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Knudsen CB, Hemager N, Greve AN, Lambek R, Andreassen AK, Veddum L, Brandt JM, Gregersen M, Krantz MF, Søndergaard A, Steffensen NL, Birk M, Stadsgaard HB, Ohland J, Burton BK, Jepsen JRM, Thorup AAE, Nordentoft M, Mors O, Bliksted VF. Neurocognitive Development in Children at Familial High Risk of Schizophrenia or Bipolar Disorder. JAMA Psychiatry 2022; 79:589-599. [PMID: 35385060 PMCID: PMC8988021 DOI: 10.1001/jamapsychiatry.2022.0465] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Neurocognitive impairments exist in children at familial high risk (FHR) of schizophrenia and bipolar disorder. Studies on preadolescent developmental courses of neurocognition are important to describe shared and distinct neurodevelopmental pathways in these groups. OBJECTIVE To assess the development in specific neurocognitive functions from age 7 to 11 years in children at FHR of schizophrenia or bipolar disorder compared with children in a population-based control (PBC) group. DESIGN, SETTING, AND PARTICIPANTS The Danish High Risk and Resilience Study is a prospective, longitudinal, cohort study that collected data from January 1, 2013, to January 31, 2016 (phase 1), and from March 1, 2017, to June 30, 2020 (phase 2). Data were collected at 2 university hospitals in Denmark, and participants included 520 children at FHR of schizophrenia or bipolar disorder along with a PBC group matched with the group of children at FHR of schizophrenia by age, sex, and municipality. EXPOSURES Parental schizophrenia, bipolar disorder, or neither. MAIN OUTCOMES AND MEASURES Neurocognitive functioning was assessed with validated tests of intelligence, processing speed, attention, memory, verbal fluency, and executive functioning. Multilevel mixed-effects linear regression models with maximum likelihood estimation were used to estimate neurocognitive development from age 7 to 11 years. RESULTS At 4-year follow-up, a total of 451 children (mean [SD] age; 11.9 [0.2] years; 208 girls [46.1%]) underwent neurocognitive testing. There were a total of 170 children at FHR of schizophrenia (mean [SD] age, 12.0 [0.3]; 81 girls [47.7%]), 103 children at FHR of bipolar disorder (mean [SD] age, 11.9 [0.2] years; 45 girls [43.7%]), and 178 children in the PBC group (mean [SD] age, 11.9 [0.2] years; 82 girls [46.1%]). At either age 7 or 11 years or at both assessments, 520 children participated in the neurocognitive assessment and were therefore included in the analyses. When correcting for multiple comparisons, no statistically significant time × group interactions were observed across the 3 groups. Compared with the PBC group at 4-year follow-up, children at FHR of schizophrenia showed significant neurocognitive impairment in 7 of 24 neurocognitive measures (29.2%; Cohen d range, 0.29-0.37). Compared with children at FHR of bipolar disorder, children at FHR of schizophrenia had significant neurocognitive impairment in 5 of 24 measures (20.8%; Cohen d range, 0.29-0.38). Children at FHR of bipolar disorder and those in the PBC group did not differ significantly. CONCLUSIONS AND RELEVANCE In this cohort study, findings suggest that neurocognitive maturation was comparable across groups of children at FHR of schizophrenia or bipolar disorder compared with PBCs from age 7 to 11 years. Compared with the PBC group, children at FHR of schizophrenia demonstrated widespread, stable, neurocognitive impairments during this period, whereas children at FHR of bipolar disorder showed no neurocognitive impairments, which may indicate distinct neurodevelopmental pathways in children at FHR of schizophrenia and bipolar disorder.
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Affiliation(s)
- Christina Bruun Knudsen
- Psychosis Research Unit, Aarhus University Hospital–Psychiatry, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
| | - Nicoline Hemager
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark,Child and Adolescent Mental Health Center, Copenhagen University Hospital–Mental Health Services, Copenhagen, Denmark
| | - Aja Neergaard Greve
- Psychosis Research Unit, Aarhus University Hospital–Psychiatry, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark
| | - Rikke Lambek
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Anna Krogh Andreassen
- Psychosis Research Unit, Aarhus University Hospital–Psychiatry, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
| | - Lotte Veddum
- Psychosis Research Unit, Aarhus University Hospital–Psychiatry, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
| | - Julie Marie Brandt
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maja Gregersen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Falkenberg Krantz
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark,Child and Adolescent Mental Health Center, Copenhagen University Hospital–Mental Health Services, Copenhagen, Denmark
| | - Anne Søndergaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Lawaetz Steffensen
- Psychosis Research Unit, Aarhus University Hospital–Psychiatry, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark
| | - Merete Birk
- Psychosis Research Unit, Aarhus University Hospital–Psychiatry, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark
| | | | - Jessica Ohland
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Birgitte Klee Burton
- Child and Adolescent Mental Health Center, Copenhagen University Hospital–Mental Health Services, Copenhagen, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark,Child and Adolescent Mental Health Center, Copenhagen University Hospital–Mental Health Services, Copenhagen, Denmark,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research and Center for Neuropsychiatric Schizophrenia Research, Mental Health Center, Glostrup, Copenhagen University Hospital–Mental Health Services CPH, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Child and Adolescent Mental Health Center, Copenhagen University Hospital–Mental Health Services, Copenhagen, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- Psychosis Research Unit, Aarhus University Hospital–Psychiatry, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark
| | - Vibeke Fuglsang Bliksted
- Psychosis Research Unit, Aarhus University Hospital–Psychiatry, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
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Klimes-Dougan B, Desjardins C, Allen TA, Gold P, Martinez P. A longitudinal investigation of intellectual functioning in youth at high risk for bipolar and depressive disorders. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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De la Serna E, Camprodon-Boadas P, Ilzarbe D, Sugranyes G, Baeza I, Moreno D, Díaz-Caneja CM, Rosa-Justicia M, Llorente C, Ayora M, Borras R, Torrent C, Bernardo M, Castro-Fornieles J. Neuropsychological development in the child and adolescent offspring of patients diagnosed with schizophrenia or bipolar disorder: A two-year follow-up comparative study. Prog Neuropsychopharmacol Biol Psychiatry 2020; 103:109972. [PMID: 32454164 DOI: 10.1016/j.pnpbp.2020.109972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023]
Abstract
UNLABELLED There has been growing scientific evidence in recent years that schizophrenia and bipolar disorder share clinical, cognitive, neuroimaging and genetic characteristics. This overlap might also be present in their offspring, who have an increased risk of developing both disorders. Comparing the characteristics of these samples may have important implications for understanding etiological processes. This study aimed to assess the development of cognitive functions over two years in a sample of child and adolescent offspring of patients diagnosed with schizophrenia (SZoff) or bipolar disorder (BDoff), comparing them with a community control group (CCoff). METHODS 90 BDoff, 41 SZoff and 107 CCoff aged between 6 and 17 years were included at baseline. At the two-year follow-up, 84.9% of the sample was re-assessed (78 BDoff, 32 SZoff and 92 CCoff). All subjects were assessed with a comprehensive neuropsychological test battery at baseline and at the two-year follow-up to evaluate: intelligence quotient, working memory, processing speed, verbal memory and learning, visual memory, executive functions and sustained attention. RESULTS Processing speed, verbal memory and executive functions showed different developmental patterns among the SZoff, BDoff and CCoff groups. The SZoff group maintained baseline performances in the three variables over time, while the BDoff group presented improved processing speed and executive functioning and the CCoff group showed improvements in verbal memory and executive functions at follow-up. CONCLUSIONS These findings suggest that the development of some cognitive functions might differ between child and adolescent SZoff and BDoff, indicating different trajectories during neurodevelopment.
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Affiliation(s)
- E De la Serna
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona 2017SGR881, Spain.
| | - P Camprodon-Boadas
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona 2017SGR881, Spain; Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain
| | - D Ilzarbe
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona 2017SGR881, Spain; Department of Child Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Department of Psychiatry, Universitair Medisch Centrum Utrecht, Utrecht, the Netherlands; Institut d'Investigació Biomèdica August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| | - G Sugranyes
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona 2017SGR881, Spain; Institut d'Investigació Biomèdica August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| | - I Baeza
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona 2017SGR881, Spain; Institut d'Investigació Biomèdica August Pi i Sunyer, IDIBAPS, Barcelona, Spain; Department of Medicine, University of Barcelona, Spain
| | - D Moreno
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - C M Díaz-Caneja
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - M Rosa-Justicia
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona 2017SGR881, Spain; Institut d'Investigació Biomèdica August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| | - C Llorente
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - M Ayora
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - R Borras
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona 2017SGR881, Spain; Institut d'Investigació Biomèdica August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| | - C Torrent
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Institut d'Investigació Biomèdica August Pi i Sunyer, IDIBAPS, Barcelona, Spain; Department of Medicine, University of Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona, Spain
| | - M Bernardo
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Institut d'Investigació Biomèdica August Pi i Sunyer, IDIBAPS, Barcelona, Spain; Department of Medicine, University of Barcelona, Spain; Barcelona Clínic Schizophrenia Unit, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona, Spain
| | - J Castro-Fornieles
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona 2017SGR881, Spain; Institut d'Investigació Biomèdica August Pi i Sunyer, IDIBAPS, Barcelona, Spain; Department of Medicine, University of Barcelona, Spain
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Dickson H, Cullen AE, Jones R, Reichenberg A, Roberts RE, Hodgins S, Morris RG, Laurens KR. Trajectories of cognitive development during adolescence among youth at-risk for schizophrenia. J Child Psychol Psychiatry 2018; 59:1215-1224. [PMID: 29683193 DOI: 10.1111/jcpp.12912] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Among adults with schizophrenia, evidence suggests that premorbid deficits in different cognitive domains follow distinct developmental courses during childhood and adolescence. The aim of this study was to delineate trajectories of adolescent cognitive functions prospectively among different groups of youth at-risk for schizophrenia, relative to their typically developing (TD) peers. METHOD Using linear mixed models adjusted for sex, ethnicity, parental occupation and practice effects, cognitive development between ages 9 and 16 years was compared for youth characterised by a triad of well-replicated developmental antecedents of schizophrenia (ASz; N = 32) and youth with a least one affected relative with schizophrenia or schizoaffective disorder (FHx; N = 29), relative to TD youth (N = 45). Participants completed measures of IQ, scholastic achievement, memory and executive function at three time-points, separated by approximately 24-month intervals. RESULTS Compared to TD youth, both ASz and FHx youth displayed stable developmental deficits in verbal working memory and inhibition/switching executive functions. ASz youth additionally presented with stable deficits in measures of vocabulary (IQ), word reading, numerical operations, and category fluency executive function, and a slower rate of growth (developmental lag) on spelling from 9 to 16 years than TD peers. Conversely, faster rates of growth relative to TD peers (developmental delay) were observed on visual and verbal memory, and on category fluency executive function (ASz youth only) and on matrix reasoning (IQ) and word reading (FHx youth only). CONCLUSIONS These differential patterns of deviation from normative adolescent cognitive development among at-risk youth imply potential for cognitive rehabilitation targeting of specific cognitive deficits at different developmental phases.
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Affiliation(s)
- Hannah Dickson
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca Jones
- Division of Psychiatry, University College London, London, UK
| | - Abraham Reichenberg
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychiatry and Preventive Medicine, The Freidman Brain Institute, Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Ruth E Roberts
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sheilagh Hodgins
- Département de Psychiatrie, Université de Montréal, Montreal, QC, Canada
| | - Robin G Morris
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Kristin R Laurens
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,School of Psychology, Australian Catholic University, Brisbane, QLD, Australia.,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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Gkintoni E, Pallis EG, Bitsios P, Giakoumaki SG. Neurocognitive performance, psychopathology and social functioning in individuals at high risk for schizophrenia or psychotic bipolar disorder. J Affect Disord 2017; 208:512-520. [PMID: 27810272 DOI: 10.1016/j.jad.2016.10.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/05/2016] [Accepted: 10/22/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although cognitive deficits are consistent endophenotypes of schizophrenia and bipolar disorder, findings in psychotic bipolar disorder (BDP) are inconsistent. In this study we compared adult unaffected first-degree relatives of schizophrenia and BDP patients on cognition, psychopathology, social functioning and quality of life. METHODS Sixty-six unaffected first-degree relatives of schizophrenia patients (SUnR), 36 unaffected first-degree relatives of BDP patients (BDPUnR) and 102 controls participated in the study. Between-group differences were examined and Discriminant Function Analysis (DFA) predicted group membership. RESULTS Visual memory, control inhibition, working memory, cognitive flexibility and abstract reasoning were linearly impaired in the relatives' groups. Poorer verbal fluency and processing speed were evident only in the SUnR group. The SUnR group had higher depressive and somatization symptoms while the BDPUnR group had higher anxiety and lower social functioning compared with the controls. Individuals with superior cognition were more likely to be classified as controls; those with higher social functioning, prolonged processing speed and lower anxiety were more likely to be classified as SUnR. LIMITATIONS The relatives' sample is quite heterogeneous; the effects of genetic or environmental risk-factors were not examined. CONCLUSIONS Cognitive functions mediated by a fronto-parietal network, show linear impairments in unaffected relatives of BDP and schizophrenia patients; processing speed and verbal fluency impairments were evident only in schizophrenia relatives. Self-perceived symptomatology and social functioning also differ between schizophrenia and BDP relatives. The continuum seen in patients in several indices was also seen in the cognitive impairments in unaffected relatives of schizophrenia and BDP patients.
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Affiliation(s)
- Evgenia Gkintoni
- Department of Psychology, Gallos University campus, University of Crete, Rethymno, Crete, Greece
| | - Eleftherios G Pallis
- Department of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Panos Bitsios
- Department of Psychiatry & Behavioral Sciences, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Stella G Giakoumaki
- Department of Psychology, Gallos University campus, University of Crete, Rethymno, Crete, Greece.
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Sharma A, Camilleri N, Grunze H, Barron E, Le Couteur J, Close A, Rushton S, Kelly T, Ferrier IN, Le Couteur A. Neuropsychological study of IQ scores in offspring of parents with bipolar I disorder. Cogn Neuropsychiatry 2017; 22:17-27. [PMID: 27855540 DOI: 10.1080/13546805.2016.1259103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Studies comparing IQ in Offspring of Bipolar Parents (OBP) with Offspring of Healthy Controls (OHC) have reported conflicting findings. They have included OBP with mental health/neurodevelopmental disorders and/or pharmacological treatment which could affect results. This UK study aimed to assess IQ in OBP with no mental health/neurodevelopmental disorder and assess the relationship of sociodemographic variables with IQ. METHODS IQ data using the Wechsler Abbreviated Scale of Intelligence (WASI) from 24 OBP and 34 OHC from the North East of England was analysed using mixed-effects modelling. RESULTS All participants had IQ in the average range. OBP differed statistically significantly from OHC on Full Scale IQ (p = .001), Performance IQ (PIQ) (p = .003) and Verbal IQ (VIQ) (p = .001) but not on the PIQ-VIQ split. OBP and OHC groups did not differ on socio-economic status (SES) and gender. SES made a statistically significant contribution to the variance of IQ scores (p = .001). CONCLUSIONS Using a robust statistical model of analysis, the OBP with no current/past history of mental health/neurodevelopmental disorders had lower IQ scores compared to OHC. This finding should be borne in mind when assessing and recommending interventions for OBP.
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Affiliation(s)
- Aditya Sharma
- a Institute of Neuroscience , Newcastle University , Newcastle upon Tyne , UK
- b Northumberland, Tyne and Wear NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Nigel Camilleri
- c Institute of Health and Society , Newcastle University , Newcastle upon Tyne , UK
- d Tees, Esk and Wear Valley NHS Foundation Trust , Middlesborough , UK
| | - Heinz Grunze
- a Institute of Neuroscience , Newcastle University , Newcastle upon Tyne , UK
- b Northumberland, Tyne and Wear NHS Foundation Trust , Newcastle upon Tyne , UK
- e Department of Psychiatry and Psychotherapy , Paracelsus Medical University , Salzburg , Austria
| | - Evelyn Barron
- a Institute of Neuroscience , Newcastle University , Newcastle upon Tyne , UK
| | - James Le Couteur
- a Institute of Neuroscience , Newcastle University , Newcastle upon Tyne , UK
| | - Andrew Close
- f School of Biology , Newcastle University , Newcastle upon Tyne , UK
| | - Steven Rushton
- f School of Biology , Newcastle University , Newcastle upon Tyne , UK
| | - Thomas Kelly
- a Institute of Neuroscience , Newcastle University , Newcastle upon Tyne , UK
- g Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Ian Nicol Ferrier
- a Institute of Neuroscience , Newcastle University , Newcastle upon Tyne , UK
- b Northumberland, Tyne and Wear NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Ann Le Couteur
- b Northumberland, Tyne and Wear NHS Foundation Trust , Newcastle upon Tyne , UK
- c Institute of Health and Society , Newcastle University , Newcastle upon Tyne , UK
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Revisiting visual dysfunctions in schizophrenia from the retina to the cortical cells: A manifestation of defective neurodevelopment. Prog Neuropsychopharmacol Biol Psychiatry 2015; 62:29-34. [PMID: 25934388 DOI: 10.1016/j.pnpbp.2015.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/11/2015] [Accepted: 04/22/2015] [Indexed: 01/08/2023]
Abstract
This review highlights morphological and functional anomalies found along the entire visual pathway in schizophrenia, from the retina to the cortex. Based on the evidence of widespread anatomical and functional visual abnormalities, we posited that a neurodevelopmental anomaly occurring early in life was likely to explain those. Incidentally, support to the neurodevelopmental theory of schizophrenia is strongly emerging from many neurobiological domains. In vertebrates, the first visual structures migrate toward the orbit position at the end of the fourth week of gestation. A neurodevelopmental defect around that time on these embryonic structures could account for the visual anomalies in schizophrenia. Retinol activity might be involved in the process. Future research in schizophrenia should focus on early visual testing, on trials combining multiple visual anomaly assessments and a closer look to retinol activity during the pregnancy.
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Berthelot N, Paccalet T, Gilbert E, Moreau I, Mérette C, Gingras N, Rouleau N, Maziade M. Childhood abuse and neglect may induce deficits in cognitive precursors of psychosis in high-risk children. J Psychiatry Neurosci 2015; 40:336-43. [PMID: 26035064 PMCID: PMC4543096 DOI: 10.1503/jpn.140211] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Millions of children are born to parents affected by major psychoses. Cognitive dysfunctions seen in patients are already detectable in these children. In parallel, childhood maltreatment increases the risk of adult psychoses through unknown mechanisms. We investigated whether high-risk offspring exposed to abuse/neglect displayed more cognitive precursors of adult psychoses in childhood and adolescence than nonexposed offspring. METHODS We used a stepwise selection strategy from a 25-year follow-up of 48 densely affected kindreds including 1500 adults (405 patients with schizophrenia or bipolar disorder) to select high-risk offspring aged 6-22 years for inclusion in our study. All offspring were assessed for childhood trauma from direct interviews with the offspring, parents and relatives and from the review of lifetime medical records of parents and children and administered a neuropsychological battery including IQ and 4 of the most impaired neuropsychological domains in psychoses. RESULTS Our study included 66 high-risk offspring. Those who were exposed to abuse/neglect had significantly lower IQ (effect size [ES] = 0.61) than nonexposed offspring and displayed poorer cognitive performance in visual episodic memory (ES = 0.67) and in executive functions of initiation (ES = 1.01). Moreover, exposed offspring presented more combinations of cognitive deficits that were associated with lower Global Assessment of Functioning scores. LIMITATIONS Exposure to abuse/neglect was not assessed in the control group, thus the study could not test whether the effect of childhood maltreatment occurred only in a high-risk setting and not in the general population. CONCLUSION In high-risk youths, maltreatment in childhood/adolescence may negatively impact cognitive domains known to be impaired in adults with psychoses, suggesting an early mediating effect in the association between abuse/neglect and adult psychoses. This finding provides a target for future developmental and preventive research.
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Affiliation(s)
| | | | | | | | | | | | | | - Michel Maziade
- Correspondence to: M. Maziade, Centre de recherche de l’Institut universitaire en santé mentale de Québec, 2601 de la Canardière, Québec, QC G1J 2G3;
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Masson M, Bussières EL, East-Richard C, R-Mercier A, Cellard C. Neuropsychological Profile of Children, Adolescents and Adults Experiencing Maltreatment: A Meta-analysis. Clin Neuropsychol 2015; 29:573-94. [PMID: 26114949 DOI: 10.1080/13854046.2015.1061057] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Few studies have attempted to describe the range of cognitive impairments affecting people who have experienced child maltreatment. The aim of this meta-analysis was to examine the neuropsychological profile of these people and to determine the cognitive impacts of maltreatment from childhood to adulthood. METHOD Fifty-two publications from 1970 to 2013 were included. RESULTS The affected cognitive domains were working memory (g = -.65), attention (g = -.63), intelligence (g = -.56) and speed of processing (g = -.49). The impact of maltreatment was greater in young children (g = -.71) and less pronounced in adults (g = -.26). CONCLUSIONS These results suggest that exposure to maltreatment has an impact on specific cognitive processes, regardless of age.
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Affiliation(s)
- Marjolaine Masson
- a École de Psychologie, Pavillon Félix-Antoine-Savard , Université Laval , Québec , QC , Canada
| | | | - Caroline East-Richard
- a École de Psychologie, Pavillon Félix-Antoine-Savard , Université Laval , Québec , QC , Canada
| | - Alexandra R-Mercier
- a École de Psychologie, Pavillon Félix-Antoine-Savard , Université Laval , Québec , QC , Canada
| | - Caroline Cellard
- a École de Psychologie, Pavillon Félix-Antoine-Savard , Université Laval , Québec , QC , Canada.,b Centre Jeunesse Québec-Institut Universitaire , Québec , QC , Canada
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10
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Bang M, Kim KR, Song YY, Baek S, Lee E, An SK. Neurocognitive impairments in individuals at ultra-high risk for psychosis: Who will really convert? Aust N Z J Psychiatry 2015; 49:462-70. [PMID: 25425742 DOI: 10.1177/0004867414561527] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Impairments in neurocognitive function are considered as core features of schizophrenia. Individuals at ultra-high risk (UHR) for psychosis, the 'putative' prodrome of schizophrenia, generally show levels of impairments intermediate between schizophrenia patients and healthy controls. We investigated the neurocognitive performance of individuals at UHR for psychosis, comparing them with patients with first-episode schizophrenia (FES) and healthy controls (HC), and explored the predictivity of baseline neurocognitive function in the UHR group for transition to overt psychosis. METHOD Individuals at UHR for psychosis (n = 60), patients with FES (n = 39), and HC subjects (n = 94) participated in the present study. All participants performed a comprehensive neurocognitive battery, consisting of tests for five separate neurocognitive domains (executive function, attention/working memory, processing speed, verbal memory, and spatial memory). UHR subjects were assessed for transition every month during 24 months of follow-up. RESULTS Neurocognitive performance in the UHR group was largely at intermediate levels. Attention/working memory and verbal memory were significantly different from both the FES and HC groups. In the UHR group, processing speed was decreased to the level of the FES group, while executive function and spatial memory were relatively preserved. In the Cox regression model, spatial memory significantly predicted the transition to overt psychosis in the UHR group. CONCLUSIONS The present study showed that neurocognitive impairments were evident in UHR individuals prior to the onset of overt psychosis. Our findings generally support the neurodevelopmental model of schizophrenia and suggest that there could be different developmental trajectories between converters and non-converters.
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Affiliation(s)
- Minji Bang
- Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Kyung Ran Kim
- Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Yun Young Song
- Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea Department of Psychiatry, Seoul National Hospital, Seoul, South Korea
| | - Seoyeon Baek
- Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Lee
- Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Suk Kyoon An
- Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea Graduate Program in Cognitive Science, Yonsei University, Seoul, South Korea
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11
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Uher R, Cumby J, MacKenzie LE, Morash-Conway J, Glover JM, Aylott A, Propper L, Abidi S, Bagnell A, Pavlova B, Hajek T, Lovas D, Pajer K, Gardner W, Levy A, Alda M. A familial risk enriched cohort as a platform for testing early interventions to prevent severe mental illness. BMC Psychiatry 2014; 14:344. [PMID: 25439055 PMCID: PMC4267051 DOI: 10.1186/s12888-014-0344-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/19/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Severe mental illness (SMI), including schizophrenia, bipolar disorder and severe depression, is responsible for a substantial proportion of disability in the population. This article describes the aims and design of a research study that takes a novel approach to targeted prevention of SMI. It is based on the rationale that early developmental antecedents to SMI are likely to be more malleable than fully developed mood or psychotic disorders and that low-risk interventions targeting antecedents may reduce the risk of SMI. METHODS/DESIGN Families Overcoming Risks and Building Opportunities for Well-being (FORBOW) is an accelerated cohort study that includes a large proportion of offspring of parents with SMI and embeds intervention trials in a cohort multiple randomized controlled trial (cmRCT) design. Antecedents are conditions of the individual that are distressing but not severely impairing, predict SMI with moderate-to-large effect sizes and precede the onset of SMI by at least several years. FORBOW focuses on the following antecedents: affective lability, anxiety, psychotic-like experiences, basic symptoms, sleep problems, somatic symptoms, cannabis use and cognitive delay. Enrolment of offspring over a broad age range (0 to 21 years) will allow researchers to draw conclusions on a longer developmental period from a study of shorter duration. Annual assessments cover a full range of psychopathology, cognitive abilities, eligibility criteria for interventions and outcomes. Pre-emptive early interventions (PEI) will include skill training for parents of younger children and courses in emotional well-being skills based on cognitive behavioural therapy for older children and youth. A sample enriched for familial risk of SMI will enhance statistical power for testing the efficacy of PEI. DISCUSSION FORBOW offers a platform for efficient and unbiased testing of interventions selected according to best available evidence. Since few differences exist between familial and 'sporadic' SMI, the same interventions are likely to be effective in the general population. Comparison of short-term efficacy of PEI on antecedents and the long term efficacy for preventing the onset of SMI will provide an experimental test of the etiological role of antecedents in the development of SMI.
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Affiliation(s)
- Rudolf Uher
- Capital District Health Authority, Halifax, Nova Scotia, Canada.
- IWK Health Centre, Halifax, Nova Scotia, Canada.
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.
- Department of Public Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Jill Cumby
- Capital District Health Authority, Halifax, Nova Scotia, Canada.
| | - Lynn E MacKenzie
- Capital District Health Authority, Halifax, Nova Scotia, Canada.
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.
| | | | | | - Alice Aylott
- Capital District Health Authority, Halifax, Nova Scotia, Canada.
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Lukas Propper
- IWK Health Centre, Halifax, Nova Scotia, Canada.
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Sabina Abidi
- IWK Health Centre, Halifax, Nova Scotia, Canada.
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Alexa Bagnell
- IWK Health Centre, Halifax, Nova Scotia, Canada.
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Barbara Pavlova
- Capital District Health Authority, Halifax, Nova Scotia, Canada.
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Tomas Hajek
- Capital District Health Authority, Halifax, Nova Scotia, Canada.
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - David Lovas
- IWK Health Centre, Halifax, Nova Scotia, Canada.
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Kathleen Pajer
- IWK Health Centre, Halifax, Nova Scotia, Canada.
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - William Gardner
- IWK Health Centre, Halifax, Nova Scotia, Canada.
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Adrian Levy
- Department of Public Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Martin Alda
- Capital District Health Authority, Halifax, Nova Scotia, Canada.
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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Duffy A. Toward a comprehensive clinical staging model for bipolar disorder: integrating the evidence. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:659-66. [PMID: 25702367 PMCID: PMC4304586 DOI: 10.1177/070674371405901208] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To describe key findings relating to the natural history and heterogeneity of bipolar disorder (BD) relevant to the development of a unitary clinical staging model. Currently proposed staging models are briefly discussed, highlighting complementary findings, and a comprehensive staging model of BD is proposed integrating the relevant evidence. METHOD A selective review of key published findings addressing the natural history, heterogeneity, and clinical staging models of BD are discussed. RESULTS The concept of BD has broadened, resulting in an increased spectrum of disorders subsumed under this diagnostic category. Different staging models for BD have been proposed based on the early psychosis literature, studies of patients with established BD, and prospective studies of the offspring of parents with BD. The overarching finding is that there are identifiable sequential clinical phases in the development of BD that differ in important ways between classical episodic and psychotic spectrum subtypes. In addition, in the context of familial risk, early risk syndromes add important predictive value and inform the staging model for BD. CONCLUSIONS A comprehensive clinical staging model of BD can be derived from the available evidence and should consider the natural history of BD and the heterogeneity of subtypes. This model will advance both early intervention efforts and neurobiological research.
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Affiliation(s)
- Anne Duffy
- Campus Alberta Innovates Program Professor in Youth Mental Health, Medical Director Mood Disorders Program, Department of Psychiatry, University of Calgary, Calgary, Alberta
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13
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Zhou FC, Hou WM, Wang CY, Ungvari GS, Chiu HFK, Correll CU, Shum DHK, Man D, Liu DT, Xiang YT. Prospective memory performance in non-psychotic first-degree relatives of patients with schizophrenia: a controlled study. PLoS One 2014; 9:e111562. [PMID: 25365028 PMCID: PMC4218767 DOI: 10.1371/journal.pone.0111562] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 10/03/2014] [Indexed: 11/24/2022] Open
Abstract
Objective We aimed at investigating prospective memory and its socio-demographic and neurocognitive correlates in non-psychotic, first-degree relatives (FDRs) of patients with schizophrenia compared to patients with first episode schizophrenia (FES), and healthy controls (HCs). Methods Forty-seven FES patients, 50 non-psychotic FDRs (23 offspring and 27 siblings) of patients with chronic schizophrenia (unrelated to the FES group) and 51 HCs were studied. The Chinese version of the Cambridge Prospective Memory Test (C-CAMPROMPT) was used to measure time-based prospective memory (TBPM) and event-based prospective memory (EBPM) performance. Other cognitive functions (involving respective memory and executive functions) were evaluated with standardized tests. Results After controlling for basic demographic characteristics including age, gender and educational level, there was a significant difference between FDRs, FES and HCs with respect to both TBPM (F(2,142) = 10.4, p<0.001) and EBPM (F(2,142) = 10.8, p<0.001). Multiple linear regression analyses revealed that lower scores of the Hopkins Verbal Learning Test-Revised (HVLT-R) and the STROOP Word-Color Test (SWCT) contributed to TBPM impairment, while lower educational level and higher scores of the Color Trails Test-2 (CTT-2) contributed to EBPM deficit in FDRs. Conclusions FDRs share similar but attenuated prospective memory impairments with schizophrenia patients, suggesting that prospective memory deficits may represent an endophenotype of schizophrenia.
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Affiliation(s)
- Fu-Chun Zhou
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Wei-Min Hou
- Beijing Daxing Mental Health Center, Beijing, China
| | - Chuan-Yue Wang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- * E-mail: (C-YW); (Y-TX)
| | - Gabor S. Ungvari
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Helen F. K. Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Christoph U. Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York, United States of America
| | - David H. K. Shum
- School of Psychology and Griffith Health Institute, Griffith University, Brisbane, Queensland, Australia
| | - David Man
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Deng-Tang Liu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macao SAR, China
- * E-mail: (C-YW); (Y-TX)
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14
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Bora E, Lin A, Wood SJ, Yung AR, McGorry PD, Pantelis C. Cognitive deficits in youth with familial and clinical high risk to psychosis: a systematic review and meta-analysis. Acta Psychiatr Scand 2014; 130:1-15. [PMID: 24611632 DOI: 10.1111/acps.12261] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE It is likely that cognitive deficits are vulnerability markers for developing schizophrenia, as these deficits are already well-established findings in first-episode psychosis. Studies at-risk adolescents and young adults are likely to provide information about cognitive deficits that predate the onset of the illness. METHOD We conducted meta-analyses of studies comparing familial-high risk (FHR) or ultra-high risk (UHR; n = 2113) and healthy controls (n = 1748) in youth studies in which the mean age was between 15 and 29. RESULTS Compared with controls, high risk subjects were impaired in each domain in both UHR (d = 0.34-0.71) and FHR (d = 0.24-0.81). Heterogeneity of effect sizes across studies was modest, increasing confidence to the findings of the current meta-analysis (I(2) = 0-0.18%). In both risk paradigms, co-occurrence of genetic risk with attenuated symptoms was associated with more severe cognitive dysfunction. In UHR, later transition to psychosis was associated with more severe cognitive deficits in all domains (d = 0.31-0.49) except sustained attention. However, cognitive impairment has a limited capacity to predict the outcome of high-risk patients. CONCLUSION Cognitive deficits are already evident in adolescents and young adults who have familial or clinical risk for psychosis. Longitudinal developmental studies are important to reveal timing and trajectory of emergence of such deficits.
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Affiliation(s)
- E Bora
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Vic., Australia
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15
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Gilbert E, Mérette C, Jomphe V, Émond C, Rouleau N, Bouchard RH, Roy MA, Paccalet T, Maziade M. Cluster analysis of cognitive deficits may mark heterogeneity in schizophrenia in terms of outcome and response to treatment. Eur Arch Psychiatry Clin Neurosci 2014; 264:333-43. [PMID: 24173295 PMCID: PMC5025284 DOI: 10.1007/s00406-013-0463-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 10/16/2013] [Indexed: 12/31/2022]
Abstract
Cognitive impairments are central to schizophrenia, but their clinical utility for tagging heterogeneity in lifetime outcome and response to treatment is not conclusive. By exploiting four cognitive domains consistently showing large deficits in studies, we tested whether cluster analysis would define separate subsets of patients and then whether the disease heterogeneity marked by these clusters would be related to lifetime outcome and response to treatment. A total of 112 schizophrenia patients completed a neuropsychological evaluation. The PANSS, GAF-S and GAF-F were rated at the onset and endpoint of the illness trajectory. A blind judgment of the lifetime response to treatment was made. The first cluster presented near-normal cognitive performance. Two other clusters of severely impaired patients were identified: one generally impaired in the four cognitive domains and another selectively impaired in visual episodic memory and processing speed, each relating to a different lifetime evolution of disease and treatment response. Although the two impaired clusters were clinically indistinguishable in symptom severity and functioning at disease onset, patients with selective cognitive impairments demonstrated better improvement at outcome, whereas the generally impaired patients were more likely to be treatment refractory. The findings have implications for the management of patients and for clinical trials since particular combinations of cognitive deficits in patients would influence their treatment response.
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Affiliation(s)
- Elsa Gilbert
- Centre de recherche, Institut universitaire en santé mentale de Québec, 2601, chemin de la Canardière (F-4500), Quebec, QC G1J 2G3, Canada
| | - Chantal Mérette
- Centre de recherche, Institut universitaire en santé mentale de Québec, 2601, chemin de la Canardière (F-4500), Quebec, QC G1J 2G3, Canada,Faculté de Médecine, Laval University, Quebec, QC, Canada
| | - Valérie Jomphe
- Centre de recherche, Institut universitaire en santé mentale de Québec, 2601, chemin de la Canardière (F-4500), Quebec, QC G1J 2G3, Canada
| | - Claudia Émond
- Centre de recherche, Institut universitaire en santé mentale de Québec, 2601, chemin de la Canardière (F-4500), Quebec, QC G1J 2G3, Canada
| | - Nancie Rouleau
- Centre de recherche, Institut universitaire en santé mentale de Québec, 2601, chemin de la Canardière (F-4500), Quebec, QC G1J 2G3, Canada,École de psychologie, Université Laval, Quebec, QC, Canada
| | - Roch-Hugo Bouchard
- Centre de recherche, Institut universitaire en santé mentale de Québec, 2601, chemin de la Canardière (F-4500), Quebec, QC G1J 2G3, Canada
| | - Marc-André Roy
- Centre de recherche, Institut universitaire en santé mentale de Québec, 2601, chemin de la Canardière (F-4500), Quebec, QC G1J 2G3, Canada,Faculté de Médecine, Laval University, Quebec, QC, Canada
| | - Thomas Paccalet
- Centre de recherche, Institut universitaire en santé mentale de Québec, 2601, chemin de la Canardière (F-4500), Quebec, QC G1J 2G3, Canada
| | - Michel Maziade
- Centre de recherche, Institut universitaire en santé mentale de Québec, 2601, chemin de la Canardière (F-4500), Quebec, QC G1J 2G3, Canada,Faculté de Médecine, Laval University, Quebec, QC, Canada
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Verweij KHW, Derks EM. The association between intelligence scores and family history of psychiatric disorder in schizophrenia patients, their siblings and healthy controls. PLoS One 2013; 8:e77215. [PMID: 24130858 PMCID: PMC3793952 DOI: 10.1371/journal.pone.0077215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 09/01/2013] [Indexed: 02/06/2023] Open
Abstract
Background The degree of intellectual impairment in schizophrenia patients and their relatives has been suggested to be associated with the degree of familial loading for schizophrenia. Since other psychiatric disorders are also more present in relatives of schizophrenia patients, the definition of family history should be broadened. The association between family history for psychiatric disorder and intelligence scores was investigated in patients with non-affective psychosis, their unaffected siblings and controls. Methods A sample of 712 schizophrenia proband families (696 patients and 766 siblings) and 427 healthy control families (517 subjects) participated in this study. Family history of psychiatric disorder was determined while excluding the data of the participating schizophrenia patient. A dichotomous division was made between families with no first- or second degree relative with psychiatric disorder and families with one or more affected relatives. Total intelligence scores were estimated by admission of the short form of the Wechsler Adult Intelligence Scale III. Results A significant interaction was found between family history of psychiatric disorder and clinical status (F(2,1086.87)= 4.17; p=.016). Patients with a positive family history of psychiatric disorder obtained higher intelligence scores compared to patients with no family history (mean IQ scores are 95.52 and 92.72) with an opposite effect in controls (mean IQ scores are 108.71 and 111.19). No significant difference was found between siblings of schizophrenia patients with or without a positive family history (mean IQ scores are 102.98 and 103.24). Conclusion In patients with schizophrenia, a negative family history of psychiatric disorder was associated with relatively low IQ suggesting that the etiology in these patients may involve environmental or genetic factors which are unique to the patient and are not observed in other relatives. Possible factors include severe environmental stressors containing premature birth or brain injury and genetic factors (e.g de novo Copy Number Variants).
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Affiliation(s)
- Kim H. W. Verweij
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, the Netherlands
- * E-mail:
| | - Eske M. Derks
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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A protective-compensatory model may reconcile the genetic and the developmental findings in schizophrenia. Schizophr Res 2013; 144:9-15. [PMID: 23360726 DOI: 10.1016/j.schres.2012.12.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 12/12/2012] [Accepted: 12/14/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The neurodevelopmental, the multifactorial-oligogenic and the gene-environment diathesis models have provoked advances in schizophrenia research, yet the exact pathophysiology remains indefinable. We broadened our analysis of 20years of findings in adults and children descending from densely affected families in the Québec population with a founder effect. The goal was to inspect the link between these family-genetic and developmental findings. METHOD 48 multigenerational families affected by schizophrenia or bipolar disorder represented a quasi-total sample of affected kindreds in the Eastern-Quebec catchment area. Among the 1274 adult family members with lifetime best-estimate diagnoses, 341 had DSM-IV schizophrenia or bipolar disorder. Young offspring of an affected parent were studied with the same clinical, physiological and cognitive measures as the adults. RESULTS Four new observations emerged: 1. A striking resemblance between the clinical, neuropsychological and genetic findings in these densely affected families and those reported in sporadic samples; 2. A high degree of heterogeneity despite the origin from a founder-effect population; 3. Cognitive deficits in some non-affected adult relatives as severe as those in patients; 4. Children descending from kindreds displayed neurodevelopmental endophenotypic anomalies comparable to those of adult patients. CONCLUSION These four observations could be reconciled under the hypothesis that highly familial and sporadic cases share mechanisms based on defective protective genes, a model to an extent similar to cancer findings. These defective protective genes running in families would longitudinally disturb the compensatory mechanisms in children inheriting them and might be at the core of the schizophrenia process.
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