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Foucher JR, Hirjak D, Walther S, Dormegny-Jeanjean LC, Humbert I, Mainberger O, de Billy CC, Schorr B, Vercueil L, Rogers J, Ungvari G, Waddington J, Berna F. From one to many: Hypertonia in schizophrenia spectrum psychosis an integrative review and adversarial collaboration report. Schizophr Res 2024; 263:66-81. [PMID: 37059654 DOI: 10.1016/j.schres.2023.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 04/16/2023]
Abstract
Different types of resistance to passive movement, i.e. hypertonia, were described in schizophrenia spectrum disorders (SSD) long before the introduction of antipsychotics. While these have been rediscovered in antipsychotic-naïve patients and their non-affected relatives, the existence of intrinsic hypertonia vs drug-induced parkinsonism (DIP) in treated SSD remains controversial. This integrative review seeks to develop a commonly accepted framework to specify the putative clinical phenomena, highlight conflicting issues and discuss ways to challenge each hypothesis and model through adversarial collaboration. The authors agreed on a common framework inspired from systems neuroscience. Specification of DIP, locomotor paratonia (LMP) and psychomotor paratonia (PMP) identified points of disagreement. Some viewed parkinsonian rigidity to be sufficient for diagnosing DIP, while others viewed DIP as a syndrome that should include bradykinesia. Sensitivity of DIP to anticholinergic drugs and the nature of LPM and PMP were the most debated issues. It was agreed that treated SSD should be investigated first. Clinical features of the phenomena at issue could be confirmed by torque, EMG and joint angle measures that could help in challenging the selectivity of DIP to anticholinergics. LMP was modeled as the release of the reticular formation from the control of the supplementary motor area (SMA), which could be challenged by the tonic vibration reflex or acoustic startle. PMP was modeled as the release of primary motor cortex from the control of the SMA and may be informed by subclinical echopraxia. If these challenges are not met, this would put new constraints on the models and have clinical and therapeutic implications.
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Affiliation(s)
- Jack R Foucher
- ICube - CNRS UMR 7357, Neurophysiology, FMTS, University of Strasbourg, France, EU; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France, EU.
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany, EU
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Ludovic C Dormegny-Jeanjean
- ICube - CNRS UMR 7357, Neurophysiology, FMTS, University of Strasbourg, France, EU; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France, EU
| | - Ilia Humbert
- CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France, EU
| | - Olivier Mainberger
- ICube - CNRS UMR 7357, Neurophysiology, FMTS, University of Strasbourg, France, EU; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France, EU
| | - Clément C de Billy
- ICube - CNRS UMR 7357, Neurophysiology, FMTS, University of Strasbourg, France, EU; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France, EU
| | - Benoit Schorr
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France, EU; Physiopathologie et Psychopathologie Cognitive de la Schizophrénie - INSERM 1114, FMTS, University of Strasbourg, France, EU
| | - Laurent Vercueil
- Unité de neurophysiologie clinique, CHU Grenoble Alpes, Université Grenoble Alpes, France, EU; INSERM U1216, Institut de neurosciences, Grenoble, France, EU
| | - Jonathan Rogers
- Division of Psychiatry, University College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Gabor Ungvari
- Section of Psychiatry, School of Medicine, University Notre Dame Australia, Fremantle, Australia
| | - John Waddington
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland, EU
| | - Fabrice Berna
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France, EU; Physiopathologie et Psychopathologie Cognitive de la Schizophrénie - INSERM 1114, FMTS, University of Strasbourg, France, EU
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Crespo Y, Ibañez A, Soriano MF, Iglesias S, Aznarte JI. Handwriting movements for assessment of motor symptoms in schizophrenia spectrum disorders and bipolar disorder. PLoS One 2019; 14:e0213657. [PMID: 30870472 PMCID: PMC6417658 DOI: 10.1371/journal.pone.0213657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/26/2019] [Indexed: 01/04/2023] Open
Abstract
The main aim of the present study was to explore the value of several measures of handwriting in the study of motor abnormalities in patients with bipolar or psychotic disorders. 54 adult participants with a schizophrenia spectrum disorder or bipolar disorder and 44 matched healthy controls, participated in the study. Participants were asked to copy a handwriting pattern consisting of four loops, with an inking pen on a digitizing tablet. We collected a number of classical, non-linear and geometrical measures of handwriting. The handwriting of patients was characterized by a significant decrease in velocity and acceleration and an increase in the length, disfluency and pressure with respect to controls. Concerning non-linear measures, we found significant differences between patients and controls in the Sample Entropy of velocity and pressure, Lempel-Ziv of velocity and pressure, and Higuchi Fractal Dimension of pressure. Finally, Lacunarity, a measure of geometrical heterogeneity, was significantly greater in handwriting patterns from patients than from controls. We did not find differences in any handwriting measure on function of the specific diagnosis or the antipsychotic dose. Results indicate that participants with a schizophrenia spectrum disorder or bipolar disorder exhibit significant motor impairments and that these impairments can be readily quantified using measures of handwriting movements. Besides, they suggest that motor abnormalities are a core feature of several mental disorders and they seem to be unrelated to the pharmacological treatment.
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Affiliation(s)
- Yasmina Crespo
- Psychology Department, University of Jaén, Jaén, Spain
- Mental Health Unit, St. Agustín Universitary Hospital, Linares, Jaén, Spain
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Hirjak D, Kubera KM, Thomann PA, Wolf RC. Motor dysfunction as an intermediate phenotype across schizophrenia and other psychotic disorders: Progress and perspectives. Schizophr Res 2018; 200:26-34. [PMID: 29074330 DOI: 10.1016/j.schres.2017.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/02/2017] [Accepted: 10/06/2017] [Indexed: 02/07/2023]
Abstract
Primary motor abnormalities (PMA), as found in patients with schizophrenia, are quantitatively and qualitatively distinct markers of motor system abnormalities. PMA have been often referred to phenomena that are present across schizophrenia-spectrum disorders. A dysfunction of frontoparietal and subcortical networks has been proposed as core pathophysiological mechanism underlying the expression of PMA. However, it is unclear at present if such mechanisms are a common within schizophrenia and other psychotic disorders. To address this question, we review recent neuroimaging studies investigating the neural substrates of PMA in schizophrenia and so-called "nonschizophrenic nonaffective psychoses" (NSNAP) such as schizophreniform, schizoaffective, brief psychotic, and other unspecified psychotic disorders. Although the extant data in patients with schizophrenia suggests that further investigation is warranted, MRI findings in NSNAP are less persuasive. It is unclear so far which PMA, if any, are characteristic features of NSNAP or, possibly even specific for these disorders. Preliminary data suggest a relationship between relapsing-remitting PMA in hyper-/hypokinetic cycloid syndromes and neurodegenerative disorders of the basal ganglia, likely reflecting the transnosological relevance of subcortical abnormalities. Despite this evidence, neural substrates and mechanisms underlying PMA that are common in schizophrenia and NSNAP cannot be clearly delineated at this stage of research. PMA and their underlying brain circuits could be promising intermediate phenotype candidates for psychotic disorders, but future multimodal neuroimaging studies in schizophrenia and NSNAP patients and their unaffected first-degree relatives are needed to answer fundamental transnosologic questions.
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Affiliation(s)
- Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University Mannheim, Germany.
| | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Germany
| | - Philipp A Thomann
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Germany; Center for Mental Health, Odenwald District Healthcare Center, Erbach, Germany
| | - Robert C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Germany
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Abstract
BACKGROUND Early response to antipsychotic medication within 2 weeks of initiating treatment can predict psychiatric outcomes. However, it is unclear whether early response is also predictive of extrapyramidal side effects (EPSs) associated with antipsychotic medications. METHODS In this study, we investigated 136 consecutive antipsychotic-naive, first-episode psychosis patients naturalistically treated with haloperidol. Patients were assessed at baseline and weekly after treatment initiation using the Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale. Dystonia, parkinsonism, akathisia, and dyskinesia were also assessed weekly using standardized rating scales. Regression analyses were used to determine whether early response at week 2 of treatment predicted the incidence of EPS at any point during hospitalization. A secondary analysis was conducted to determine whether early response continued to predict EPS in patients who experienced no EPS within the first 2 weeks of treatment. RESULTS The analyses demonstrated that greater Brief Psychiatric Rating Scale percent improvement at week 2 predicted a decreased risk of EPSs (P = 0.004), even in patients who did not show any EPSs within the first 2 weeks of treatment (P = 0.005). For specific EPS, early response predicted decreased incidences of parkinsonism (P = 0.028) and dyskinesia (P = 0.025), but not akathisia or dystonia. Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale improvement at week 2 did not predict EPSs. In addition, EPSs were not predicted by the maximum antipsychotic dose received during hospitalization. CONCLUSIONS These results indicate that early antipsychotic response is valuable not only for predicting psychiatric outcomes, but also for predicting the risk of EPSs.
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Cuesta MJ, Sánchez-Torres AM, de Jalón EG, Campos MS, Ibáñez B, Moreno-Izco L, Peralta V. Spontaneous parkinsonism is associated with cognitive impairment in antipsychotic-naive patients with first-episode psychosis: a 6-month follow-up study. Schizophr Bull 2014; 40:1164-73. [PMID: 24072809 PMCID: PMC4133659 DOI: 10.1093/schbul/sbt125] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There is now growing evidence that parkinsonism and other extrapyramidal signs are highly prevalent in patients with first-episode psychosis who have never been exposed to antipsychotic drugs. However, the neurocognitive correlates of parkinsonism in this population remained to be clarified. A sample comprising 100 consecutive drug-naive patients with first-episode psychosis were enrolled on the study and followed up for 6 months. Seventy-seven completed assessments at 3 time points (baseline, 1 mo, and 6 mo), involving clinical and cognitive examinations and a specific assessment of motor abnormalities. The Simpson-Angus Scale (SAS) was used for the assessment of extrapyramidal signs, and each motor domain was evaluated with a standard assessment scale. Linear mixed models were built to explore the longitudinal relationships between parkinsonism scores and cognitive impairment. Parkinsonism scores showed significant strong longitudinal associations with deficits in memory, executive functioning, and attention. Spontaneous parkinsonism (total SAS score and hypokinesia and rigidity subscores at baseline) showed high 6-month predictive values for cognitive impairment. In addition, they also had high predictive values for neurologic soft-sign abnormalities but not for dyskinesia, akathisia, and pure catatonic abnormalities. No predictive value was found for glabella-salivation or tremor subscores on the SAS scale. These results emphasize the relevance of the assessment of parkinsonism signs prior to starting to administer antipsychotic drugs, as core manifestations of psychotic illness with a high predictive value for cognitive impairment.
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Affiliation(s)
- Manuel J Cuesta
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona, Spain;
| | | | | | - Maria S Campos
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Berta Ibáñez
- Methodology Unit, Biomedical Research Center, Fundación Miguel Servet, Pamplona, Spain
| | - Lucía Moreno-Izco
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Víctor Peralta
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona, Spain
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Koning JPF, Tenback DE, van Os J, Aleman A, Kahn RS, van Harten PN. Dyskinesia and parkinsonism in antipsychotic-naive patients with schizophrenia, first-degree relatives and healthy controls: a meta-analysis. Schizophr Bull 2010; 36:723-31. [PMID: 18990712 PMCID: PMC2894597 DOI: 10.1093/schbul/sbn146] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Several studies have reported the presence of dyskinesia and parkinsonism in antipsychotic-naive patients with schizophrenia as well as in their first-degree relatives. These movement disorders may therefore form an integral part of the illness and its (genetic) liability. METHOD A systematic search was conducted in the Medline, EMBASE, and PsychINFO databases to identify studies reporting on dyskinesia and parkinsonism assessed in antipsychotic-naive patients with schizophrenia (n = 213) and controls (n = 242) and separately in nonill first-degree relatives (n = 395) and controls (n = 379). Effect sizes were pooled using random-effect models to calculate odds ratios (ORs) to compare the risk of these movement disorders among patients and healthy relatives each with matched controls. RESULTS Antipsychotic-naive schizophrenia was found to be strongly associated with dyskinesia (OR: 3.59, 95% confidence interval [CI]: 1.53-8.41) and parkinsonism (OR: 5.32, 95% CI: 1.75-16.23) compared with controls. Dyskinesia and parkinsonism were also significantly more prevalent in healthy first-degree relatives of patients with schizophrenia as compared with healthy controls (OR: 1.38, 95% CI: 1.06-1.81, and OR: 1.37, 95% CI: 1.05-1.79, respectively). CONCLUSION The results suggest that movement disorders, and by inference abnormalities in the nigrostriatal pathway, are not only associated with schizophrenia itself but may also be related to the (genetic) risk of developing the disease.
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Affiliation(s)
- Jeroen PF Koning
- Psychiatric Center Symfora groep, Amersfoort, The Netherlands,Rudolph Magnus Institute of Neuroscience,To whom correspondence should be addressed; c/o. Mrs T. van Polanen, Symfora groep, Medisch centrum, PO Box 3051, 3800 DB Amersfoort, The Netherlands; tel: +31-33-4609568, fax: +31-33-4609557, e-mail:
| | - Diederik E. Tenback
- Psychiatric Center Symfora groep, Amersfoort, The Netherlands,Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands,Division of Psychological Medicine, Institute of Psychiatry, London, UK
| | - André Aleman
- BCN Neuroimaging Center,University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - René S. Kahn
- Rudolph Magnus Institute of Neuroscience,Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter N. van Harten
- Psychiatric Center Symfora groep, Amersfoort, The Netherlands,University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Pappa S, Dazzan P. Spontaneous movement disorders in antipsychotic-naive patients with first-episode psychoses: a systematic review. Psychol Med 2009; 39:1065-1076. [PMID: 19000340 DOI: 10.1017/s0033291708004716] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Spontaneous movement disorders (SMDs), such as spontaneous dyskinesia and parkinsonism, have been described in patients with schizophrenia who have never been treated with antipsychotic medication. Their presence has been documented extensively in chronic schizophrenia but not at the time of illness onset. METHOD We performed a systematic review of studies investigating spontaneous abnormal movements elicited on clinical examination in antipsychotic-naive patients with first-episode psychosis. RESULTS We identified a total of 13 studies. Findings suggest a spontaneous dyskinesia median rate of 9% and a spontaneous parkinsonism median rate of 17%. Information on akathisia and dystonia was limited. The presence of SMDs may be associated with negative symptoms and cognitive dysfunction. CONCLUSIONS These findings support the notion that spontaneous abnormal movements are part of a neurodysfunction intrinsic to the pathogenesis of schizophrenia. Future studies should further investigate the role of basal ganglia and extrapyramidal pathways in the pathophysiology of psychosis, with particular attention to treatment implications.
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Affiliation(s)
- S Pappa
- Institute of Psychiatry, Division of Psychological Medicine, King's College London, UK.
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Whitty PF, Owoeye O, Waddington JL. Neurological signs and involuntary movements in schizophrenia: intrinsic to and informative on systems pathobiology. Schizophr Bull 2009; 35:415-24. [PMID: 18791074 PMCID: PMC2659305 DOI: 10.1093/schbul/sbn126] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
While it has long been considered whether the pathobiology of schizophrenia extends beyond its defining symptoms to involve diverse domains of abnormality, in the manner of a systemic disease, studies of neuromotor dysfunction have been confounded by treatment with antipsychotic drugs. This challenge has been illuminated by a new generation of studies on first-episode schizophrenia before initiation of antipsychotic treatment and by opportunities in developing countries to study chronically ill patients who have remained antipsychotic naive due to limitations in provision of psychiatric care. Building from studies in antipsychotic-naive patients, this article reviews 2 domains of neuromotor dysfunction in schizophrenia: neurological signs and involuntary movements. The presence and characteristics of neurological signs in untreated vis-à-vis treated psychosis indicate a vulnerability marker for schizophrenia and implicate disruption to neuronal circuits linking the basal ganglia, cerebral cortex, and cerebellum. The presence and characteristics of involuntary movements in untreated vis-à-vis treated psychosis indicate an intrinsic feature of the disease process and implicate dysfunction in cortical-basal ganglia-cortical circuitry. These neuromotor disorders of schizophrenia join other markers of subtle but pervasive cerebral and extracerebral, systemic dysfunction, and complement current concepts of schizophrenia as a disorder of developmentally determined cortical-basal ganglia-thalamo-cortical/cerebellar network disconnectivity.
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Affiliation(s)
- Peter F. Whitty
- Department of Psychiatry, The Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Olabisi Owoeye
- Cavan-Monaghan Mental Health Service, St Davnet's Hospital, Monaghan, Ireland
| | - John L. Waddington
- Cavan-Monaghan Mental Health Service, St Davnet's Hospital, Monaghan, Ireland
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, St Stephen's Green, Dublin 2, Ireland
- To whom correspondence should be addressed; tel: +353-1-402-2129, fax: +353-1-402-2453, e-mail:
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Lee J, Poon LY, Chong SA. Spontaneous dyskinesia in first-episode psychosis in a Southeast Asian population. J Clin Psychopharmacol 2008; 28:536-9. [PMID: 18794649 DOI: 10.1097/jcp.0b013e3181845f59] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Spontaneous dyskinesia in first-episode psychosis was described previously with varying incidence rates ranging from zero to 53%. Dyskinesia was also found to be more common in siblings of patients with both schizophrenia and dyskinesia. This condition was linked with structural brain abnormalities and posited to be another subtype of schizophrenia with striatal pathology. Whether there are ethnic variations in the rates of spontaneous dyskinesia is unknown because of the paucity of studies in this area. This study aims to establish the rates of spontaneous dyskinesia in a Southeast Asian population of drug-naive patients experiencing their first psychotic episode and to examine the clinical correlates. A total of 908 patients were examined, of which, 76.1% were Chinese; 15.4%, Malays; 6.2%, Indians; and 2.3%, from other minor ethnic groups. Schizophrenia was diagnosed in 48.9% of the population. There were 3 patients of Chinese descent who had "minimal" or "mild" dyskinetic movements when rated with the Abnormal Involuntary Movement Scale, but none fulfilled the Schooler and Kane criteria for spontaneous dyskinesia. Their dyskinetic movements resolved when reassessed 3 and 6 months after treatment with antipsychotic medications. Of the 3 patients, 2 were treatment resistant and subsequently treated with clozapine. This is the largest study to date examining the prevalence of spontaneous dyskinesia. We hypothesize that there is an ethnically based difference in the rates of spontaneous dyskinesia that could reflect underlying genetic variations. Patients with dyskinetic movements at baseline could have a more treatment refractory course of illness.
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Affiliation(s)
- Jimmy Lee
- Institute of Mental Health/Woodbridge Hospital, Singapore.
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Opposite changes in predominantly docosahexaenoic acid (DHA) in cerebrospinal fluid and red blood cells from never-medicated first-episode psychotic patients. Schizophr Res 2008; 98:295-301. [PMID: 17997280 DOI: 10.1016/j.schres.2007.09.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 09/29/2007] [Indexed: 01/25/2023]
Abstract
Variable levels of essential polyunsaturated fatty acids (EPUFAs) reported in schizophrenia are likely due to differences in age, sex, ethnicity, diet, life style and treatments. The present study examined the EPUFAs levels in plasma, RBC and CSF in never-medicated first-episode psychotic patients and normal controls matched for ethnicity, diet and life style. The plasma EPUFAs levels were similar in both groups. Among the EPUFAs enriched in the brain, predominantly docosahexaenoic acid (DHA) levels were lower in RBC (p=<0.01) whereas higher in CSF (p=<0.01) in male>female patients. This altered DHA metabolism may provide clues for neuropathology and treatment of schizophrenia.
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