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Genkel V, Domozhirova E, Malinina E. Multimorbidity in Severe Mental Illness as Part of the Neurodevelopmental Continuum: Physical Health-Related Endophenotypes of Schizophrenia-A Narrative Review. Brain Sci 2024; 14:725. [PMID: 39061465 PMCID: PMC11274495 DOI: 10.3390/brainsci14070725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/14/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The majority of deaths in patients with schizophrenia and other severe mental illnesses (SMIs) are caused by natural causes, such as cardiovascular diseases (CVDs). The increased risk of CVD and other somatic diseases in SMIs cannot be fully explained by the contribution of traditional risk factors, behavioral risk factors, patients' lifestyle peculiarities, and the influence of antipsychotics. The present review has the following main objectives: (1) to aggregate evidence that neurodevelopmental disorders are the basis of SMIs; (2) to provide a review of studies that have addressed the shared genetic architecture of SMI and cardiovascular disease; and (3) to propose and substantiate the consideration of somatic diseases as independent endophenotypes of SMIs, which will make it possible to place the research of somatic diseases in SMIs within the framework of the concepts of the "neurodevelopmental continuum and gradient" and "endophenotype". METHODS A comprehensive literature search was performed on 1 July 2024. The search was performed using PubMed and Google Scholar databases up to June 2024. RESULTS The current literature reveals considerable overlap between the genetic susceptibility loci for SMIs and CVDs. We propose that somatic diseases observed in SMIs that have a shared genetic architecture with SMIs can be considered distinct physical health-related endophenotypes. CONCLUSIONS In this narrative review, the results of recent studies of CVDs in SMIs are summarized. Reframing schizophrenia as a multisystem disease should contribute to the activation of new research on somatic diseases in SMIs.
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Affiliation(s)
- Vadim Genkel
- Department of Internal Medicine, South-Ural State Medical University, Chelyabinsk 454092, Russia
| | - Elena Domozhirova
- Department of Psychiatry, South-Ural State Medical University, Chelyabinsk 454092, Russia; (E.D.); (E.M.)
| | - Elena Malinina
- Department of Psychiatry, South-Ural State Medical University, Chelyabinsk 454092, Russia; (E.D.); (E.M.)
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Kapıcı Y, Kapıcı OB, Abuş S, Örüm MH, Ayhan S, Bozkurt M, Özer B, Tekin A. Investigation of carotid intima-media thickness in patients with schizophrenia. BMC Psychiatry 2024; 24:54. [PMID: 38233818 PMCID: PMC10795201 DOI: 10.1186/s12888-024-05496-7] [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: 04/20/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Patients with schizophrenia (SCZ) have a higher risk of cardiovascular diseases than the average population. Early diagnosis of SCZ patients with subclinical atherosclerosis is great importance in reducing cardiovascular morbidity and mortality. The aim of this study was to investigate some clinical risk factors for atherosclerosis in patients with SCZ. METHODS Fifty-one SCZ patients (20 females, 31 males) and 55 healthy controls (HCs) (25 females, 30 males) were included in the study. Electrocardiography (ECG), lipid parameters, hemogram, and biochemistry values of the participants were taken. Low-density lipoprotein (LDL), high-density lipoprotein (HDL), fasting triglycerides, and total cholesterol were measured. The arrhythmogenic index of plasma (AIP) was analyzed. The recorded right and left carotid intima-media thickness (CIMT) measurements by carotid ultrasonography were scanned. RESULTS QT interval (p = 0.035), CIMT-left (p = 0.008), CIMT-right (p = 0.002), fasting triglyceride (p = 0.005), AIP (p = 0.005) in the SCZ group compared to HCs (< 0.001) was statistically higher, while HDL (p = 0.003) was statistically lower. Smoking rates, QT interval (p = 0.035), CIMT-left (p = 0.008), and CIMT-right (p = 0.002) were significantly higher in the the SCZ group than in the HCs. According to odds ratios, individuals with SCZ have a 6.3-fold higher smoking rate. According to Pearson correlation analysis, CIMT-left was positively correlated with age and QT interval (r = 0.568, p < 0.001 and r = 0.589, p < 0.001, respectively). CIMT-right value was also positively correlated with age and QT interval (r = 0.533, p < 0.001 and r = 0.555, p < 0.001, respectively). QT interval positively and significantly predicted CIMT-left and CIMT-right (p < 0.001, β = 0.549 and p = 0.001 and β = 0.506 accordingly). CONCLUSION In this study, a close relationship was found between the QT interval and CIMT in SCZ patients. This finding could be valuable for using an easy-to-calculate data such as QT in place of a laborious test such as CIMT.
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Affiliation(s)
- Yaşar Kapıcı
- Psychiatry Department, Adıyaman University Faculty of Medicine, Adıyaman, Turkey.
| | - Olga Bayar Kapıcı
- Radiology Department, Adıyaman Training and Research Hospital, Adıyaman, Turkey
| | - Sabri Abuş
- Cardiology Department, Adıyaman University Faculty of Medicine, Adıyaman, Turkey
| | - Mehmet Hamdi Örüm
- Psychiatry Department, Elazığ Mental Health and Diseases Hospital, Elazığ, Turkey
| | - Selçuk Ayhan
- Cardiology Department, Adıyaman Training and Research Hospital, Adıyaman, Turkey
| | - Mehmet Bozkurt
- Cardiology Department, Kahta State Hospital, Adıyaman, Turkey
| | - Bilal Özer
- Radiology Department, Kahta State Hospital, Adıyaman, Turkey
| | - Atilla Tekin
- Psychiatry Department, Adıyaman University Faculty of Medicine, Adıyaman, Turkey
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Wagner SK, Cortina-Borja M, Silverstein SM, Zhou Y, Romero-Bascones D, Struyven RR, Trucco E, Mookiah MRK, MacGillivray T, Hogg S, Liu T, Williamson DJ, Pontikos N, Patel PJ, Balaskas K, Alexander DC, Stuart KV, Khawaja AP, Denniston AK, Rahi JS, Petzold A, Keane PA. Association Between Retinal Features From Multimodal Imaging and Schizophrenia. JAMA Psychiatry 2023; 80:478-487. [PMID: 36947045 PMCID: PMC10034669 DOI: 10.1001/jamapsychiatry.2023.0171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/23/2023] [Indexed: 03/23/2023]
Abstract
Importance The potential association of schizophrenia with distinct retinal changes is of clinical interest but has been challenging to investigate because of a lack of sufficiently large and detailed cohorts. Objective To investigate the association between retinal biomarkers from multimodal imaging (oculomics) and schizophrenia in a large real-world population. Design, Setting, and Participants This cross-sectional analysis used data from a retrospective cohort of 154 830 patients 40 years and older from the AlzEye study, which linked ophthalmic data with hospital admission data across England. Patients attended Moorfields Eye Hospital, a secondary care ophthalmic hospital with a principal central site, 4 district hubs, and 5 satellite clinics in and around London, United Kingdom, and had retinal imaging during the study period (January 2008 and April 2018). Data were analyzed from January 2022 to July 2022. Main Outcomes and Measures Retinovascular and optic nerve indices were computed from color fundus photography. Macular retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (mGC-IPL) thicknesses were extracted from optical coherence tomography. Linear mixed-effects models were used to examine the association between schizophrenia and retinal biomarkers. Results A total of 485 individuals (747 eyes) with schizophrenia (mean [SD] age, 64.9 years [12.2]; 258 [53.2%] female) and 100 931 individuals (165 400 eyes) without schizophrenia (mean age, 65.9 years [13.7]; 53 253 [52.8%] female) were included after images underwent quality control and potentially confounding conditions were excluded. Individuals with schizophrenia were more likely to have hypertension (407 [83.9%] vs 49 971 [48.0%]) and diabetes (364 [75.1%] vs 28 762 [27.6%]). The schizophrenia group had thinner mGC-IPL (-4.05 μm, 95% CI, -5.40 to -2.69; P = 5.4 × 10-9), which persisted when investigating only patients without diabetes (-3.99 μm; 95% CI, -6.67 to -1.30; P = .004) or just those 55 years and younger (-2.90 μm; 95% CI, -5.55 to -0.24; P = .03). On adjusted analysis, retinal fractal dimension among vascular variables was reduced in individuals with schizophrenia (-0.14 units; 95% CI, -0.22 to -0.05; P = .001), although this was not present when excluding patients with diabetes. Conclusions and Relevance In this study, patients with schizophrenia had measurable differences in neural and vascular integrity of the retina. Differences in retinal vasculature were mostly secondary to the higher prevalence of diabetes and hypertension in patients with schizophrenia. The role of retinal features as adjunct outcomes in patients with schizophrenia warrants further investigation.
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Affiliation(s)
- Siegfried K. Wagner
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Mario Cortina-Borja
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Steven M. Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, New York
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York
- Center for Visual Science, University of Rochester, Rochester, New York
| | - Yukun Zhou
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - David Romero-Bascones
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Biomedical Engineering Department, Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Mondragón, Spain
| | - Robbert R. Struyven
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Emanuele Trucco
- VAMPIRE Project, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Muthu R. K. Mookiah
- VAMPIRE Project, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Tom MacGillivray
- VAMPIRE Project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Stephen Hogg
- VAMPIRE Project, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Timing Liu
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Dominic J. Williamson
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Nikolas Pontikos
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Praveen J. Patel
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Konstantinos Balaskas
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Daniel C. Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Kelsey V. Stuart
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Anthony P. Khawaja
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Alastair K. Denniston
- University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
| | - Jugnoo S. Rahi
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- Ulverscroft Vision Research Group, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
| | - Axel Petzold
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Pearse A. Keane
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Seitz-Holland J, Wojcik JD, Cetin-Karayumak S, Lyall AE, Pasternak O, Rathi Y, Vangel M, Pearlson G, Tamminga C, Sweeney JA, Clementz BA, Schretlen DA, Viher PV, Stegmayer K, Walther S, Lee J, Crow T, James A, Voineskos A, Buchanan RW, Szeszko PR, Malhotra AK, Kelly S, Shenton ME, Keshavan MS, Mesholam-Gately RI, Kubicki M. Cognitive deficits, clinical variables, and white matter microstructure in schizophrenia: a multisite harmonization study. Mol Psychiatry 2022; 27:3719-3730. [PMID: 35982257 PMCID: PMC10538303 DOI: 10.1038/s41380-022-01731-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/18/2022] [Accepted: 07/29/2022] [Indexed: 02/08/2023]
Abstract
Cognitive deficits are among the best predictors of real-world functioning in schizophrenia. However, our understanding of how cognitive deficits relate to neuropathology and clinical presentation over the disease lifespan is limited. Here, we combine multi-site, harmonized cognitive, imaging, demographic, and clinical data from over 900 individuals to characterize a) cognitive deficits across the schizophrenia lifespan and b) the association between cognitive deficits, clinical presentation, and white matter (WM) microstructure. Multimodal harmonization was accomplished using T-scores for cognitive data, previously reported standardization methods for demographic and clinical data, and an established harmonization method for imaging data. We applied t-tests and correlation analysis to describe cognitive deficits in individuals with schizophrenia. We then calculated whole-brain WM fractional anisotropy (FA) and utilized regression-mediation analyses to model the association between diagnosis, FA, and cognitive deficits. We observed pronounced cognitive deficits in individuals with schizophrenia (p < 0.006), associated with more positive symptoms and medication dosage. Regression-mediation analyses showed that WM microstructure mediated the association between schizophrenia and language/processing speed/working memory/non-verbal memory. In addition, processing speed mediated the influence of diagnosis and WM microstructure on the other cognitive domains. Our study highlights the critical role of cognitive deficits in schizophrenia. We further show that WM is crucial when trying to understand the role of cognitive deficits, given that it explains the association between schizophrenia and cognitive deficits (directly and via processing speed).
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Affiliation(s)
- Johanna Seitz-Holland
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Joanne D Wojcik
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, Boston, MA, USA
| | - Suheyla Cetin-Karayumak
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amanda E Lyall
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ofer Pasternak
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yogesh Rathi
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Vangel
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Carol Tamminga
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - John A Sweeney
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Brett A Clementz
- Department of Psychology and Neuroscience, Bio-Imaging Research Center, University of Georgia, Athens, GA, USA
| | - David A Schretlen
- Department of Psychiatry and Behavioral Sciences, Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Petra Verena Viher
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katharina Stegmayer
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jungsun Lee
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Tim Crow
- Department of Psychiatry, SANE POWIC, Warneford Hospital, University of Oxford, Oxford, UK
| | - Anthony James
- Department of Psychiatry, SANE POWIC, Warneford Hospital, University of Oxford, Oxford, UK
| | - Aristotle Voineskos
- Center for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Philip R Szeszko
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, NY, USA
| | - Anil K Malhotra
- The Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Sinead Kelly
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, Boston, MA, USA
| | - Martha E Shenton
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, Boston, MA, USA
| | - Raquelle I Mesholam-Gately
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, Boston, MA, USA
| | - Marek Kubicki
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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5
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Silverstein SM, Choi JJ, Green KM, Bowles-Johnson KE, Ramchandran RS. Schizophrenia in Translation: Why the Eye? Schizophr Bull 2022; 48:728-737. [PMID: 35640030 PMCID: PMC9212100 DOI: 10.1093/schbul/sbac050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Schizophrenia is increasingly recognized as a systemic disease, characterized by dysregulation in multiple physiological systems (eg, neural, cardiovascular, endocrine). Many of these changes are observed as early as the first psychotic episode, and in people at high risk for the disorder. Expanding the search for biomarkers of schizophrenia beyond genes, blood, and brain may allow for inexpensive, noninvasive, and objective markers of diagnosis, phenotype, treatment response, and prognosis. Several anatomic and physiologic aspects of the eye have shown promise as biomarkers of brain health in a range of neurological disorders, and of heart, kidney, endocrine, and other impairments in other medical conditions. In schizophrenia, thinning and volume loss in retinal neural layers have been observed, and are associated with illness progression, brain volume loss, and cognitive impairment. Retinal microvascular changes have also been observed. Abnormal pupil responses and corneal nerve disintegration are related to aspects of brain function and structure in schizophrenia. In addition, studying the eye can inform about emerging cardiovascular, neuroinflammatory, and metabolic diseases in people with early psychosis, and about the causes of several of the visual changes observed in the disorder. Application of the methods of oculomics, or eye-based biomarkers of non-ophthalmological pathology, to the treatment and study of schizophrenia has the potential to provide tools for patient monitoring and data-driven prediction, as well as for clarifying pathophysiology and course of illness. Given their demonstrated utility in neuropsychiatry, we recommend greater adoption of these tools for schizophrenia research and patient care.
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Affiliation(s)
- Steven M Silverstein
- To whom correspondence should be addressed; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA; tel: +1 585-275-6742, e-mail:
| | - Joy J Choi
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Kyle M Green
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Rajeev S Ramchandran
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Owusu–Ansah A, Berko Panyin A, Obirikorang C, Agyare C, Acheampong E, Kwofie S, Odame Anto E, Nsenbah Batu E. Metabolic Syndrome among Schizophrenic Patients: A Comparative Cross-Sectional Study in the Middle Belt of Ghana. SCHIZOPHRENIA RESEARCH AND TREATMENT 2018; 2018:6542983. [PMID: 30050695 PMCID: PMC6046121 DOI: 10.1155/2018/6542983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/28/2018] [Accepted: 06/13/2018] [Indexed: 01/05/2023]
Abstract
The study determined the prevalence of MetS in patients with schizophrenia at the Psychiatric Unit of the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. This comparative cross-sectional study recruited 348 schizophrenic patients comprising 236 antipsychotic-treated and 112 newly diagnosed treatment-naïve patients. The MetS prevalence was assessed based on World Health Organization (WHO), International Diabetes Federation (IDF), and the National Cholesterol Education Programme, Adult Treatment Panel III (NCEP ATP III) criteria. The overall prevalence of MetS was 14.1%, 20.4%, and 23.6% using NCEP ATP III, WHO, and IDF criteria, respectively, compared to 7.8%, 3.9%, and 2.2% reported in the general Ghanaian population. The prevalence was significantly higher among treated psychiatric patients compared to treatment-naïve group based on NCEP ATP III (17.8% versus 6.2%; p = 0.0001), WHO (26.2% versus 8.0%; p < 0.0001), and IDF (30.3% versus 10.0%; p < 0.0001). MetS was prevalent among patients on atypical antipsychotics compared to typical antipsychotics irrespective of the criteria used (i.e., 17.1% versus 11.1% for NCEP ATP III; 29.5% versus 25.9% for WHO; and 44.3% versus 18.5% for IDF). Using logistic regression model, obesity, raised fasting blood sugar, raised total cholesterol, and decreased high density lipoprotein were observed to be significant predictors of MetS (p<0.05).The study found high prevalence of MetS in Ghanaians with schizophrenia and higher prevalence rate of MetS associated with monotherapy. Regular monitoring of cardiometabolic parameters should be an important therapeutic objective in the management of these patients.
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Affiliation(s)
- Angela Owusu–Ansah
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Anto Berko Panyin
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Christian Obirikorang
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Christian Agyare
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Emmanuel Acheampong
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- School of Medical and Health Sciences, Edith Cowan University, WA, Australia
| | - Simon Kwofie
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Enoch Odame Anto
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- School of Medical and Health Sciences, Edith Cowan University, WA, Australia
| | - Emmanuella Nsenbah Batu
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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7
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Aftab A, Bhat C, Gunzler D, Cassidy K, Thomas C, McCormick R, Dawson NV, Sajatovic M. Associations among comorbid anxiety, psychiatric symptomatology, and diabetic control in a population with serious mental illness and diabetes: Findings from an interventional randomized controlled trial. Int J Psychiatry Med 2018; 53:126-140. [PMID: 29280685 PMCID: PMC5919280 DOI: 10.1177/0091217417749795] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Serious mental illness and type II diabetes mellitus have a high comorbidity, and both have a higher prevalence of anxiety disorders compared to the general population. Targeted Training in Illness Management is a group-based self-management training approach which targets serious mental illness and type II diabetes mellitus concurrently. This analysis examines data from a randomized controlled trial of Targeted Training in Illness Management intervention to examine the impact of comorbid anxiety on baseline psychiatric symptomatology and diabetic control, and on longitudinal treatment outcomes. Methods We conducted secondary analyses on data from a prospective, 60-week, randomized controlled trial testing Targeted Training in Illness Management versus treatment as usual in 200 individuals with serious mental illness and diabetes. Primary outcomes included measures related to serious mental illness symptoms, functional status, general health status, and diabetes control. Measures were compared between those participants with anxiety disorders versus those without anxiety at baseline as well as over time using linear mixed effects analyses. Results Forty seven percent of the participants had one or more anxiety disorders. At baseline, those with an anxiety diagnosis had higher illness severity, depressive, and other psychiatric symptomatology and disability. Diabetic control (HbA1c) was not significantly different at baseline. In the longitudinal analyses, no significant mean slope differences over time (group-by-time interaction effect) between those with anxiety diagnoses and those without in treatment as usual group were found for primary outcomes. Within the Targeted Training in Illness Management arm, those with anxiety disorders had significantly greater improvement in mental health functioning. Those with anxiety comorbidity in the Targeted Training in Illness Management group demonstrated significantly lower HbA1c levels compared to no anxiety comorbidity and also demonstrated a greater improvement in HbA1c over the first 30 weeks compared to those without anxiety comorbidity. Conclusion Comorbid anxiety in serious mental illness and type II diabetes mellitus population is associated with increased psychiatric symptomatology and greater disability. Individuals from this population appear to experience greater improvement in functioning from baseline with the Targeted Training in Illness Management intervention. Anxiety comorbidity in the serious mental illness and type II diabetes mellitus population does not appear to have a negative impact on diabetic control. These complex relationships need further study. Clinical Trials Registration ClinicalTrials.gov: Improving outcomes for individuals with serious mental illness and diabetes (NCT01410357).
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Affiliation(s)
- Awais Aftab
- Case Western Reserve University School of Medicine/University Hospitals
Cleveland Medical Center, Cleveland, Ohio
| | - Chetan Bhat
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Douglas Gunzler
- Center for Health Care Research and Policy. Case Western Reserve University,
MetroHealth Medical Center, Cleveland, Ohio
| | - Kristin Cassidy
- Case Western Reserve University School of Medicine, University Hospitals
Cleveland Medical Center, Cleveland, Ohio
| | - Charles Thomas
- Center for Health Care Research and Policy. Case Western Reserve University,
MetroHealth Medical Center, Cleveland, Ohio
| | - Richard McCormick
- Center for Health Care Research and Policy. Case Western Reserve University,
MetroHealth Medical Center, Cleveland, Ohio
| | - Neal V. Dawson
- Professor of Medicine, Epidemiology & Biostatistics Center for Health
Care Research and Policy. Case Western Reserve University, MetroHealth Medical Center,
Cleveland, Ohio
| | - Martha Sajatovic
- Professor of Psychiatry, Neurology and Epidemiology & Biostatistics
Case Western Reserve University School of Medicine and Neurological Institute,
University Hospitals Cleveland Medical Center, Cleveland, Ohio
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8
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Savignac HM, Couch Y, Stratford M, Bannerman DM, Tzortzis G, Anthony DC, Burnet PW. Prebiotic administration normalizes lipopolysaccharide (LPS)-induced anxiety and cortical 5-HT2A receptor and IL1-β levels in male mice. Brain Behav Immun 2016; 52:120-131. [PMID: 26476141 PMCID: PMC4927692 DOI: 10.1016/j.bbi.2015.10.007] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 12/26/2022] Open
Abstract
The manipulation of the enteric microbiota with specific prebiotics and probiotics, has been shown to reduce the host's inflammatory response, alter brain chemistry, and modulate anxiety behaviour in both rodents and humans. However, the neuro-immune and behavioural effects of prebiotics on sickness behaviour have not been explored. Here, adult male CD1 mice were fed with a specific mix of non-digestible galacto-oligosaccharides (Bimuno®, BGOS) for 3 weeks, before receiving a single injection of lipopolysaccharide (LPS), which induces sickness behaviour and anxiety. Locomotor and marble burying activities were assessed 4h after LPS injection, and after 24h, anxiety in the light-dark box was assessed. Cytokine expression, and key components of the serotonergic (5-Hydroxytryptamine, 5-HT) and glutamatergic system were evaluated in the frontal cortex to determine the impact of BGOS administration at a molecular level. BGOS-fed mice were less anxious in the light-dark box compared to controls 24h after the LPS injection. Elevated cortical IL-1β concentrations in control mice 28 h after LPS were not observed in BGOS-fed animals. This significant BGOS×LPS interaction was also observed for 5HT2A receptors, but not for 5HT1A receptors, 5HT, 5HIAA, NMDA receptor subunits, or other cytokines. The intake of BGOS did not influence LPS-mediated reductions in marble burying behaviour, and its effect on locomotor activity was equivocal. Together, our data show that the prebiotic BGOS has an anxiolytic effect, which may be related to the modulation of cortical IL-1β and 5-HT2A receptor expression. Our data suggest a potential role for prebiotics in the treatment of neuropsychiatric disorders where anxiety and neuroinflammation are prominent clinical features.
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Affiliation(s)
| | - Yvonne Couch
- Department of Pharmacology, University of Oxford, Oxford OX1, UK
| | - Michael Stratford
- CR-UK/MRC Oxford Institute for Radiation Oncology, University of Oxford, OX3 7DQ, UK
| | - David M. Bannerman
- Department of Experimental Psychology, University of Oxford, Oxford OX1, UK
| | | | | | - Philip W.J. Burnet
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK,Corresponding author at: Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.Neurosciences BuildingDepartment of PsychiatryUniversity of OxfordWarneford HospitalOxfordOX3 7JXUK
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9
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Bartoli F, Lax A, Crocamo C, Clerici M, Carrà G. Plasma adiponectin levels in schizophrenia and role of second-generation antipsychotics: a meta-analysis. Psychoneuroendocrinology 2015; 56:179-89. [PMID: 25827962 DOI: 10.1016/j.psyneuen.2015.03.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/06/2015] [Accepted: 03/06/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with schizophrenia are more likely than general population to suffer from metabolic abnormalities, with second-generation antipsychotics (SGAs) increasing the risk. Low plasma adiponectin levels may lead to metabolic dysregulations but evidence in people with schizophrenia, especially for the role of SGAs, is still inconclusive. OBJECTIVE To compare plasma adiponectin levels between people with schizophrenia and healthy controls, and to estimate the relative effect of schizophrenia and SGAs on adiponectin. METHODS We performed a systematic review and meta-analysis of observational studies published up to 13 June 2014 in main electronic databases. Pooled standardized mean differences (SMDs) between index and control groups were generated. Appropriate subanalyses and additional subgroup analyses were carried out. RESULTS Data from 2735 individuals, 1013 with and 1722 without schizophrenia, respectively, were analysed. Schizophrenia was not associated with lower adiponectin levels (SMD of -0.28, 95%CI: -0.59, 0.04; p=0.09). However, individuals with schizophrenia taking SGAs had plasma levels significantly lower than controls (p=0.002), which was not the case of drug free/drug naïve subjects (p=0.52). As regards single antipsychotic drugs clozapine (p<0.001) and olanzapine (p=0.04)--but not risperidone (p=0.88)--were associated with adiponectin levels lower than controls. CONCLUSIONS People with schizophrenia per se may not have levels of adiponectin lower than controls, though treatment with SGAs is associated with this metabolic abnormality. This bears clinical significance because of hypoadiponectinemia involvement in cardiovascular diseases, even if mechanisms whereby SGAs affect adiponectin remain unexplained. Longitudinal studies evaluating long-term effects of SGAs on adiponectin are needed.
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Affiliation(s)
- Francesco Bartoli
- Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore 48, 20900 Monza, MB, Italy.
| | - Annamaria Lax
- Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore 48, 20900 Monza, MB, Italy
| | - Cristina Crocamo
- Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore 48, 20900 Monza, MB, Italy
| | - Massimo Clerici
- Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore 48, 20900 Monza, MB, Italy
| | - Giuseppe Carrà
- Division of Psychiatry, Faculty of Brain Sciences, University College London, Charles Bell House, 67-73 Riding House Street, London W1W7EJ, UK
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10
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Abstract
The prevalence of diabetes mellitus is twofold to threefold higher in people with severe mental illness (SMI) than in the general population, with diabetes mellitus affecting ∼12% of people receiving antipsychotics. The consequences of diabetes mellitus are more severe and frequent in people with SMI than in those without these conditions, with increased rates of microvascular and macrovascular complications, acute metabolic dysregulation and deaths related to diabetes mellitus. Multiple complex mechanisms underlie the association between diabetes mellitus and SMI; these mechanisms include genetic, environmental and disease-specific factors, and treatment-specific factors. Although antipsychotics are the mainstay of treatment in SMI, a causative link, albeit of uncertain magnitude, seems to exist between antipsychotics and diabetes mellitus. The principles of managing diabetes mellitus in people with SMI are similar to those for the general population and should follow currently established treatment algorithms. Lifestyle interventions are needed to reduce incident diabetes mellitus. In addition, improved uptake of opportunities to screen for this disease will reduce the high prevalence of undiagnosed diabetes mellitus. Currently, people with SMI receive poorer treatment for diabetes mellitus than the general population. Thus, health-care professionals in primary care, diabetes mellitus services and mental health teams have a responsibility to ensure that patients with SMI are not disadvantaged.
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Affiliation(s)
- Richard I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Alex J Mitchell
- Department of Cancer Studies and Molecular Medicine, Infirmary Close, University of Leicester, Leicester LE1 5WW, UK
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11
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Bajor LA, Gunzler D, Einstadter D, Thomas C, McCormick R, Perzynski AT, Kanuch SW, Cassidy KA, Dawson NV, Sajatovic M. Associations between comorbid anxiety, diabetes control, and overall medical burden in patients with serious mental illness and diabetes. Int J Psychiatry Med 2015; 49:309-20. [PMID: 26060262 PMCID: PMC4698974 DOI: 10.1177/0091217415589307] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE While previous work has demonstrated elevation of both comorbid anxiety disorders and diabetes mellitus type II in individuals with serious mental illness, little is known regarding the impact of comorbid anxiety on diabetes mellitus type II outcomes in serious mental illness populations. We analyzed baseline data from patients with serious mental illness and diabetes mellitus type II to examine relationships between comorbid anxiety, glucose control as measured by hemoglobin A1c score, and overall illness burden. METHODS Using baseline data from an ongoing prospective treatment study involving 157 individuals with serious mental illness and diabetes mellitus type II, we compared individuals with and without a comorbid anxiety disorder and compared hemoglobin A1c levels between these groups to assess the relationship between anxiety and management of diabetes mellitus type II. We conducted a similar analysis using cumulative number of anxiety diagnoses as a proxy for anxiety load. Finally, we searched for associations between anxiety and overall medical illness burden as measured by Charlson score. RESULTS Anxiety disorders were seen in 33.1% (N=52) of individuals with serious mental illness and diabetes mellitus type II and were associated with increased severity of depressive symptoms and decreased function. Hemoglobin A1c levels were not significantly different in those with or without anxiety, and having multiple anxiety disorders was not associated with differences in diabetes mellitus type II control. However, depressive symptoms were significantly associated with higher hemoglobin A1c levels. Neither comorbid anxiety nor anxiety load was significantly associated with overall medical burden. CONCLUSION One in three people with serious mental illness and diabetes mellitus type II had anxiety. Depressive symptoms were significantly associated with Hb1Ac levels while anxiety symptoms had no relation to hemoglobin A1c; this is consistent with previously published work. More studies are needed to better understand the relationship between depression, anxiety, and health management in people with serious mental illness and diabetes mellitus type II.
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Affiliation(s)
- Laura A. Bajor
- VA Boston Healthcare Center, Boston, MA and Instructor of Psychiatry, Harvard Medical School
| | - Douglas Gunzler
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA
| | - Douglas Einstadter
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA
| | - Charles Thomas
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA
| | - Richard McCormick
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA
| | - Adam T Perzynski
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA
| | - Stephanie W Kanuch
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA
| | - Kristin A Cassidy
- School of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, USA
| | - Neal V Dawson
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, USA
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12
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Modeling combined schizophrenia-related behavioral and metabolic phenotypes in rodents. Behav Brain Res 2014; 276:130-42. [PMID: 24747658 DOI: 10.1016/j.bbr.2014.04.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 12/11/2022]
Abstract
Schizophrenia is a chronic, debilitating disorder with a complex behavioral and cognitive phenotype underlined by a similarly complex etiology involving an interaction between susceptibility genes and environmental factors during early development. Limited progress has been made in developing novel pharmacotherapy, partly due to a lack of valid animal models. The recent recognition of the potentially causal role of central and peripheral energy metabolism in the pathophysiology of schizophrenia raises the need of research on animal models that combine both behavioral and metabolic phenotypic domains, similar to what have been identified in humans. In this review we focus on selected genetic (DBA/2J mice, leptin receptor mutants, and PSD-93 knockout mice), early neurodevelopmental (maternal protein deprivation) and pharmacological (acute phencyclidine) animal models that capture the combined behavioral and metabolic abnormalities shown by schizophrenic patients. In reviewing behavioral phenotypes relevant to schizophrenia we apply the principles established by the Research Domain Criteria (RDoC) for better translation. We demonstrate that etiologically diverse manipulations such as specific breeding, deletion of genes that are primarily involved in metabolic regulation and in synaptic plasticity, as well as early metabolic deprivation and adult pharmacological challenge of the glutamate system can lead to schizophrenia-related behavioral and metabolic phenotypes, which suggest that these pathways might be interlinked. We propose that using animal models that combine different domains of schizophrenia can be used as a translationally valid approach to capture the system-level complex interplay between peripheral and central processes in the development of psychopathology.
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13
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Schoepf D, Uppal H, Potluri R, Heun R. Physical comorbidity and its relevance on mortality in schizophrenia: a naturalistic 12-year follow-up in general hospital admissions. Eur Arch Psychiatry Clin Neurosci 2014; 264:3-28. [PMID: 23942824 DOI: 10.1007/s00406-013-0436-x] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/26/2013] [Indexed: 12/12/2022]
Abstract
Schizophrenia is a major psychotic disorder with significant comorbidity and mortality. Patients with schizophrenia are said to suffer more type-2 diabetes mellitus (T2DM) and diabetogenic complications. However, there is little consistent evidence that comorbidity with physical diseases leads to excess mortality in schizophrenic patients. Consequently, we investigated whether the burden of physical comorbidity and its relevance on hospital mortality differed between patients with and without schizophrenia in a 12-year follow-up in general hospital admissions. During 1 January 2000 and 31 June 2012, 1418 adult patients with schizophrenia were admitted to three General Manchester NHS Hospitals. All comorbid diseases with a prevalemce ≥1% were compared with those of 14,180 age- and gender-matched hospital controls. Risk factors, i.e. comorbid diseases that were predictors for general hospital mortality were identified using multivariate logistic regression analyses. Compared with controls, schizophrenic patients had a higher proportion of emergency admissions (69.8 vs. 43.0%), an extended average length of stay at index hospitalization (8.1 vs. 3.4 days), a higher number of hospital admissions (11.5 vs. 6.3), a shorter length of survival (1895 vs. 2161 days), and a nearly twofold increased mortality rate (18.0 vs. 9.7%). Schizophrenic patients suffered more depression, T2DM, alcohol abuse, asthma, COPD, and twenty-three more diseases, many of them diabetic-related complications or other environmentally influenced conditions. In contrast, hypertension, cataract, angina, and hyperlipidaemia were less prevalent in the schizophrenia population compared to the control population. In deceased schizophrenic patients, T2DM was the most frequently recorded comorbidity, contributing to 31.4% of hospital deaths (only 14.4% of schizophrenic patients with comorbid T2DM survived the study period). Further predictors of general hospital mortality in schizophrenia were found to be alcoholic liver disease (OR = 10.3), parkinsonism (OR = 5.0), T1DM (OR = 3.8), non-specific renal failure (OR = 3.5), ischaemic stroke (OR = 3.3), pneumonia (OR = 3.0), iron-deficiency anaemia (OR = 2.8), COPD (OR = 2.8), and bronchitis (OR = 2.6). There were no significant differences in their impact on hospital mortality compared to control subjects with the same diseases except parkinsonism which was associated with higher mortality in the schizophrenia population compared with the control population. The prevalence of parkinsonism was significantly elevated in the 255 deceased schizophrenic patients (5.5 %) than in those 1,163 surviving the study period (0.8 %, OR = 5.0) and deceased schizophrenic patients had significantly more suffered extrapyramidal symptoms than deceased control subjects (5.5 vs. 1.5 %). Therefore patients with schizophrenia have a higher burden of physical comorbidity that is associated with a worse outcome in a 12-year follow-up of mortality in general hospitals compared with hospital controls. However, schizophrenic patients die of the same physical diseases as their peers without schizophrenia. The most relevant physical risk factors of general hospital mortality are T2DM, COPD and infectious respiratory complications, iron-deficiency anaemia, T1DM, unspecific renal failure, ischaemic stroke, and alcoholic liver disease. Additionally, parkinsonism is a major risk factor for general hospital mortality in schizophrenia. Thus, optimal monitoring and management of acute T2DM and COPD with its infectious respiratory complications, as well as the accurate detection and management of iron-deficiency anaemia, of diabetic-related long-term micro- and macrovascular complications, of alcoholic liver disease, and of extrapyramidal symptoms are of utmost relevance in schizophrenia.
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Affiliation(s)
- Dieter Schoepf
- Department of Psychiatry, University of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany,
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14
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Vancampfort D, Probst M, De Hert M, Soundy A, Stubbs B, Stroobants M, De Herdt A. Neurobiological effects of physical exercise in schizophrenia: a systematic review. Disabil Rehabil 2014; 36:1749-54. [PMID: 24383471 DOI: 10.3109/09638288.2013.874505] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of the present systematic review was to provide a summary of neurobiological effects of physical exercise for people with schizophrenia. METHODS A systematic review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Searches were conducted up to April 2013 across three databases: Medline, PsycINFO, and Embase. A methodological quality assessment using the Downs and Black Quality Index was carried out with all of the included studies. RESULTS Of the 654 initial data search results, two studies reported in 3 articles including 48 patients (six women) with schizophrenia, met the eligibility criteria. The methodological quality of each study was high. Data on hippocampal volume changes following physical exercise were conflicting while physical exercise-induced changes in other brain areas were absent. Increases in hippocampal volume following physical exercise were correlated with improvements in aerobic fitness and short-term memory. CONCLUSIONS Future research is needed to investigate whether brain health in people with schizophrenia is activity-dependent. Additionally, research that considers the neurobiological mechanisms and associated functional outcomes of physical exercise in individuals with schizophrenia is required. IMPLICATIONS FOR REHABILITATION Understanding the neurobiological effects of physical exercise in patients with schizophrenia may contribute to the development of new rehabilitation strategies. There is currently insufficient evidence to determine if physical exercise has a beneficial influence on the brain health of people with schizophrenia.
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Affiliation(s)
- Davy Vancampfort
- Department of Neurosciences, University Psychiatric Centre , KU Leuven, Kortenberg , Belgium
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15
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van Alphen B, van Swinderen B. Drosophila strategies to study psychiatric disorders. Brain Res Bull 2013; 92:1-11. [DOI: 10.1016/j.brainresbull.2011.09.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 09/08/2011] [Accepted: 09/09/2011] [Indexed: 01/03/2023]
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16
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Unsal C, Oran M, Tureli HO, Alpsoy S, Yeşilyurt S, Arslan M, Topcu B, Karakaya O, Kurt E. Detection of subclinical atherosclerosis and diastolic dysfunction in patients with schizophrenia. Neuropsychiatr Dis Treat 2013; 9:1531-7. [PMID: 24143102 PMCID: PMC3797283 DOI: 10.2147/ndt.s52030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patients with schizophrenia have a higher risk for cardiovascular diseases, which is associated with early mortality compared with the nonschizophrenic population. Early diagnosis of cardiovascular diseases in asymptomatic periods in patients with schizophrenia would enhance their quality of life and reduce mortality. Echocardiography, carotid ultrasonography, and ankle brachial index (ABI) measurement are known to be beneficial methods of detecting subclinical cardiovascular diseases and of risk stratification. The present study investigated carotid intima media thickness (CIMT) and ABI and echocardiographic parameters measured via conventional and tissue Doppler echocardiography in patients with schizophrenia in comparison with a control group. METHODS The present case-control study included 116 patients with schizophrenia and 88 healthy patients. Participants with any current comorbid psychiatric disorder, current or lifetime neurological and medical problems, current coronary artery disease, diabetes, hypertension, hypothyroidism, or hyperthyroidism or who were using antihypertensives, antidiabetic agents, or antiobesity drugs were excluded. High-resolution B-mode ultrasound images were used to measure CIMT. Conventional and tissue Doppler measurements were performed according to the recommendations of the American Society of Echocardiography. RESULTS Low ABI, mitral ratio of the early (E) to late (A) ventricular filling velocities, septal E', septal S', lateral E', lateral S', septal E'/septal A', lateral E'/lateral A', and high septal A', mitral E/septal E', mitral E/lateral E', and CIMT values were observed in the schizophrenia group compared with the control group. CONCLUSION Doppler parameters supported the hypothesis that patients with schizophrenia are at high risk for cardiovascular diseases.
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Affiliation(s)
- Cüneyt Unsal
- Department of Psychiatry, Namık Kemal University, School of Medicine, Tekirdag, Turkey
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Ernst A, Ma D, Garcia-Perez I, Tsang TM, Kluge W, Schwarz E, Guest PC, Holmes E, Sarnyai Z, Bahn S. Molecular validation of the acute phencyclidine rat model for schizophrenia: identification of translational changes in energy metabolism and neurotransmission. J Proteome Res 2012; 11:3704-14. [PMID: 22613019 DOI: 10.1021/pr300197d] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Administration of the noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist phencyclidine (PCP) to rodents is widely used as preclinical model for schizophrenia. Most studies on this model employ methods investigating behavior and brain abnormalities. However, little is known about the corresponding peripheral effects. In this study, we analyzed changes in brain and serum molecular profiles, together with alterations in behavior after acute PCP treatment of rats. Furthermore, abnormalities in peripheral protein expression of first and recent onset antipsychotic free schizophrenia patients were assessed for comparison with the preclinical model. PCP treatment induced hyperlocomotion and stereotypic behavior, which have been related to positive symptoms of schizophrenia. Multiplex immunoassay profiling of serum revealed molecular abnormalities similar to those seen in first and recent onset, antipsychotic free schizophrenia patients. Also, increased insulin levels were detected after administration of a glucose tolerance test (GTT), consistent with previous studies showing changes in insulin signaling in patients with schizophrenia. Finally, schizophrenia-relevant alterations in brain molecules were found in the hippocampus and to a lesser extent in the frontal cortex using liquid-chromatography mass spectrometry and (1)H nuclear magnetic resonance spectroscopy. In conclusion, this study identified behavioral and molecular alterations in the acute PCP rat model, which are also observed in human schizophrenia. We propose that the corresponding changes in serum in both animals and patients may have utility as surrogate markers in this model to facilitate discovery and development of novel drugs for treatment of certain pathological features of schizophrenia.
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Affiliation(s)
- Agnes Ernst
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge CB2 1QT, UK
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18
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Beary M, Hodgson R, Wildgust HJ. A critical review of major mortality risk factors for all-cause mortality in first-episode schizophrenia: clinical and research implications. J Psychopharmacol 2012; 26:52-61. [PMID: 22465947 DOI: 10.1177/0269881112440512] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A bibliographical search was performed to identify and evaluate the impact in first-episode schizophrenia of the major mortality risk factors as described by the World Health Organisation (2009). We found that at first diagnosis rates of diabetes were only slightly increased, although lipid abnormalities, mild hypertension and being overweight were commonly reported. Levels of drug and alcohol abuse were high, as were pre-diagnosis rates of smoking, physical inactivity and poor cardiorespiratory fitness. During the first year of antipsychotic treatment, there were significant increases in the rates of hyperglycaemia/diabetes, obesity, lipid abnormalities and hypertension, but no changes in fitness levels, smoking or drug and alcohol abuse. In chronic schizophrenia, excess cancer and cardiac deaths seem linked in part to availability and quality of care. Innate risk factors such as abnormal reelin and raised prolactin may also be important. New evidence, such as an inverse relationship between body mass index and suicide in the general population, suggests accepted wisdom may not apply to patients at high risk of ending their own lives. With current knowledge emphasis needs to be placed by early intervention services on physical fitness, smoking and other substance misuse, diabetes and hypertension, as well as focusing on weight reduction only in the obese.
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