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Hu J, Geng B, Song Y, Zhang X, Zhou M, Zhang P, Song H, Li K, Zhang X. Effect of Group Cognitive Behavioral Therapy on Patients with Early-Onset Schizophrenia. ALPHA PSYCHIATRY 2024; 25:407-412. [PMID: 39148598 PMCID: PMC11322724 DOI: 10.5152/alphapsychiatry.2024.241524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/17/2024] [Indexed: 08/17/2024]
Abstract
Objective To study the clinical effect of group cognitive behavioral therapy to one-on-one treatment on patients with early-onset schizophrenia. Methods Totally,133 patients with early-onset schizophrenia admitted to the Department of Psychiatry of our hospital from September 2020 to September 2023 were selected and divided into a control group and an observation group according to whether group behavioral cognitive therapy was performed. The general demographic data of the patients were collected, and the propensity score matching method was used to balance the baseline data of the 2 groups. The Positive and negative syndrome scale, Personal and Social Performance Scale, severity of illness (SI), and efficacy index (EI) were compared between the 2 groups after matching. Results After matching, 72 patients were included in our study. Compared to the control group, observation group PANSS score were decreased including after intervention (P > .05). Both groups showed a decrease between before and after treatments. Positive and Negative Syndrome Scale reduction rate after treatment and total response rate were increased in the observation group (P <.001). Personal and Social Performance Scale of the Clinical Global Impression (CGI) scores were higher than those of the control group. In the CGI scores, there is a significant difference that SI scores were lower in the observation group (P = .002), while EI scores were higher (P <.001). Conclusion Group cognitive behavioral therapy is beneficial to the improvement of mental symptoms and disease severity, social function, and curative effect, which is advocated and popularized.
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Affiliation(s)
- Jing Hu
- Department of Paediatric Psychiatry I, Mental Health Center of Hebei Province, Baoding, Hebei, China
| | - Bojing Geng
- Department of Paediatric Psychiatry I, Mental Health Center of Hebei Province, Baoding, Hebei, China
| | - Yu Song
- Department of Paediatric Psychiatry I, Mental Health Center of Hebei Province, Baoding, Hebei, China
| | - Xujing Zhang
- Department of Paediatric Psychiatry I, Mental Health Center of Hebei Province, Baoding, Hebei, China
| | - Mengdi Zhou
- Department of Pediatric Psychiatry II, Mental Health Center of Hebei Province, Baoding, Hebei, China
| | - Ping Zhang
- Department of Pediatric Psychiatry II, Mental Health Center of Hebei Province, Baoding, Hebei, China
| | - Hongjing Song
- Department of Clinical Psychology II, Mental Health Center of Hebei Province, Baoding, Hebei, China
| | - Keqing Li
- Department of Paediatric Psychiatry I, Mental Health Center of Hebei Province, Baoding, Hebei, China
| | - Xin Zhang
- Department of Paediatric Psychiatry I, Mental Health Center of Hebei Province, Baoding, Hebei, China
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Mulkey SB, Corn E, Williams ME, Peyton C, Andringa-Seed R, Arroyave-Wessel M, Vezina G, Bulas DI, Podolsky RH, Msall ME, Cure C. Neurodevelopmental Outcomes of Normocephalic Colombian Children with Antenatal Zika Virus Exposure at School Entry. Pathogens 2024; 13:170. [PMID: 38392908 PMCID: PMC10892822 DOI: 10.3390/pathogens13020170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
The long-term neurodevelopmental effects of antenatal Zika virus (ZIKV) exposure in children without congenital Zika syndrome (CZS) remain unclear, as few children have been examined to the age of school entry level. A total of 51 Colombian children with antenatal ZIKV exposure without CZS and 70 unexposed controls were evaluated at 4-5 years of age using the Behavior Rating Inventory of Executive Function (BRIEF), the Pediatric Evaluation of Disability Inventory (PEDI-CAT), the Bracken School Readiness Assessment (BSRA), and the Movement Assessment Battery for Children (MABC). The mean ages at evaluation were 5.3 and 5.2 years for cases and controls, respectively. Elevated BRIEF scores in Shift and Emotional Control may suggest lower emotional regulation in cases. A greater number of cases were reported by parents to have behavior and mood problems. BSRA and PEDI-CAT activity scores were unexpectedly higher in cases, most likely related to the COVID-19 pandemic and a delayed school entry among the controls. Although PEDI-CAT mobility scores were lower in cases, there were no differences in motor scores on the MABC. Of 40 cases with neonatal neuroimaging, neurodevelopment in 17 with mild non-specific findings was no different from 23 cases with normal neuroimaging. Normocephalic children with ZIKV exposure have positive developmental trajectories at 4-5 years of age but differ from controls in measures of emotional regulation and adaptive mobility, necessitating continued follow-up.
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Affiliation(s)
- Sarah B. Mulkey
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA; (E.C.); (M.E.W.); (R.A.-S.); (M.A.-W.)
- Department of Neurology, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Elizabeth Corn
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA; (E.C.); (M.E.W.); (R.A.-S.); (M.A.-W.)
| | - Meagan E. Williams
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA; (E.C.); (M.E.W.); (R.A.-S.); (M.A.-W.)
| | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Regan Andringa-Seed
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA; (E.C.); (M.E.W.); (R.A.-S.); (M.A.-W.)
| | - Margarita Arroyave-Wessel
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA; (E.C.); (M.E.W.); (R.A.-S.); (M.A.-W.)
| | - Gilbert Vezina
- Division of Radiology, Children’s National Hospital, Washington, DC 20010, USA; (G.V.); (D.I.B.)
| | - Dorothy I. Bulas
- Division of Radiology, Children’s National Hospital, Washington, DC 20010, USA; (G.V.); (D.I.B.)
| | - Robert H. Podolsky
- Division of Biostatistics and Study Methodology, Children’s National Hospital, Washington, DC 20010, USA;
| | - Michael E. Msall
- Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, University of Chicago Medicine, Chicago, IL 60637, USA;
| | - Carlos Cure
- BIOMELab, Atlántico, Barranquilla 080001, Colombia;
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Environmental Risk Factors and Cognitive Outcomes in Psychosis: Pre-, Perinatal, and Early Life Adversity. Curr Top Behav Neurosci 2023; 63:205-240. [PMID: 35915384 PMCID: PMC9892366 DOI: 10.1007/7854_2022_378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Risk for psychosis begins to accumulate as early as the fetal period through exposure to obstetric complications like fetal hypoxia, maternal stress, and prenatal infection. Stressors in the postnatal period, such as childhood trauma, peer victimization, and neighborhood-level adversity, further increase susceptibility for psychosis. Cognitive difficulties are among the first symptoms to emerge in individuals who go on to develop a psychotic disorder. We review the relationship between pre-, perinatal, and early childhood adversities and cognitive outcomes in individuals with psychosis. Current evidence shows that the aforementioned environmental risk factors may be linked to lower overall intelligence and executive dysfunction, beginning in the premorbid period and persisting into adulthood in individuals with psychosis. It is likely that early life stress contributes to cognitive difficulties in psychosis through dysregulation of the body's response to stress, causing changes such as increased cortisol levels and chronic immune activation, which can negatively impact neurodevelopment. Intersectional aspects of identity (e.g., sex/gender, race/ethnicity), as well as gene-environment interactions, likely inform the developmental cascade to cognitive difficulties throughout the course of psychotic disorders and are reviewed below. Prospective studies of birth cohorts will serve to further clarify the relationship between early-life environmental risk factors and cognitive outcomes in the developmental course of psychotic disorders. Specific methodological recommendations are provided for future research.
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Identification of cerebrospinal fluid and serum metabolomic biomarkers in first episode psychosis patients. Transl Psychiatry 2022; 12:229. [PMID: 35665740 PMCID: PMC9166796 DOI: 10.1038/s41398-022-02000-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 11/24/2022] Open
Abstract
Psychotic disorders are currently diagnosed by examining the patient's mental state and medical history. Identifying reliable diagnostic, monitoring, predictive, or prognostic biomarkers would be useful in clinical settings and help to understand the pathophysiology of schizophrenia. Here, we performed an untargeted metabolomics analysis using ultra-high pressure liquid chromatography coupled with time-of-flight mass spectroscopy on cerebrospinal fluid (CSF) and serum samples of 25 patients at their first-episode psychosis (FEP) manifestation (baseline) and after 18 months (follow-up). CSF and serum samples of 21 healthy control (HC) subjects were also analyzed. By comparing FEP and HC groups at baseline, we found eight CSF and 32 serum psychosis-associated metabolites with non-redundant identifications. Most remarkable was the finding of increased CSF serotonin (5-HT) levels. Most metabolites identified at baseline did not differ between groups at 18-month follow-up with significant improvement of positive symptoms and cognitive functions. Comparing FEP patients at baseline and 18-month follow-up, we identified 20 CSF metabolites and 90 serum metabolites that changed at follow-up. We further utilized Ingenuity Pathway Analysis (IPA) and identified candidate signaling pathways involved in psychosis pathogenesis and progression. In an extended cohort, we validated that CSF 5-HT levels were higher in FEP patients than in HC at baseline by reversed-phase high-pressure liquid chromatography. To conclude, these findings provide insights into the pathophysiology of psychosis and identify potential psychosis-associated biomarkers.
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Murray RM, Bora E, Modinos G, Vernon A. Schizophrenia: A developmental disorder with a risk of non-specific but avoidable decline. Schizophr Res 2022; 243:181-186. [PMID: 35390609 DOI: 10.1016/j.schres.2022.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 12/31/2022]
Abstract
The onset of schizophrenia is determined by biological and social risk factors operating predominantly during development. These result in subtle deviations in brain structure and cognitive function. Striatal dopamine dysregulation follows, causing abnormal salience and resultant psychotic symptoms. Most people diagnosed as having schizophrenia do not progressively deteriorate; many improve or recover. However, poor care can allow a cycle of deterioration to be established, stress increasing dopamine dysregulation, leading to more stress consequent on continuing psychotic experiences, and so further dopamine release. Additionally, long-term antipsychotics can induce dopamine supersensitivity with resultant relapse and eventually treatment resistance. Some patients suffer loss of social and cognitive function, but this is a consequence of the hazards that afflict the person with schizophrenia, not a direct consequence of genetic predisposition. Thus, brain health and cognition can be further impaired by chronic medication effects, cardiovascular and cerebrovascular events, obesity, poor diet, and lack of exercise; drug use, especially of tobacco and cannabis, are likely to contribute. Poverty, homelessness and poor nutrition which become the lot of some people with schizophrenia, can also affect cognition. Regrettably, the model of progressive deterioration provides psychiatry and its funders with an alibi for the effects of poor care.
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Affiliation(s)
- R M Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
| | - E Bora
- Dokuz Eylül Üniversitesi, Izmir, Izmir, Turkey
| | - G Modinos
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - A Vernon
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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Chiu EC, Lee YC, Lee SC, Hsueh IP. Reliability of the performance-based measure of executive functions in people with schizophrenia. BMC Psychiatry 2021; 21:553. [PMID: 34758768 PMCID: PMC8579687 DOI: 10.1186/s12888-021-03562-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Performance-based measure of Executive Functions (PEF) with four domains is designed to assess executive functions in people with schizophrenia. The purpose of this study was to examine the test-retest reliability of the PEF administered by the same rater (intra-rater agreement) and by different raters (inter-rater agreement) in people with schizophrenia and to estimate the values of minimal detectable change (MDC) and MDC%. METHODS Two convenience samples (each sample, n = 60) with schizophrenia were conducted two assessments (two weeks apart). The intraclass correlation coefficient (ICC) was analyzed to examine intra-rater and inter-rater agreements of the test-retest reliability of the PEF. The MDC was calculated through standard error of measurement. RESULTS For the intra-rater agreement study, the ICC values of the four domains were 0.88-0.92. The MDC (MDC%) of the four domains (volition, planning, purposive action, and perfromance effective) were 13.0 (13.0%), 12.2 (16.4%), 16.2 (16.2%), and 16.3 (18.8%), respectively. For the inter-rater agreement study, the ICC values of the four domains were 0.82-0.89. The MDC (MDC%) were 15.8 (15.8%), 17.4 (20.0%), 20.9 (20.9%), and 18.6 (18.6%) for the volition, planning, purposive action, and performance effective domains, respectively. CONCLUSIONS The PEF has good test-retest reliability, including intra-rater and inter-rater agreements, for people with schizophrenia. Clinicians and researchers can use the MDC values to verify whether an individual with schizophrenia shows any real change (improvement or deterioration) between repeated PEF assessments by the same or different raters.
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Affiliation(s)
- En-Chi Chiu
- grid.412146.40000 0004 0573 0416Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan ,Department of Occupational Therapy, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Ya-Chen Lee
- grid.252470.60000 0000 9263 9645Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Shu-Chun Lee
- Department of Occupational Therapy, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan ,grid.411447.30000 0004 0637 1806Department of Occupational Therapy, I-Shou University, Kaohsiung, Taiwan ,grid.419832.50000 0001 2167 1370University of Taipei, Taipei, Taiwan
| | - I-Ping Hsueh
- School of Occupational Therapy, College of Medicine, National Taiwan University, No.17, Xuzhou Rd., Zhongzheng Dist, Taipei City, Taiwan. .,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
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Paquin V, Lapierre M, Veru F, King S. Early Environmental Upheaval and the Risk for Schizophrenia. Annu Rev Clin Psychol 2021; 17:285-311. [PMID: 33544627 DOI: 10.1146/annurev-clinpsy-081219-103805] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Why does prenatal exposure to wars, natural disasters, urbanicity, or winter increase the risk for schizophrenia? Research from the last two decades has provided rich insight about the underlying chains of causation at play during environmental upheaval, from conception to early infancy. In this review, we appraise the evidence linking schizophrenia spectrum disorder to prenatal maternal stress, obstetric complications, early infections, and maternal nutrition and other lifestyle factors. We discuss putative mechanisms, including the maternal stress system, perinatal hypoxia, and maternal-offspring immune activation. We propose that gene-environment interactions, timing during development, and sex differentiate the neuropsychiatric outcomes. Future research should pursue the translation of animal studies to humans and the longitudinal associations between early exposures, intermediate phenotypes, and psychiatric disorders. Finally, to paint a comprehensive model of risk and to harness targets for prevention, we argue that risk factors should be situated within the individual's personal ecosystem.
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Affiliation(s)
- Vincent Paquin
- Department of Psychiatry, McGill University, Montréal, Québec H3A 1A1, Canada; .,Douglas Research Centre, Montréal, Québec H4H 1R3, Canada
| | - Mylène Lapierre
- Douglas Research Centre, Montréal, Québec H4H 1R3, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec H2V 2S9, Canada
| | - Franz Veru
- Department of Psychiatry, McGill University, Montréal, Québec H3A 1A1, Canada; .,Douglas Research Centre, Montréal, Québec H4H 1R3, Canada
| | - Suzanne King
- Department of Psychiatry, McGill University, Montréal, Québec H3A 1A1, Canada; .,Douglas Research Centre, Montréal, Québec H4H 1R3, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec H2V 2S9, Canada
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Air Pollution-Related Brain Metal Dyshomeostasis as a Potential Risk Factor for Neurodevelopmental Disorders and Neurodegenerative Diseases. ATMOSPHERE 2020. [DOI: 10.3390/atmos11101098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Increasing evidence links air pollution (AP) exposure to effects on the central nervous system structure and function. Particulate matter AP, especially the ultrafine (nanoparticle) components, can carry numerous metal and trace element contaminants that can reach the brain in utero and after birth. Excess brain exposure to either essential or non-essential elements can result in brain dyshomeostasis, which has been implicated in both neurodevelopmental disorders (NDDs; autism spectrum disorder, schizophrenia, and attention deficit hyperactivity disorder) and neurodegenerative diseases (NDGDs; Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, and amyotrophic lateral sclerosis). This review summarizes the current understanding of the extent to which the inhalational or intranasal instillation of metals reproduces in vivo the shared features of NDDs and NDGDs, including enlarged lateral ventricles, alterations in myelination, glutamatergic dysfunction, neuronal cell death, inflammation, microglial activation, oxidative stress, mitochondrial dysfunction, altered social behaviors, cognitive dysfunction, and impulsivity. Although evidence is limited to date, neuronal cell death, oxidative stress, and mitochondrial dysfunction are reproduced by numerous metals. Understanding the specific contribution of metals/trace elements to this neurotoxicity can guide the development of more realistic animal exposure models of human AP exposure and consequently lead to a more meaningful approach to mechanistic studies, potential intervention strategies, and regulatory requirements.
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Costas-Carrera A, Garcia-Rizo C, Bitanihirwe B, Penadés R. Obstetric Complications and Brain Imaging in Schizophrenia: A Systematic Review. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:1077-1084. [PMID: 33012683 DOI: 10.1016/j.bpsc.2020.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/28/2022]
Abstract
Schizophrenia is a complex disorder in which clinical symptomatology typically reflects underlying brain abnormalities that coalign with multiple physical health comorbidities. The pathogenesis of schizophrenia involves the interplay between genetic and environmental factors, with obstetric complications widely described as key players in elevating the risk of psychosis. In this regard, understanding the anatomical and functional alterations associated with obstetric complications may help to elucidate potential mechanisms through which birth complications could contribute to schizophrenia pathogenesis. We conducted a systematic review of the extant literature describing brain abnormalities and obstetric complications in patients with schizophrenia and related disorders in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A total of 471 studies were retrieved and screened, and 33 studies met inclusion criteria for our review. Studies varied considerably in their methods, with 11 studies employing computed tomography, 1 using magnetic resonance spectroscopy, and 21 using magnetic resonance imaging. The scientific quality of the included studies was assessed and documented. Obstetric complications increase the risk of provoking brain abnormalities. These abnormalities range from decreased gray matter volume and abnormal brain-ventricle ratios to a reduction of volume in limbic regions-which relate to what is commonly observed in schizophrenia. However, current evidence from neuroimaging studies remains scant in relation to establishing obstetric complications as an independent risk factor for schizophrenia.
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Affiliation(s)
- Ana Costas-Carrera
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain.
| | - Clemente Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain; Agusti Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; Psychiatry Unit, Department of Medicine, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Byron Bitanihirwe
- Centre for Global Health, Trinity College, Dublin, Ireland; Department of Psychology, Trinity College, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
| | - Rafael Penadés
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain; Agusti Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; Psychiatry Unit, Department of Medicine, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
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