schizotypal personality traits in male youth showed specific geographical trends in Sichuan province, providing some evidence that kriging based on GIS can be used to geographically localize genetic and environmental factors associated with schizotypal personality traits. This approach could be used to help allocate public health resources to specific areas and could also have personnel selection applications.
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Affiliation(s)
- Jiaxi Zhang
- Department of Psychology, Fourth Military Medical University, Chang Le Western Street No.169, Xi'an, Shannxi, China
| | - Wei Wang
- Department of Psychology, Fourth Military Medical University, Chang Le Western Street No.169, Xi'an, Shannxi, China
| | - Zhijun Tan
- Department of Statistics, Fourth Military Medical University, Xi'an, China
| | - Qing Wu
- Department of Psychology, Fourth Military Medical University, Chang Le Western Street No.169, Xi'an, Shannxi, China.,Foreign Language Teaching and Researching Office of Basic Education Department, Chongqing Communication Institute, Chongqing, China
| | - Wei Xiao
- Department of Psychology, Fourth Military Medical University, Chang Le Western Street No.169, Xi'an, Shannxi, China
| | - Lei Shang
- Department of Statistics, Fourth Military Medical University, Xi'an, China
| | - Yan Zhang
- Department of Psychology, Fourth Military Medical University, Chang Le Western Street No.169, Xi'an, Shannxi, China
| | - Jiaxi Peng
- Department of Psychology, Fourth Military Medical University, Chang Le Western Street No.169, Xi'an, Shannxi, China
| | - Danmin Miao
- Department of Psychology, Fourth Military Medical University, Chang Le Western Street No.169, Xi'an, Shannxi, China
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Cortisol levels and risk for psychosis: initial findings from the North American prodrome longitudinal study. Biol Psychiatry 2013; 74:410-7. [PMID: 23562006 PMCID: PMC3707958 DOI: 10.1016/j.biopsych.2013.02.016] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 01/31/2013] [Accepted: 02/03/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Studies of biomarkers of hypothalamic-pituitary-adrenal activity indicate that psychotic disorders are associated with elevated cortisol. This study examined cortisol levels in healthy control subjects and individuals who met clinical high-risk (CHR) criteria for psychosis. It was hypothesized that cortisol levels would be 1) elevated in the CHR group relative to control subjects, 2) positively correlated with symptom severity, and 3) most elevated in CHR patients who transition to psychotic level severity. METHODS Baseline assessments were conducted at eight centers in the North American Prodrome Longitudinal Study. The present CHR sample included 256 individuals meeting the Scale for Prodromal Symptoms criteria and 141 control subjects, all of whom underwent baseline assessment and measurement of salivary cortisol. RESULTS Consistent with previous reports, there was an effect of age on cortisol, with increases through the adolescent/early adult years. Analysis of covariance showed a main effect of diagnostic group, with the CHR group showing higher cortisol. There were modest, positive correlations of cortisol with baseline symptom severity, and analysis of covariance revealed higher baseline cortisol in those who transitioned to psychotic level symptoms when compared with healthy control subjects and CHR subjects who remitted. CONCLUSIONS The present findings add to accumulating evidence of heightened cortisol secretion in CHR individuals. The findings also indicate nonspecific associations between cortisol levels and symptom severity, as well as symptom progression. The role of hypothalamic-pituitary-adrenal activity in prediction of conversion to psychosis and its relation with other biomarkers of risk should receive attention in future research.
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Trotman HD, Holtzman CW, Ryan AT, Shapiro DI, MacDonald AN, Goulding SM, Brasfield JL, Walker EF. The development of psychotic disorders in adolescence: a potential role for hormones. Horm Behav 2013; 64:411-9. [PMID: 23998682 PMCID: PMC4070947 DOI: 10.1016/j.yhbeh.2013.02.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 01/20/2013] [Accepted: 02/26/2013] [Indexed: 12/14/2022]
Abstract
This article is part of a Special Issue "Puberty and Adolescence". The notion that adolescence is characterized by dramatic changes in behavior, and often by emotional upheaval, is widespread and longstanding in popular western culture. In recent decades, this notion has gained increasing support from empirical research showing that the peri- and post-pubertal developmental stages are associated with a significant rise in the rate of psychiatric symptoms and syndromes. As a result, interest in adolescent development has burgeoned among researchers focused on the origins of schizophrenia and other psychotic disorders. Two factors have fueled this trend: 1) increasing evidence from longitudinal research that adolescence is the modal period for the emergence of "prodromal" manifestations, or precursors of psychotic symptoms, and 2) the rapidly accumulating scientific findings on brain structural and functional changes occurring during adolescence and young adulthood. Further, gonadal and adrenal hormones are beginning to play a more prominent role in conceptualizations of adolescent brain development, as well as in the origins of psychiatric symptoms during this period (Walker and Bollini, 2002; Walker et al., 2008). In this paper, we begin by providing an overview of the nature and course of psychotic disorders during adolescence/young adulthood. We then turn to the role of hormones in modulating normal brain development, and the potential role they might play in the abnormal brain changes that characterize youth at clinical high-risk (CHR) for psychosis. The activational and organizational effects of hormones are explored, with a focus on how hormone-induced changes might be linked with neuropathological processes in the emergence of psychosis.
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Affiliation(s)
- Hanan D Trotman
- Department of Psychology, Emory University, Atlanta, GA 30322, USA.
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16
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Golembo-Smith S, Walder DJ, Daly MP, Mittal VA, Kline E, Reeves G, Schiffman J. The presentation of dermatoglyphic abnormalities in schizophrenia: a meta-analytic review. Schizophr Res 2012; 142:1-11. [PMID: 23116885 PMCID: PMC3502669 DOI: 10.1016/j.schres.2012.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/28/2012] [Accepted: 10/01/2012] [Indexed: 11/21/2022]
Abstract
Within a neurodevelopmental model of schizophrenia, prenatal developmental deviations are implicated as early signs of increased risk for future illness. External markers of central nervous system maldevelopment may provide information regarding the nature and timing of prenatal disruptions among individuals with schizophrenia. One such marker is dermatoglyphic abnormalities (DAs) or unusual epidermal ridge patterns. Studies targeting DAs as a potential sign of early developmental disruption have yielded mixed results with regard to the strength of the association between DAs and schizophrenia. The current study aimed to resolve these inconsistencies by conducting a meta-analysis examining the six most commonly cited dermatoglyphic features among individuals with diagnoses of schizophrenia. Twenty-two studies published between 1968 and 2012 were included. Results indicated significant but small effects for total finger ridge count and total A-B ridge count, with lower counts among individuals with schizophrenia relative to controls. Other DAs examined in the current meta-analysis did not yield significant effects. Total finger ridge count and total A-B ridge count appear to yield the most reliable dermatoglyphic differences between individuals with and without schizophrenia.
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Sugranyes G, Thompson JL, Corcoran CM. HPA-axis function, symptoms, and medication exposure in youths at clinical high risk for psychosis. J Psychiatr Res 2012; 46:1389-93. [PMID: 22892058 PMCID: PMC3463772 DOI: 10.1016/j.jpsychires.2012.07.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 06/23/2012] [Accepted: 07/16/2012] [Indexed: 11/26/2022]
Abstract
AIM Increased basal cortisol secretion has been associated with heightened clinical risk for psychosis, and among at-risk individuals, has been variably related to positive and mood symptoms, as well as clinical outcome. METHODS Basal salivary cortisol secretion was assessed in 33 patients at clinical high risk (CHR) for psychosis (21 medication-free and 12 taking a serotonin reuptake inhibitor and/or atypical antipsychotic), and 13 healthy controls. Among the CHR patients, we also examined associations of basal salivary cortisol with symptoms (positive, negative, mood, stress sensitivity) and clinical outcome. RESULTS Basal salivary cortisol secretion was significantly higher in CHR patients who were medication-free compared to CHR patients taking medications and to healthy controls. In this small cohort, basal salivary cortisol secretion was associated at trend level with stress sensitivity, and was not significantly related to other symptoms. CONCLUSIONS Our finding of elevated basal cortisol secretion in CHR patients supports the premise that excess activation of the HPA axis and/or neuroendocrine abnormalities characterize the psychosis risk state for at least a subset of patients. Our findings further suggest that psychotropic medications may have a normalizing effect on HPA-axis dysfunction in CHR patients, which could potentially inform intervention strategies for the prodrome.
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Affiliation(s)
- G Sugranyes
- Servei de Psiquiatria i Psicologia Infantil i Juvenil, Institut de Neurociències, Hospital Clínic de Barcelona, c. Villarroel 140, 08015 Barcelona, Spain.
| | - JL Thompson
- Center of Prevention and Evaluation, New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York City, New York
| | - CM Corcoran
- Center of Prevention and Evaluation, New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York City, New York
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Courvoisie H, Labellarte MJ, Riddle MA. Psychosis in children: diagnosis and treatment. DIALOGUES IN CLINICAL NEUROSCIENCE 2012. [PMID: 22033588 PMCID: PMC3181648 DOI: 10.31887/dcns.2001.3.2/hcourvoisie] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The diagnosis of childhood psychosis raises a host of unresolved problems, despite the Diagnostic and Statistical Manual Of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) giving identical symptoms and definitions for children, adolescents, and adults. The fantasy lives of children, and issues of developing language and cognition (including retardation), all impair diagnostic accuracy, particularly when differentiating between childhood-onset schizophrenia (COS) (≤12 years), bipolar affective disorder, major depressive disorder, and even obsessive-compulsive disorder and attention-deficit/hyperactivity disorder: the catch-all classification, psychosis not otherwise specified (PNOS), is always available for conundra that prove unsolvable. Typical if nonpathognomonic features include neurocognitive difficulties. Multiple screening instruments and specialized versions of semistructured diagnostic interviews are available. Although smooth-pursuit eye-tracking movements may prove a genetic marker for COS, etiologies are likely to be oligogenetic rather than related to a single gene. No specific biological markers or neuroimages have been identified. As such, psychoses may be indicative of a more general pattern of brain dysfunction. Drug treatments are largely based on the adult literature because of a dearth of controlled data below age 18. There are still no rigorous studies of psychosocial treatments and psychotherapy specific to childhood psychosis.
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Affiliation(s)
- H Courvoisie
- Division of Child and Adolescent Psychiatry, Johns Hopkins Medical Institutions, Baltimore, Md, USA
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19
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Mittal VA, Walker EF. Minor physical anomalies and vulnerability in prodromal youth. Schizophr Res 2011; 129:116-21. [PMID: 21429715 PMCID: PMC3110506 DOI: 10.1016/j.schres.2011.02.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 02/21/2011] [Accepted: 02/24/2011] [Indexed: 11/26/2022]
Abstract
Because both the brain and craniofacial/limb features originate from the same germinal layer during early gestation, the postnatal presence of minor physical anomalies (MPAs) involving these physical features may be indicative of defects in prenatal neural migration and consequent brain abnormalities among individuals with psychosis. However, to date it is unknown what symptoms and characteristics MPAs may be associated with, or how these markers may reflect vulnerability among adolescents at high-risk for developing psychosis. This information is particularly vital for understanding susceptibility and informing etiological conceptualizations such as the neural diathesis-stress model. In this study, 50 adolescents with a prodromal syndrome were evaluated for MPAs, salivary cortisol, auditory and visual memory function, and attenuated positive, negative, and disorganized symptoms. Results indicated that the participants showing elevated MPAs (n=25) were distinguished by elevated cortisol, deficit immediate and delayed visual memory, and higher levels of disorganized prodromal symptoms when compared with those participants exhibiting a lower incidence of MPAs. This was supported by supplementary correlational analyses examining the entire sample. These findings provide preliminary support for a theory that MPAs may reflect hippocampal system vulnerability among prodromal patients.
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Affiliation(s)
- Vijay A. Mittal
- Department of Psychology and Neuroscience, University of Colorado at Boulder,Center for Neuroscience, University of Colorado at Boulder
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20
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Developmental changes in hypothalamus-pituitary-adrenal activity over the transition to adolescence: normative changes and associations with puberty. Dev Psychopathol 2009; 21:69-85. [PMID: 19144223 DOI: 10.1017/s0954579409000054] [Citation(s) in RCA: 470] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Home baseline and laboratory stressor (Trier Social Stress Test for Children) measures of salivary cortisol were obtained from 82 participants (40 girls) aged 9, 11, 13, and 15 years. Measures of pubertal development, self-reported stress, parent reports of child depressive symptoms and fearful temperament, and cardiac measures of sympathetic and parasympathetic activity were also obtained. Significant increases in the home cortisol baselines were found with age and pubertal development. Cortisol stress reactivity differed by age group with 11-year-olds and 13-year-old boys showing blunted reactivity and 9-year-olds, 13-year-old girls, and 15-year-olds showing significant cortisol reactions. Cortisol reactivity correlated marginally with sexual maturation. Measures of sympathetic activity revealed increased sympathetic modulation with age. Higher sympathetic tone was associated with more fearful temperament, whereas greater cortisol reactivity was associated with more anxious and depressed symptoms for girls. The importance of these findings for the hypothesis that puberty-associated increases in hypothalamic-pituitary-adrenal axis activity heightens the risk of psychopathology is discussed.
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21
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Stroud LR, Foster E, Papandonatos GD, Handwerger K, Granger DA, Kivlighan KT, Niaura R. Stress response and the adolescent transition: performance versus peer rejection stressors. Dev Psychopathol 2009; 21:47-68. [PMID: 19144222 PMCID: PMC2700625 DOI: 10.1017/s0954579409000042] [Citation(s) in RCA: 404] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Little is known about normative variation in stress response over the adolescent transition. This study examined neuroendocrine and cardiovascular responses to performance and peer rejection stressors over the adolescent transition in a normative sample. Participants were 82 healthy children (ages 7-12 years, n = 39, 22 females) and adolescents (ages 13-17, n = 43, 20 females) recruited through community postings. Following a habituation session, participants completed a performance (public speaking, mental arithmetic, mirror tracing) or peer rejection (exclusion challenges) stress session. Salivary cortisol, salivary alpha amylase (sAA), systolic and diastolic blood pressure (SBP, DBP), and heart rate were measured throughout. Adolescents showed significantly greater cortisol, sAA, SBP, and DBP stress response relative to children. Developmental differences were most pronounced in the performance stress session for cortisol and DBP and in the peer rejection session for sAA and SBP. Heightened physiological stress responses in typical adolescents may facilitate adaptation to new challenges of adolescence and adulthood. In high-risk adolescents, this normative shift may tip the balance toward stress response dysregulation associated with depression and other psychopathology. Specificity of physiological response by stressor type highlights the importance of a multisystem approach to the psychobiology of stress and may also have implications for understanding trajectories to psychopathology.
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Affiliation(s)
- Laura R Stroud
- Center for Behavioral Medicine, Department of Psychiatry and Human Behavior, Brown Medical School and The Miriam Hospital, CoroWest, Suite 500, 1 Hoppin Street, Providence, RI 02903, USA.
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22
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Mittal VA, Ellman LM, Cannon TD. Gene-environment interaction and covariation in schizophrenia: the role of obstetric complications. Schizophr Bull 2008; 34:1083-94. [PMID: 18635675 PMCID: PMC2632505 DOI: 10.1093/schbul/sbn080] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
While genetic factors account for a significant proportion of liability to schizophrenia, a body of evidence attests to a significant environmental contribution. Understanding the mechanisms through which genetic and environmental factors coalesce in influencing schizophrenia is critical for elucidating the pathways underlying psychotic illness and for developing primary prevention strategies. Although obstetric complications (OCs) remain among the most well-documented environmental indicators of risk for schizophrenia, the pathogenic role they play in the etiology of schizophrenia continues to remain poorly understood. A question of major importance is do these factors result from a genetic diathesis to schizophrenia (as in gene-environment covariation), act additively or interactively with predisposing genes for the disorder in influencing disease risk, or independently cause disease onset? In this review, we evaluate 3 classes of OCs commonly related to schizophrenia including hypoxia-associated OCs, maternal infection during pregnancy, and maternal stress during pregnancy. In addition, we discuss several mechanisms by which OCs impact on genetically susceptible brain regions, increasing constitutional vulnerability to neuromaturational events and stressors later in life (ie, adolescence), which may in turn contribute to triggering psychosis.
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Affiliation(s)
- Vijay A. Mittal
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
- Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | | | - Tyrone D. Cannon
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
- Department of Psychology, University of California Los Angeles, Los Angeles, CA
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Weinberg SM, Jenkins EA, Marazita ML, Maher BS. Minor physical anomalies in schizophrenia: a meta-analysis. Schizophr Res 2007; 89:72-85. [PMID: 17079117 PMCID: PMC2666162 DOI: 10.1016/j.schres.2006.09.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Revised: 08/30/2006] [Accepted: 09/06/2006] [Indexed: 01/06/2023]
Abstract
Numerous studies report an increased frequency of minor physical anomalies (MPAs) in schizophrenic individuals compared with controls. However, these studies vary considerably regarding the magnitude of the case-control disparity and the topographical distribution of the anomalies. A meta-analysis was carried out on the existing MPA literature in an effort to better understand the relationship between MPAs and schizophrenia. Following a literature search, 13 studies were identified that met our inclusion criteria. Mean total MPA scores were available for 11 of these studies, whereas only seven studies provided regional MPA scores. For both the total MPA and regional MPA analyses, pooled effect sizes (Hedges' g and pooled odds ratios, respectively) were calculated along with tests of heterogeneity. For the total MPA analyses, a meta-regression approach was used to explore the relationship between possible moderator variables (e.g., number of MPA scale items) and effect size heterogeneity. The magnitude of the pooled effect size for the total MPA scores was high (1.131; p<0.001), indicating significantly more overall MPAs in schizophrenic individuals. Significant effect size heterogeneity was present (p<0.001); however, this heterogeneity could not be explained by any of the included moderator variables. The regional MPA analysis revealed significantly increased MPAs in all six anatomical regions (p<0.05), although the pooled odds ratios for these regions did not differ significantly from one another. These results suggest a lack of regional specificity for MPAs in schizophrenia.
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Affiliation(s)
- Seth M Weinberg
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA.
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Scutt L, Chow E, Weksberg R, Honer W, Bassett AS. Patterns of dysmorphic features in schizophrenia. AMERICAN JOURNAL OF MEDICAL GENETICS 2001; 105:713-23. [PMID: 11803519 PMCID: PMC3142273 DOI: 10.1002/ajmg.1612] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Congenital dysmorphic features are prevalent in schizophrenia and may reflect underlying neurodevelopmental abnormalities. A cluster analysis approach delineating patterns of dysmorphic features has been used in genetics to classify individuals into more etiologically homogeneous subgroups. In the present study, this approach was applied to schizophrenia, using a sample with a suspected genetic syndrome as a testable model. Subjects (n = 159) with schizophrenia or schizoaffective disorder were ascertained from chronic patient populations (random, n = 123) or referred with possible 22q11 deletion syndrome (referred, n = 36). All subjects were evaluated for presence or absence of 70 reliably assessed dysmorphic features, which were used in a three-step cluster analysis. The analysis produced four major clusters with different patterns of dysmorphic features. Significant between-cluster differences were found for rates of 37 dysmorphic features (P < 0.05), median number of dysmorphic features (P = 0.0001), and validating features not used in the cluster analysis: mild mental retardation (P = 0.001) and congenital heart defects (P = 0.002). Two clusters (1 and 4) appeared to represent more developmental subgroups of schizophrenia with elevated rates of dysmorphic features and validating features. Cluster 1 (n = 27) comprised mostly referred subjects. Cluster 4 (n = 18) had a different pattern of dysmorphic features; one subject had a mosaic Turner syndrome variant. Two other clusters had lower rates and patterns of features consistent with those found in previous studies of schizophrenia. Delineating patterns of dysmorphic features may help identify subgroups that could represent neurodevelopmental forms of schizophrenia with more homogeneous origins.
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Affiliation(s)
- L.E. Scutt
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - E.W.C. Chow
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - R. Weksberg
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - W.G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne S. Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Correspondence to: Dr. Anne S. Bassett, Clinical Genetics Research Program, Centre for Addiction and Mental Health, Queen Street Division, 1001 Queen Street West, Toronto, Ontario, M6J 1H4, Canada.
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