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Carmassi C, Dell'Oste V, Fantasia S, Bordacchini A, Bertelloni CA, Scarpellini P, Pedrinelli V. A 12-month longitudinal naturalistic follow-up of cariprazine in schizophrenia. Front Psychiatry 2024; 15:1382013. [PMID: 38835554 PMCID: PMC11148343 DOI: 10.3389/fpsyt.2024.1382013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/29/2024] [Indexed: 06/06/2024] Open
Abstract
Background Cariprazine, a third-generation antipsychotic (TGAs), has demonstrated efficacy in the treatment of schizophrenia with good tolerability profile. Actual real-world literature data are lacking, particularly when exploring its efficacy in the long term. The present study examined the effects of cariprazine treatment on specific psychopathological domains with a particular focus on outcomes and side effects in real-life experience, after a long-term treatment. Methods The present 12-month longitudinal naturalistic study included a sample of subjects with a DSM-5-TR diagnosis of schizophrenia, recruited in the outpatients' psychiatric services of university and community hospitals in Italy, naturally treated with cariprazine. The assessments included: a sociodemographic data sheet, the Structured Clinical Interview for the DSM-5 (SCID-5), the Positive and Negative Symptom Scale (PANSS) and the St. Hans Rating Scale (SHRS). The PANSS was also administered after 6 (T1) and 12 (T2) months of treatment with cariprazine while the SHRS at T1. Results The total sample consisted of 31 patients, 15 males and 16 females. A significant decrease of the PANSS' subscales, Marder factors and total mean scores emerged at both T1 and T2 with respect to T0. Extrapyramidal symptoms occurred in a minority of patients and in mild or mild/moderate forms: no patient showed moderate forms of psychic/motor akathisia or dystonia, three subjects showed moderate parkinsonism. Conclusions This study confirms a good efficacy profile of cariprazine in both positive and negative symptoms in patients with Schizophrenia, combined with a good tolerability profile in extrapyramidal symptoms.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
- Unità Funzionale Complessa Salute Mentale Adulti Zona Valdinievole, Azienda USL Toscana Centro, Montecatini Terme, Italy
| | - Sara Fantasia
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Bordacchini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carlo Antonio Bertelloni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Unità Funzionale Salute Mentale Adulti Zona Apuana, Azienda USL Toscana Nord Ovest, Massa, Italy
| | - Pietro Scarpellini
- Unità Funzionale Salute Mentale Adulti Zona Apuana, Azienda USL Toscana Nord Ovest, Massa, Italy
| | - Virginia Pedrinelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
- Unità Funzionale Salute Mentale Adulti Zona Apuana, Azienda USL Toscana Nord Ovest, Massa, Italy
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Citrome L, Castelli M, Hasebe M, Terahara T, Faden J, Komaroff M. Efficacy of HP-3070, A Once-Daily Asenapine Transdermal System, in the Treatment of Adults with Schizophrenia: A PANSS Five-Factor Analysis. Neuropsychiatr Dis Treat 2024; 20:755-764. [PMID: 38566884 PMCID: PMC10986403 DOI: 10.2147/ndt.s439712] [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: 12/13/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction HP-3070, a once-daily asenapine transdermal system, is the first antipsychotic "patch" formulation FDA approved for adults with schizophrenia. Positive and Negative Syndrome Scale (PANSS) score items can be grouped into a five-factor structure to describe specific schizophrenia symptom domains. This post hoc analysis of data from a pivotal study evaluated HP-3070's efficacy by examining these factors. Methods In a phase 3 study, adults with an acute exacerbation of schizophrenia were randomized to six weeks of treatment with HP-3070 3.8mg/24h, 7.6mg/24h, or placebo. An analysis was performed using the five PANSS factor domains (negative symptoms, positive symptoms, disorganized thought, uncontrolled hostility/excitement, anxiety/depression). Mixed-model repeated-measures (MMRM) analysis included change from baseline (CFB) in PANSS factor score as the repeated dependent variable, with country, treatment, visit, treatment by visit interaction, and baseline PANSS score as covariates. Results The analysis included 607 patients. Treatment with HP-3070 3.8mg/24h resulted in a statistically significant LS mean CFB (improvement) vs placebo at Weeks 4-6 for all domains except for anxiety/depression, where a numerical difference was observed in favor of active treatments. Among the domains, the positive symptom factor demonstrated the numerically greatest LS mean (SE) difference from placebo in CFB, which for HP-3070 7.6mg/24h was -2.0 [0.57] and for HP-3070 3.8mg/24h was -2.3 [0.57]; P<0.001 for both. Treatment effect size for the positive symptom factor using Cohen's d (95% confidence intervals) was 0.39 (0.17, 0.61) for HP-3070 7.6mg/24h and 0.45 (0.20, 0.64) for HP-3070 3.8mg/24h. Discussion Post hoc analysis using a PANSS five-factor model suggests that HP-3070 may address a broad range of symptoms in people with schizophrenia.
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Affiliation(s)
- Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
| | | | | | | | - Justin Faden
- Department of Psychiatry, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Marina Komaroff
- Product Development, Noven Pharmaceuticals, Inc, Jersey City, NJ, USA
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Lisoni J, Nibbio G, Baldacci G, Zucchetti A, Cicale A, Zardini D, Miotto P, Deste G, Barlati S, Vita A. Improving depressive symptoms in patients with schizophrenia using bilateral bipolar-nonbalanced prefrontal tDCS: Results from a double-blind sham-controlled trial. J Affect Disord 2024; 349:165-175. [PMID: 38199388 DOI: 10.1016/j.jad.2024.01.050] [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: 07/21/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Treating depressive symptoms in patients with schizophrenia is challenging. While transcranical Dicrect Current Stimulation (tDCS) improved other core symptoms of schizophrenia, conflicting results have been obtained on depressive symptoms. Thus, we aimed to expand current evidence on tDCS efficacy to improve depressive symptoms in patients with schizophrenia. METHODS A double-blind RCT was performed with patients randomized to 2 mA active-tDCS or sham-tDCS (15 daily sessions) with a bilateral bipolar-nonbalanced prefrontal placement (anode: left Dorsolateral prefrontal cortex; cathode: right orbitofrontal region). Clinical outcomes included variations of Calgary Depression Scale for Schizophrenia total score (CDSS) and of Depression-hopelessness and Guilty idea of reference-pathological guilt factors. Analysis of covariance was performed evaluating between-group changes over time. The presence/absence of probable clinically significant depression was determined when CDSS > 6. RESULTS As 50 outpatients were included (both groups, n = 25), significant improvements following active-tDCS were observed for CDSS total score (p = 0.001), Depression-hopelessness (p = 0.001) and Guilty idea of reference-pathological guilt (p = 0.03). Considering patients with CDSS>6 (n = 23), compared to sham, active-tDCS significantly improved CDSS total score (p < 0.001), Depression-hopelessness (p = 0.001) but Guilty idea of reference-pathological guilt only marginally improved (p = 0.051). Considering response rates of clinically significant depression, important reductions of CDSS score were observed (78 % of the sample scored ≤6; active-tDCS, n = 23; sham-tDCS, n = 16; p = 0.017). Early wakening item did not significantly change in any group. LIMITATIONS The study lacks a follow-up period and evaluation of tDCS effects on psychosocial functioning. CONCLUSIONS Bilateral bipolar-nonbalanced prefrontal tDCS is a successful protocol for the treatment of depressive symptoms in patients with schizophrenia.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Giulia Baldacci
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Andrea Zucchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Andrea Cicale
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Daniela Zardini
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Paola Miotto
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
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Raugh IM, Strauss GP. Trait Mindfulness in Psychotic Disorders: Dimensions Predicting Symptoms, Cognition, and Functional Outcome. Behav Ther 2024; 55:55-67. [PMID: 38216237 PMCID: PMC10787159 DOI: 10.1016/j.beth.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 01/14/2024]
Abstract
Mindfulness-based treatments are efficacious for psychotic disorders (PD). However, which components of mindfulness (i.e., attentive monitoring and nonjudgmental acceptance) are most relevant treatment targets is unclear. Further, there is a dearth of literature examining clinical correlates of mindfulness in people with PD. The present study aimed to examine group differences and clinical correlates of mindfulness in people with PD. We hypothesized that PD would report lower monitoring and acceptance than CN and that mindfulness components would be associated with symptoms including dysfunctional beliefs, alexithymia, neurocognitive ability, positive symptoms, and mood symptoms. Groups included individuals with PD (n = 54) and nonpsychiatric controls (n = 55). Participants completed self-report measures of mindfulness and related constructs and clinical interviews of symptoms. Results of ANOVA models indicated that global mindfulness was lower in PD relative to CN, with greatest differences evident for acceptance in the affective psychosis group. Regression models found that greater monitoring was associated with improved neurocognitive performance, while acceptance was associated with lower defeatist beliefs, alexithymia, and depression/anxiety symptoms. Results highlight the importance of targeting acceptance in the psychosocial treatment of PDs, especially for those with mood symptoms.
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Wasserthal S, Lehmann M, Neumann C, Delis A, Philipsen A, Hurlemann R, Ettinger U, Schultz J. Effects of NMDA-receptor blockade by ketamine on mentalizing and its neural correlates in humans: a randomized control trial. Sci Rep 2023; 13:17184. [PMID: 37821513 PMCID: PMC10567921 DOI: 10.1038/s41598-023-44443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/08/2023] [Indexed: 10/13/2023] Open
Abstract
Schizophrenia is associated with various deficits in social cognition that remain relatively unaltered by antipsychotic treatment. While faulty glutamate signaling has been associated with general cognitive deficits as well as negative symptoms of schizophrenia, no direct link between manipulation of glutamate signaling and deficits in mentalizing has been demonstrated thus far. Here, we experimentally investigated whether ketamine, an uncompetitive N-methyl-D-aspartate receptor antagonist known to induce psychotomimetic effects, influences mentalizing and its neural correlates. In a randomized, placebo-controlled between-subjects experiment, we intravenously administered ketamine or placebo to healthy participants performing a video-based social cognition task during functional magnetic resonance imaging. Psychotomimetic effects of ketamine were assessed using the Positive and Negative Syndrome Scale. Compared to placebo, ketamine led to significantly more psychotic symptoms and reduced mentalizing performance (more "no mentalizing" errors). Ketamine also influenced blood oxygen level dependent (BOLD) response during mentalizing compared to placebo. Specifically, ketamine increased BOLD in right posterior superior temporal sulcus (pSTS) and increased connectivity between pSTS and anterior precuneus. These increases may reflect a dysfunctional shift of attention induced by ketamine that leads to mentalizing deficits. Our findings show that a psychotomimetic dose of ketamine impairs mentalizing and influences its neural correlates, a result compatible with the notion that deficient glutamate signaling may contribute to deficits in mentalizing in schizophrenia. The results also support efforts to seek novel psychopharmacological treatments for psychosis and schizophrenia targeting glutamatergic transmission.
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Affiliation(s)
- Sven Wasserthal
- Division of Medical Psychology, Department of Psychiatry and Psychotherapy, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Mirko Lehmann
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Claudia Neumann
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Achilles Delis
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital of Bonn, Bonn, Germany
| | - René Hurlemann
- Department of Psychiatry, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | | | - Johannes Schultz
- Center for Economics and Neuroscience, University of Bonn, Bonn, Germany
- Institute for Experimental Epileptology and Cognition Research, Medical Faculty, University of Bonn, Bonn, Germany
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Achim AM, Roy MA, Fossard M. The other side of the social interaction: Theory of mind impairments in people with schizophrenia are linked to other people's difficulties in understanding them. Schizophr Res 2023; 259:150-157. [PMID: 35906170 DOI: 10.1016/j.schres.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND People with schizophrenia (SZ) often present with theory of mind (ToM) deficits and with speech production deficits. While a link has been established between ToM abilities and symptoms of thought disorder, much less is known about other aspects of speech production in SZ. STUDY DESIGN This is a case-control study in which 25 stable outpatients with recent-onset SZ (27.1 years, 22 men) and 22 matched healthy controls (25.6 years, 16 men) performed a collaborative, verbal production task with a real interaction partner. Blind raters scored how easy participants made it to understand them (Facility ratings), how interesting they were to listen to (Interest ratings) and how expressive they were (Expressivity ratings). ToM was assessed with the Combined Stories Test and Sarfati's cartoon task. Symptoms were assessed with the PANSS five-factor version. STUDY RESULTS Compared to healthy controls, SZ received significantly lower ratings for all three aspects of their verbal productions (Facility, Interest and Expressivity), despite the raters being blind to group membership. Interestingly, the Facility ratings were linked to ToM performance in the SZ group, which suggest that SZ participants who have difficulties understanding others (ToM deficits) also make it harder for others to understand them. Other notable findings include a strong link between the Expressivity ratings and the Interest ratings for both groups, and significant correlations between the Facility ratings and Cognitive/Disorganisation symptoms, and between the Expressivity ratings and both Negative and Depression/Anxiety symptoms in SZ. CONCLUSION Studying speech production during real, collaborative social interactions could help move beyond the individual approach to SZ deficits, making it possible to involve the interaction partners to promote more efficient communication for people with schizophrenia.
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Affiliation(s)
- Amélie M Achim
- Département de psychiatrie et neurosciences, Université Laval, Pavillon Ferdinand-Vandry, (room 4873), 1050, avenue de la Médecine, Quebec City G1V 0A6, QC, Canada; Centre de recherche CERVO, 2601, de la Canardière, Quebec City G1J 2G3, QC, Canada.
| | - Marc-André Roy
- Département de psychiatrie et neurosciences, Université Laval, Pavillon Ferdinand-Vandry, (room 4873), 1050, avenue de la Médecine, Quebec City G1V 0A6, QC, Canada; Centre de recherche CERVO, 2601, de la Canardière, Quebec City G1J 2G3, QC, Canada
| | - Marion Fossard
- Institut des sciences logopédiques, Université de Neuchâtel, Rue Pierre-à-Mazel 7, CH-2000 Neuchâtel, Switzerland
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Cho LL, Jones AA, Gao C, Leonova O, Vila-Rodriguez F, Buchanan T, Lang DJ, MacEwan GW, Procyshyn RM, Panenka WJ, Barr AM, Thornton AE, Gicas KM, Honer WG, Barbic SP. Rasch analysis of the beck depression inventory in a homeless and precariously housed sample. Psychiatry Res 2023; 326:115331. [PMID: 37437487 DOI: 10.1016/j.psychres.2023.115331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/01/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023]
Abstract
The approach to analysis of and interpretation of findings from the Beck Depression Inventory (BDI), a self-report questionnaire, depends on sample characteristics. To extend work using conventional BDI scoring, the BDI's suitability in assessing symptom severity in a homeless and precariously housed sample was examined using Rasch analysis. Participants (n=478) recruited from an impoverished neighbourhood in Vancouver, Canada, completed the BDI. Rasch analysis using the partial credit model was done, and the structural validity, unidimensionality, and reliability of the BDI were studied. A receiver operating characteristic curve determined a Rasch cut-off score consistent with clinical depression, and Rasch scores were correlated with raw scores. Good fit to the Rasch model was observed after rescoring all items and removing Item 19 (Weight Loss), and unidimensionality and reliability were satisfactory. Item 9 (Suicidal Wishes) represented the most severe symptom. Rasch-based scores detected clinical depression with moderate sensitivity and specificity, and were positively correlated with conventional scores. The BDI in a community-based sample of homeless and precariously housed adults satisfied Rasch model expectations in a 20-item format, and is suitable for assessing symptom severity. Future research on depression in similar samples may reveal more information on using specific symptoms to determine clinical significance.
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Affiliation(s)
- Lianne L Cho
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chloe Gao
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325 - 2211 Wesbrook Mall, Vancouver, British Columbia, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna J Lang
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - William J Panenka
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada; Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada; Department of Anesthesia, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Skye P Barbic
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325 - 2211 Wesbrook Mall, Vancouver, British Columbia, Canada.
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Thibaudeau E, Rae J, Raucher-Chéné D, Bougeard A, Lepage M. Disentangling the Relationships Between the Clinical Symptoms of Schizophrenia Spectrum Disorders and Theory of Mind: A Meta-analysis. Schizophr Bull 2023; 49:255-274. [PMID: 36244001 PMCID: PMC10016420 DOI: 10.1093/schbul/sbac150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND HYPOTHESIS Previous studies have suggested links between clinical symptoms and theory of mind (ToM) impairments in schizophrenia spectrum disorders (SSD), but it remains unclear whether some symptoms are more strongly linked to ToM than others. STUDY DESIGN A meta-analysis (Prospero; CRD42021259723) was conducted to quantify and compare the strength of the associations between ToM and the clinical symptoms of SSD (Positive, Negative, Cognitive/Disorganization, Depression/Anxiety, Excitability/Hostility). Studies (N = 130, 137 samples) including people with SSD and reporting a correlation between clinical symptoms and ToM were retrieved from Pubmed, PsycNet, Embase, Cochrane Library, Science Direct, Proquest, WorldCat, and Open Gray. Correlations for each dimension and each symptom were entered into a random-effect model using a Fisher's r-to-z transformation and were compared using focused-tests. Publication bias was assessed with the Rosenthal failsafe and by inspecting the funnel plot and the standardized residual histogram. STUDY RESULTS The Cognitive/Disorganization (Zr = 0.28) and Negative (Zr = 0.24) dimensions revealed a small to moderate association with ToM, which was significantly stronger than the other dimensions. Within the Cognitive/Disorganization dimension, Difficulty in abstract thinking (Zr = 0.36) and Conceptual disorganization (Zr = 0.39) showed the strongest associations with ToM. The association with the Positive dimension (Zr = 0.16) was small and significantly stronger than the relationship with Depression/Anxiety (Zr = 0.09). Stronger associations were observed between ToM and clinical symptoms in younger patients, those with an earlier age at onset of illness and for tasks assessing a combination of different mental states. CONCLUSIONS The relationships between Cognitive/Disorganization, Negative symptoms, and ToM should be considered in treating individuals with SSD.
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Affiliation(s)
- Elisabeth Thibaudeau
- McGill University, Department of Psychiatry, Montreal, Canada
- Douglas Research Centre, Montreal, Canada
| | - Jesse Rae
- Douglas Research Centre, Montreal, Canada
- McGill University, Department of Psychology, Montreal, Canada
| | - Delphine Raucher-Chéné
- McGill University, Department of Psychiatry, Montreal, Canada
- Douglas Research Centre, Montreal, Canada
- Cognition, Health, and Society Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France
- Academic Department of Psychiatry, University Hospital of Reims, EPSM Marne, Reims, France
| | | | - Martin Lepage
- McGill University, Department of Psychiatry, Montreal, Canada
- Douglas Research Centre, Montreal, Canada
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Hoprekstad GE, Kjelby E, Gjestad R, Fathian F, Larsen TK, Reitan SK, Rettenbacher M, Torsvik A, Skrede S, Johnsen E, Kroken RA. Depression trajectories and cytokines in schizophrenia spectrum disorders - A longitudinal observational study. Schizophr Res 2023; 252:77-87. [PMID: 36634451 DOI: 10.1016/j.schres.2022.12.049] [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: 06/23/2022] [Revised: 12/01/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023]
Abstract
Depression occurs frequently in all phases of schizophrenia spectrum disorders. Altered activity in the immune system is seen in both depression and schizophrenia. We aimed to uncover depressive trajectories in a sample of 144 adult individuals with schizophrenia spectrum disorders followed for one year, in order to identify possible cytokine profile differences. Patients were assessed longitudinally with the Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS), where a score above 6 predicts depression. The serum cytokine concentrations for tumor necrosis factor (TNF)-alpha, interferon (IFN)-gamma, interleukin (IL)-1beta, IL-2, IL-4, IL-6, IL-10, IL-12p70 and IL-17A were measured using immunoassays. Latent growth curve models, multilevel models and latent class growth analysis (LCGA) were applied. The LCGA model supported three latent classes (trajectories) with differing CDSS profiles during the one-year follow-up: a high CDSS group (40.8 % of participants), a moderate CDSS group (43.9 %) and a low CDSS group (15.3 %). Five single PANSS items predicted affiliation to depressive trajectory: hallucinations, difficulty in abstract thinking, anxiety, guilt feelings and tension. In the high CDSS group, despite diminishing psychotic symptoms, depressive symptoms persisted throughout one year. The pro-inflammatory cytokines IFN-γ, IL-1β and TNF-α were differentially distributed between the depressive trajectories, although levels remained remarkably stable throughout 12 months. Significant changes were found for the anti-inflammatory cytokine IL-10 at baseline with an accompanying difference in change over time. More research is required to optimize future treatment stratification and investigate the contribution of inflammation in depressed patients with schizophrenia spectrum disorders.
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Affiliation(s)
- Gunnhild E Hoprekstad
- Division of Psychiatry, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Box 1400, 5021 Bergen, Norway.
| | - Eirik Kjelby
- Division of Psychiatry, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Farivar Fathian
- Division of Psychiatry, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
| | - Tor K Larsen
- Department of Clinical Medicine, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; The TIPS-center, Stavanger University Hospital, Stavanger, Norway
| | - Solveig K Reitan
- St. Olav's University Hospital, Department of Mental Health, Trondheim, Norway; Norwegian University of Science and Technology, Department of Mental Health, Trondheim, Norway
| | | | - Anja Torsvik
- Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Silje Skrede
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Section of Clinical Pharmacology, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
| | - Rune A Kroken
- Division of Psychiatry, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
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10
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Buizza C, Strozza C, Sbravati G, de Girolamo G, Ferrari C, Iozzino L, Macis A, Kennedy HG, Candini V. Positive and negative syndrome scale in forensic patients with schizophrenia spectrum disorders: a systematic review and meta-analysis. Ann Gen Psychiatry 2022; 21:36. [PMID: 36088451 PMCID: PMC9463849 DOI: 10.1186/s12991-022-00413-2] [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: 01/12/2022] [Accepted: 06/19/2022] [Indexed: 01/10/2023] Open
Abstract
Among forensic patients with schizophrenia spectrum disorders, the association between symptomatology and violence is still not entirely clear in literature, especially because symptoms shift both during the acute phase of the illness and after. The aims were to investigate the level of symptomatology in forensic patients and to evaluate if there are differences in the level of symptoms between forensic and non-forensic patients. According to PRISMA guidelines, a systematic search was performed in PubMed, Web of Science, and ProQuest, using the following key words: "forensic" AND "Positive and Negative Syndrome Scale" OR "PANSS". A total of 27 studies were included in the systematic review, while only 23 studies in the meta-analysis. The overall sample included a total of 1702 participants, most commonly male and inpatients in forensic settings. We found that studies with an entirely male sample had significantly lower Positive PANSS ratings than studies with mixed samples. Although both forensic and non-forensic patients were affected by mild psychopathological symptoms, forensic patients presented higher ratings in all four PANSS scales. This meta-analysis shows that forensic patients reported a mild level of symptomatology, as assessed with the PANSS, and therefore might be considered as patients in partial remission. Among patients with schizophrenia, the association between symptoms and violence is very complex: many factors might be considered as key mediators and thus should be taken into account to explain this association. Further studies are needed.Trial registration all materials and data can be found on the OSF framework: https://osf.io/5ceja (date of registration: 8 September 2021).
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Affiliation(s)
- Chiara Buizza
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
| | - Cosmo Strozza
- Interdisciplinary Centre On Population Dynamics, University of Southern Denmark, 5000, Odense, Denmark
| | - Giulio Sbravati
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy
| | - Giovanni de Girolamo
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, Brescia, Italy
| | - Laura Iozzino
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy
| | - Ambra Macis
- Service of Statistics, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, Brescia, Italy
| | - Harry G Kennedy
- The National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland.,Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Valentina Candini
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy.
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11
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Bridging the phenomenological gap between predictive basic-symptoms and attenuated positive symptoms: a cross-sectional network analysis. SCHIZOPHRENIA 2022; 8:68. [PMID: 36002447 PMCID: PMC9402628 DOI: 10.1038/s41537-022-00274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 07/22/2022] [Indexed: 11/29/2022]
Abstract
Attenuated positive symptoms (APS), transient psychotic-like symptoms (brief, limited intermittent psychotic symptoms, BLIPS), and predictive cognitive-perceptive basic-symptoms (BS) criteria can help identify a help-seeking population of young people at clinical high-risk of a first episode psychosis (CHRp). Phenomenological, there are substantial differences between BS and APS or BLIPS. BS do not feature psychotic content as delusion or hallucinations, and reality testing is preserved. One fundamental problem in the psychopathology of CHRp is to understand how the non-psychotic BS are related to APS. To explore the interrelationship of APS and predictive BS, we fitted a network analysis to a dataset of 231 patients at CHRp, aged 24.4 years (SD = 5.3) with 65% male. Particular emphasis was placed on points of interaction (bridge symptoms) between the two criteria sets. The BS ‘unstable ideas of reference’ and “inability to discriminate between imagination and reality” interacted with attenuated delusional ideation. Perceptual BS were linked to perceptual APS. Albeit central for the network, predictive cognitive basic BS were relatively isolated from APS. Our analysis provides empirical support for existing theoretical accounts that interaction between the distinct phenomenological domains of BS and APS is characterized by impairments in source monitoring and perspective-taking. Identifying bridge symptoms between the symptom domains holds the potential to empirically advance the etiological understanding of psychosis and pave the way for tailored clinical interventions.
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12
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Psychopharmakologische Zwangsbehandlung im Maßregelvollzug. FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2022. [DOI: 10.1007/s11757-022-00716-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDas nordrhein-westfälische Maßregelvollzugsgesetz regelte in § 17a Abs. 2 bis vor Kurzem die Zwangsbehandlung einwilligungsunfähiger Patienten zur „Erreichung der Entlassfähigkeit“. Bislang ist wenig über die Effekte derartiger Zwangsbehandlungen auf dieses vorgegebene Ziel bekannt. Ziel der Arbeit stellt daher die Evaluation antipsychotischer Zwangsmedikationen bei gem. § 63 StGB Untergebrachten mit einer Erkrankung aus dem schizophrenen Formenkreis dar.Für alle n = 16 in 2019 entsprechend erfolgten Zwangsmedikationen zur Erreichung der Entlassfähigkeit in 3 Maßregelvollzugsklinken des Landschaftsverbands Westfalen-Lippe wurden direkt vor Erstapplikation sowie 4 Wochen und 6 Monate danach mittels Positive and Negative Syndrome Scale (PANSS) bzw. Global Assessment of Functioning (GAF) die psychotische Symptomatik und das Funktionsniveau der Patienten durch die Behandelnden bewertet. Die Erreichung weiterer Behandlungsziele sowie Einschätzungen zur Entlassfähigkeit und eine Gesamtbewertung der Zwangsbehandlung wurden ebenfalls erfragt.Zum ersten Katamnesezeitpunkt ergaben sich eine signifikante Reduktion der PANSS-Faktoren „Positivsymptomatik“ und „erregbar/feindselig“ sowie eine Steigerung des Funktionsniveaus, die sich je leicht abgeschwächt fortsetzten. Auf individueller Ebene zeigte sich nur bei 2 Patienten kein oder ein negativer Effekt. Obwohl die Auswirkungen auf die Behandlungsziele hinter den Erwartungen zurückblieben, bewerteten die Behandler die Maßnahme überwiegend positiv.Zwangsweise verabreichte Antipsychotika können sich günstig auf das Ziel der „Erreichung der Entlassfähigkeit“ auswirken. Insbesondere eingeschränkte Effekte auf Krankheitseinsicht und die Einsicht in die Notwendigkeit der Medikamenteneinnahme zeigen Limitationen auf, die deutlich machen, dass diese Maßnahme allein nicht ausreicht, um die Entlassfähigkeit herzustellen.
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13
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Higuchi CH, Cogo-Moreira H, Fonseca L, Ortiz BB, Correll CU, Noto C, Cordeiro Q, de Freitas R, Elkis H, Belangero SI, Bressan RA, Gadelha A. Identifying strategies to improve PANSS based dimensional models in schizophrenia: Accounting for multilevel structure, Bayesian model and clinical staging. Schizophr Res 2022; 243:424-430. [PMID: 34304964 DOI: 10.1016/j.schres.2021.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/10/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dimensional approaches can decompose a construct in a set of continuous variables, improving the characterization of complex phenotypes, such as schizophrenia. However, the five-factor model of the Positive and Negative Syndrome Scale (PANSS), the most used instrument in schizophrenia research, yielded poor fits in most confirmatory factor analysis (CFA) studies, raising concerns about its applications. Thus, we aimed to identify dimensional PANSS CFA models with good psychometric properties by comparing the traditional CFA with three methodological approaches: Bayesian CFA, multilevel modeling, and Multiple Indicators Multiple Causes (MIMIC) modeling. METHODS Clinical data of 700 schizophrenia patients from four centers were analyzed. We first performed a traditional CFA. Next, we tested the three techniques: 1) a Bayesian CFA; 2) a multilevel analysis using the centers as level; and 3) a MIMIC modeling to evaluate the impact of clinical staging on PANSS factors and items. RESULTS CFA and Bayesian CFA produced poor fit models. However, when adding a multilevel structure to the CFA model, a good fit model emerged. MIMIC modeling yielded significant differences in the factor structure between the clinical stages of schizophrenia. Sex, age, age of onset, and duration of illness did not significantly affect the model fit. CONCLUSION Our comparison of different CFA methods highlights the need for multilevel structure to achieve a good fit model and the potential utility of staging models (rather than the duration of illness) to deal with clinical heterogeneity in schizophrenia. Large prospective samples with biological data should help to understand the interplay between psychometrics concerns and neurobiology research.
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Affiliation(s)
- Cinthia H Higuchi
- Laboratory of Integrative Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo, SP, Brazil; Programa de Esquizofrenia da Universidade Federal de São Paulo (PROESQ), SP, Brazil
| | | | - Lais Fonseca
- Laboratory of Integrative Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo, SP, Brazil; Programa de Esquizofrenia da Universidade Federal de São Paulo (PROESQ), SP, Brazil
| | - Bruno B Ortiz
- Laboratory of Integrative Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo, SP, Brazil; Programa de Esquizofrenia da Universidade Federal de São Paulo (PROESQ), SP, Brazil
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Glen Oaks, NY, USA; Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Cristiano Noto
- Laboratory of Integrative Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo, SP, Brazil; Programa de Esquizofrenia da Universidade Federal de São Paulo (PROESQ), SP, Brazil
| | - Quirino Cordeiro
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, SP, Brazil
| | - Rosana de Freitas
- Schizophrenia Research Program (PROJESQ), Department and Institute of Psychiatry, Universidade de São Paulo (USP), SP, Brazil
| | - Helio Elkis
- Schizophrenia Research Program (PROJESQ), Department and Institute of Psychiatry, Universidade de São Paulo (USP), SP, Brazil
| | - Sintia I Belangero
- Laboratory of Integrative Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo, SP, Brazil; Department of Morphology and Genetics, Universidade Federal de São Paulo, SP, Brazil
| | - Rodrigo A Bressan
- Laboratory of Integrative Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo, SP, Brazil; Programa de Esquizofrenia da Universidade Federal de São Paulo (PROESQ), SP, Brazil; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ary Gadelha
- Laboratory of Integrative Neuroscience (LiNC), Department of Psychiatry, Universidade Federal de São Paulo, SP, Brazil; Programa de Esquizofrenia da Universidade Federal de São Paulo (PROESQ), SP, Brazil.
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14
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Kagan S, Cogo-Moreira H, Barbosa MG, Cavalcante D, Shinji A, Noto M, Haguiara B, Cordeiro Q, Belangeiro S, Bressan RA, Noto C, Gadelha A. Longitudinal invariance of the positive and negative syndrome scale negative dimension in antipsychotic naïve first-episode schizophrenia. Early Interv Psychiatry 2022; 16:581-586. [PMID: 34265870 DOI: 10.1111/eip.13200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/29/2021] [Accepted: 07/04/2021] [Indexed: 11/29/2022]
Abstract
AIM Construct stability over time is required for reliable inference, but evidence regarding the longitudinal invariance of negative symptoms is still limited. Thus, we examined the longitudinal invariance of the negative dimension using the positive and negative syndrome scale (PANSS) in an antipsychotic-naïve first-episode schizophrenia sample at baseline and after 10 weeks. METHODS Our study was conducted at a specialized early intervention service. PANSS ratings were analysed for 138 patients, and two different models were specified and tested: a unidimensional and a two-correlated factor solution. RESULTS The unidimensional model fulfilled criteria for longitudinal invariance, whilst the two-correlated did not. CONCLUSION Our study provides support for the PANSS negative unidimensional model use to evaluate negative symptoms' longitudinal change following first-episode schizophrenia.
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Affiliation(s)
- Simão Kagan
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Hugo Cogo-Moreira
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil
| | - Matheus Ghossain Barbosa
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil
| | - Daniel Cavalcante
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Early Psychosis Group (GAPI), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - André Shinji
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Early Psychosis Group (GAPI), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Mariane Noto
- Early Psychosis Group (GAPI), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Bernardo Haguiara
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Quirino Cordeiro
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil
| | - Sintia Belangeiro
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Department of Morphology and Genetics, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Rodrigo A Bressan
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.,Center for Research and Innovation in Prevention of Mental Disorders and Drug Use (CEPIPREV), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Cristiano Noto
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.,Early Psychosis Group (GAPI), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.,Center for Research and Innovation in Prevention of Mental Disorders and Drug Use (CEPIPREV), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Ary Gadelha
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.,Early Psychosis Group (GAPI), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.,Center for Research and Innovation in Prevention of Mental Disorders and Drug Use (CEPIPREV), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
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15
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Demyttenaere K, Leenaerts N, Acsai K, Sebe B, Laszlovszky I, Barabássy Á, Fonticoli L, Szatmári B, Earley W, Németh G, Correll CU. Disentangling the symptoms of schizophrenia: Network analysis in acute phase patients and in patients with predominant negative symptoms. Eur Psychiatry 2021; 65:e18. [PMID: 34641986 PMCID: PMC8926909 DOI: 10.1192/j.eurpsy.2021.2241] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The Positive and Negative Syndrome Scale (PANSS) is widely used in schizophrenia and has been divided into distinct factors (5-factor models) and subfactors. Network analyses are newer in psychiatry and can help to better understand the relationships and interactions between the symptoms of a psychiatric disorder. The aim of this study was threefold: (a) to evaluate connections between schizophrenia symptoms in two populations of patients (patients in the acutely exacerbated phase of schizophrenia and patients with predominant negative symptoms [PNS]), (b) to test whether network analyses support the Mohr 5 factor model of the PANSS and the Kahn 2 factor model of negative symptoms, and finally (c) to identify the most central symptoms in the two populations. Methods Using pooled baseline data from four cariprazine clinical trials in patients with acute exacerbation of schizophrenia (n = 2193) and the cariprazine–risperidone study in patients with PNS (n = 460), separate network analyses were performed. Network structures were estimated for all 30 items of the PANSS. Results While negative symptoms in patients with an acute exacerbation of schizophrenia are correlated with other PANSS symptoms, these negative symptoms are not correlated with other PANSS symptoms in patients with PNS. The Mohr factors were partially reflected in the network analyses. The two most central symptoms (largest node strength) were delusions and uncooperativeness in acute phase patients and hostility and delusions in patients with PNS. Conclusions This network analysis suggests that symptoms of schizophrenia are differently structured in acute and PNS patients. While in the former, negative symptoms are mainly secondary, in patients with PNS, they are mainly primary. Further, primary negative symptoms are better conceptualized as distinct negative symptom dimensions of the PANSS.
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Affiliation(s)
- Koen Demyttenaere
- University of Leuven, Faculty of Medicine, Department of Neurosciences, Psychiatry Research Group and University Psychiatric Center KU Leuven, Belgium.,University Psychiatric Center KU Leuven, Belgium
| | | | - Károly Acsai
- Gedeon Richter Plc., Medical Division, Budapest, Hungary
| | - Barbara Sebe
- Gedeon Richter Plc., Medical Division, Budapest, Hungary
| | | | | | | | | | | | - György Németh
- Gedeon Richter Plc., Medical Division, Budapest, Hungary
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA.,Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
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16
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The Relationship between Negative Symptoms and Both Emotion Management and Non-social Cognition in Schizophrenia Spectrum Disorders. J Int Neuropsychol Soc 2021; 27:916-928. [PMID: 33342446 DOI: 10.1017/s1355617720001290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE There is ongoing debate regarding the relationship between clinical symptoms and cognition in schizophrenia spectrum disorders (SSD). The present study aimed to explore the potential relationships between symptoms, with an emphasis on negative symptoms, and social and non-social cognition. METHOD Hierarchical cluster analysis with k-means optimisation was conducted to characterise clinical subgroups using the Scale for the Assessment of Negative Symptoms and Scale for the Assessment of Positive Symptoms in n = 130 SSD participants. Emergent clusters were compared on the MATRICS Consensus Cognitive Battery, which measures non-social cognition and emotion management as well as demographic and clinical variables. Spearman's correlations were then used to investigate potential relationships between specific negative symptoms and emotion management and non-social cognition. RESULTS Four distinct clinical subgroups were identified: 1. high hallucinations, 2. mixed symptoms, 3. high negative symptoms, and 4. relatively asymptomatic. The high negative symptom subgroup was found to have significantly poorer emotion management than the high hallucination and relatively asymptomatic subgroups. No further differences between subgroups were observed. Correlation analyses revealed avolition-apathy and anhedonia-asociality were negatively correlated with emotion management, but not non-social cognition. Affective flattening and alogia were not associated with either emotion management or non-social cognition. CONCLUSIONS The present study identified associations between negative symptoms and emotion management within social cognition, but no domains of non-social cognition. This relationship may be specific to motivation, anhedonia and apathy, but not expressive deficits. This suggests that targeted interventions for social cognition may also result in parallel improvement in some specific negative symptoms.
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17
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Borgan F, Veronese M, Reis Marques T, Lythgoe DJ, Howes O. Association between cannabinoid 1 receptor availability and glutamate levels in healthy controls and drug-free patients with first episode psychosis: a multi-modal PET and 1H-MRS study. Eur Arch Psychiatry Clin Neurosci 2021; 271:677-687. [PMID: 32986150 PMCID: PMC8119269 DOI: 10.1007/s00406-020-01191-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/20/2020] [Indexed: 12/16/2022]
Abstract
Cannabinoid 1 receptor and glutamatergic dysfunction have both been implicated in the pathophysiology of schizophrenia. However, it remains unclear if cannabinoid 1 receptor alterations shown in drug-naïve/free patients with first episode psychosis may be linked to glutamatergic alterations in the illness. We aimed to investigate glutamate levels and cannabinoid 1 receptor levels in the same region in patients with first episode psychosis. Forty volunteers (20 healthy volunteers, 20 drug-naïve/free patients with first episode psychosis diagnosed with schizophrenia/schizoaffective disorder) were included in the study. Glutamate levels were measured using proton magnetic resonance spectroscopy. CB1R availability was indexed using the distribution volume (VT (ml/cm3)) of [11C]MePPEP using arterial blood sampling. There were no significant associations between ACC CB1R levels and ACC glutamate levels in controls (R = - 0.24, p = 0.32) or patients (R = - 0.10, p = 0.25). However, ACC glutamate levels were negatively associated with CB1R availability in the striatum (R = - 0.50, p = 0.02) and hippocampus (R = - 0.50, p = 0.042) in controls, but these associations were not observed in patients (p > 0.05). Our findings extend our previous work in an overlapping sample to show, for the first time as far as we're aware, that cannabinoid 1 receptor alterations in the anterior cingulate cortex are shown in the absence of glutamatergic dysfunction in the same region, and indicate potential interactions between glutamatergic signalling in the anterior cingulate cortex and the endocannabinoid system in the striatum and hippocampus.
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Affiliation(s)
- Faith Borgan
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England.
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK.
| | - Mattia Veronese
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Tiago Reis Marques
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
| | - David J Lythgoe
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Oliver Howes
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
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18
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Smith EL, Garety PA, Harding H, Hardy A. Are there reliable and valid measures of anxiety for people with psychosis? A systematic review of psychometric properties. Psychol Psychother 2021; 94:173-198. [PMID: 31880406 DOI: 10.1111/papt.12265] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 12/03/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Current models of psychosis posit a developmental and maintaining role for anxiety, supported by robust empirical evidence. Given the central role for anxiety in psychosis, valid and reliable assessment is necessary. This systematic review is the first to critically appraise measures of anxiety applied to psychosis samples. METHODS Web of Science, MEDLINE, PsycINFO, EMBASE, and CINAHL were systematically searched for studies evaluating psychometric properties of instruments measuring anxiety in samples with non-affective psychosis diagnoses. Psychometric properties were extracted and rated according to established criteria. The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist was used to assess the methodological quality of studies. RESULTS Of 4,344 records identified, 11 studies were identified as eligible for inclusion, by two independent raters with high reliability. Reported psychometric properties for 17 different instruments ranged from unacceptable to excellent. The Scale of Anxiety Evaluation in Schizophrenia was assessed most extensively and demonstrated consistently good psychometric properties. The Beck Anxiety Index, Depression Anxiety Stress Scale, DSM-based Generalised Anxiety Disorder Symptoms Severity Scale, Liebowitz Social Anxiety Scale, Obsessive-Compulsive Inventory, Psychological Stress Index, Perseverative Thinking Questionnaire, and Yale-Brown Obsessive Compulsive Scale demonstrated adequate reliability and/or validity on the limited properties reported. Methodological quality was largely poor according to the requirements of the COSMIN checklist. CONCLUSIONS The instruments listed are recommended as at least adequate for the assessment of anxiety in psychosis on the basis of these preliminary data. Further validation of existing instruments designed to measure anxiety in people with psychosis is strongly recommended. PRACTITIONER POINTS Anxiety has a developmental and maintaining role in psychosis; therefore, we should routinely screen for symptoms of anxiety when working with people with psychosis spectrum disorders. Studies included in this review reported reliable and valid measures of anxiety for people with psychosis; however, the methodological quality of most studies was poor. We recommend the BAI, DASS, or SAES for general screening, and the DGSS, LSAS, OCI, PSI, PTQ, and Y-BOCS to assess symptoms associated with specific anxiety disorders and anxiety-related processes.
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Affiliation(s)
- Emma L Smith
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,Headroom: Youth Psychosis Service, Cardiff and Vale University Health Board, UK
| | - Philippa A Garety
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, UK
| | - Helen Harding
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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19
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Afshari B, Shiri N, Ghoreishi FS, Valianpour M. Examination and Comparison of Cognitive and Executive Functions in Clinically Stable Schizophrenia Disorder, Bipolar Disorder, and Major Depressive Disorder. DEPRESSION RESEARCH AND TREATMENT 2020; 2020:2543541. [PMID: 33414961 PMCID: PMC7752301 DOI: 10.1155/2020/2543541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 11/29/2020] [Accepted: 12/10/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Schizophrenia (SC), bipolar disorder (BD), and major depressive disorder (MDD) are associated with various cognitive and executive dysfunctions. The aim of the present study was to evaluate and compare cognitive and executive dysfunctions in schizophrenia, bipolar disorder, and major depressive disorder. MATERIALS AND METHODS Sixty-four schizophrenia patients, 68 bipolar patients, 62 patients with major depressive disorder, and 75 healthy individuals participated in the present study. All participants were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Young Mania Rating Scale (YMRS), Positive and Negative Syndrome Scale (PANSS), Beck Depression Inventory (BDI-II), Trial Making Test (TMT), Four-Choice Reaction Time Task, Ruler Drop Method (RDM), Tower of London (TOL) task, and the Wisconsin Card Sorting Task (WCST). Data were analyzed by chi-square, Kolmogorov-Smirnov, and independent t-tests; ANOVA; and MANOVA. RESULTS In the cognitive function, the scores of SC, BD, and MDD patients were lower than those of healthy individuals. Also, the scores of MDD patients were lower than those of other patients, and the scores of BD patients were lower than those of SC patients. In the executive function, the scores of SC, BD, and MDD patients were lower than those of healthy individuals. Moreover, the scores of the MDD group were higher than those of the BD and SC groups, and the scores of the SC group were higher than those of the BD group. CONCLUSION Patients with SC, BD, and MDD have poorer cognitive and executive functions than healthy individuals, even when these patients are in a stable state. Assessment of cognitive and executive functions in SC, BD, and MDD patients can help in understanding the pathology of these disorders.
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Affiliation(s)
| | - Nasrin Shiri
- Kashan University of Medical Science, Kashan, Iran
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20
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Clark SV, Tannahill A, Calhoun VD, Bernard JA, Bustillo J, Turner JA. Weaker Cerebellocortical Connectivity Within Sensorimotor and Executive Networks in Schizophrenia Compared to Healthy Controls: Relationships with Processing Speed. Brain Connect 2020; 10:490-503. [PMID: 32893675 PMCID: PMC7699013 DOI: 10.1089/brain.2020.0792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The cognitive dysmetria theory of schizophrenia proposes that communication between the cerebellum and cerebral cortex is disrupted by structural and functional abnormalities, resulting in psychotic symptoms and cognitive deficits. Methods: Using publicly available data, resting-state functional connectivity (rsFC) was calculated from 20 hemispheric cerebellar lobules as seed regions of interest to the rest of the brain. Group differences in rsFC between individuals with schizophrenia (SZ) and healthy controls (HCs) were computed, and relationships between rsFC and symptom severity and cognitive functioning were explored. Results: HCs demonstrated stronger connectivity than SZ between several cerebellar lobules and cortical regions, most robustly between motor-related cerebellar lobules (V and VIIIa/b) and temporal and parietal cortices. In addition, seven of nine lobules in which reduced cerebellocortical connectivity was observed showed diagnosis × processing speed interactions; HC showed a positive relationship between connectivity and processing speed, whereas SZ did not show this relationship. Other cognitive domains and symptom severity did not show relationships with connectivity. Conclusions: These findings partially support the cognitive dysmetria theory, and suggest that disrupted cerebellocortical connectivity is associated with slowed processing speed in schizophrenia. Impact statement We show in this work that in chronic schizophrenia, there is weaker functional connectivity between previously unstudied inferior posterior cerebellar lobules and cortical association areas. These findings align and extend previous work showing abnormal connectivity of anterior cerebellar lobules. Further, we present a novel finding that these connectivity deficits are differentially associated with processing speed in the schizophrenia versus healthy control groups. Findings provide further evidence for cerebellocortical dysconnectivity and processing speed deficits as biomarkers of schizophrenia, which may have implications for downstream effects on higher order cognitive functions, in line with the cognitive dysmetria theory.
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Affiliation(s)
- Sarah V. Clark
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Amber Tannahill
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Vince D. Calhoun
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
- Department of Neuroscience, Georgia State University, Atlanta, Georgia, USA
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, USA
- Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico, USA
- The Mind Research Network, Albuquerque, New Mexico, USA
| | - Jessica A. Bernard
- Department of Psychological and Brain Sciences and Texas A&M Institute for Neuroscience, Texas A&M University, College Station, Texas, USA
| | - Juan Bustillo
- Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jessica A. Turner
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
- Department of Neuroscience, Georgia State University, Atlanta, Georgia, USA
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, USA
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21
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Watts JJ, Jacobson MR, Lalang N, Boileau I, Tyndale RF, Kiang M, Ross RA, Houle S, Wilson AA, Rusjan P, Mizrahi R. Imaging Brain Fatty Acid Amide Hydrolase in Untreated Patients With Psychosis. Biol Psychiatry 2020; 88:727-735. [PMID: 32387132 PMCID: PMC8240477 DOI: 10.1016/j.biopsych.2020.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/01/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The brain's endocannabinoid system, the primary target of cannabis, has been implicated in psychosis. The endocannabinoid anandamide is elevated in cerebrospinal fluid of patients with schizophrenia. Fatty acid amide hydrolase (FAAH) controls brain anandamide levels; however, it is unknown if FAAH is altered in vivo in psychosis or related to positive psychotic symptoms. METHODS Twenty-seven patients with schizophrenia spectrum disorders and 36 healthy control subjects completed high-resolution positron emission tomography scans with the novel FAAH radioligand [11C]CURB and structural magnetic resonance imaging. Data were analyzed using the validated irreversible 2-tissue compartment model with a metabolite-corrected arterial input function. RESULTS FAAH did not differ significantly between patients with psychotic disorders and healthy control subjects (F1,62.85 = 0.48, p = .49). In contrast, lower FAAH predicted greater positive psychotic symptom severity, with the strongest effect observed for the positive symptom dimension, which includes suspiciousness, delusions, unusual thought content, and hallucinations (F1,26.69 = 12.42, p = .002; Cohen's f = 0.42, large effect). Shorter duration of illness (F1,26.95 = 13.78, p = .001; Cohen's f = 0.39, medium to large effect) and duration of untreated psychosis predicted lower FAAH (F1,26.95 = 6.03, p = .021, Cohen's f = 0.27, medium effect). These results were not explained by past cannabis exposure or current intake of antipsychotic medications. FAAH exhibited marked differences across brain regions (F7,112.62 = 175.85, p < 1 × 10-56; Cohen's f > 1). Overall, FAAH was higher in female subjects than in male subjects (F1,62.84 = 10.05, p = .002; Cohen's f = 0.37). CONCLUSIONS This first study of brain FAAH in psychosis indicates that FAAH may represent a biomarker of disease state of potential utility for clinical studies targeting psychotic symptoms or as a novel target for interventions to treat psychotic symptoms.
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Affiliation(s)
- Jeremy J Watts
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Maya R Jacobson
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Nittha Lalang
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Isabelle Boileau
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rachel F Tyndale
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michael Kiang
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ruth A Ross
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Sylvain Houle
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alan A Wilson
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Pablo Rusjan
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Romina Mizrahi
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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22
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Tronchin G, Akudjedu TN, Kenney JP, McInerney S, Scanlon C, McFarland J, McCarthy P, Cannon DM, Hallahan B, McDonald C. Cognitive and Clinical Predictors of Prefrontal Cortical Thickness Change Following First-Episode of Psychosis. Psychiatry Res Neuroimaging 2020; 302:111100. [PMID: 32464535 DOI: 10.1016/j.pscychresns.2020.111100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022]
Abstract
The association of neuroanatomical progression with cognitive and clinical deterioration after first-episode of psychosis remains uncertain. This longitudinal study aims to assess whether i)impaired executive functioning and emotional intelligence at first presentation are associated with progressive prefrontal and orbitofrontal cortical thinning ii)negative symptom severity is linked to progressive prefrontal cortical thinning. 1.5T MRI images were acquired at baseline and after 3.5 years for 20 individuals with first-episode psychosis and 18 controls. The longitudinal pipeline of Freesurfer was employed to parcellate prefrontal cortex at two time points. Baseline cognitive performance was compared between diagnostic groups using MANCOVA. Partial correlations investigated relationships between cognition and negative symptoms at baseline and cortical thickness change over time. Patients displayed poorer performance than controls at baseline in working memory, reasoning/problem solving and emotional intelligence. In patients, loss of prefrontal and orbitofrontal thickness over time was predicted by impaired working memory and emotional intelligence respectively at baseline. Moreover, exploratory analyses revealed that the worsening of negative symptoms over time was significantly related to prefrontal cortical thinning. Results indicate that specific cognitive deficits at the onset of psychotic illness are markers of progressive neuroanatomical deficits and that worsening of negative symptoms occurs with prefrontal thickness reduction as the illness progresses.
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Affiliation(s)
- Giulia Tronchin
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland.
| | - Theophilus N Akudjedu
- Faculty of Health & Social Science, Institute of Medical Imaging & Visualisation, Bournemouth University, Bournemouth, United Kingdom
| | - Joanne Pm Kenney
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Shane McInerney
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - Cathy Scanlon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - John McFarland
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - Peter McCarthy
- Department of Radiology, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Dara M Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - Brian Hallahan
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland
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23
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Chen J, Patil KR, Weis S, Sim K, Nickl-Jockschat T, Zhou J, Aleman A, Sommer IE, Liemburg EJ, Hoffstaedter F, Habel U, Derntl B, Liu X, Fischer JM, Kogler L, Regenbogen C, Diwadkar VA, Stanley JA, Riedl V, Jardri R, Gruber O, Sotiras A, Davatzikos C, Eickhoff SB. Neurobiological Divergence of the Positive and Negative Schizophrenia Subtypes Identified on a New Factor Structure of Psychopathology Using Non-negative Factorization: An International Machine Learning Study. Biol Psychiatry 2020; 87:282-293. [PMID: 31748126 PMCID: PMC6946875 DOI: 10.1016/j.biopsych.2019.08.031] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/22/2019] [Accepted: 08/31/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Disentangling psychopathological heterogeneity in schizophrenia is challenging, and previous results remain inconclusive. We employed advanced machine learning to identify a stable and generalizable factorization of the Positive and Negative Syndrome Scale and used it to identify psychopathological subtypes as well as their neurobiological differentiations. METHODS Positive and Negative Syndrome Scale data from the Pharmacotherapy Monitoring and Outcome Survey cohort (1545 patients; 586 followed up after 1.35 ± 0.70 years) were used for learning the factor structure by an orthonormal projective non-negative factorization. An international sample, pooled from 9 medical centers across Europe, the United States, and Asia (490 patients), was used for validation. Patients were clustered into psychopathological subtypes based on the identified factor structure, and the neurobiological divergence between the subtypes was assessed by classification analysis on functional magnetic resonance imaging connectivity patterns. RESULTS A 4-factor structure representing negative, positive, affective, and cognitive symptoms was identified as the most stable and generalizable representation of psychopathology. It showed higher internal consistency than the original Positive and Negative Syndrome Scale subscales and previously proposed factor models. Based on this representation, the positive-negative dichotomy was confirmed as the (only) robust psychopathological subtypes, and these subtypes were longitudinally stable in about 80% of the repeatedly assessed patients. Finally, the individual subtype could be predicted with good accuracy from functional connectivity profiles of the ventromedial frontal cortex, temporoparietal junction, and precuneus. CONCLUSIONS Machine learning applied to multisite data with cross-validation yielded a factorization generalizable across populations and medical systems. Together with subtyping and the demonstrated ability to predict subtype membership from neuroimaging data, this work further disentangles the heterogeneity in schizophrenia.
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Affiliation(s)
- Ji Chen
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Kaustubh R Patil
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Susanne Weis
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Kang Sim
- Department of General Psychiatry, Institute of Mental Health, Singapore; Research Division, Institute of Mental Health, Singapore
| | - Thomas Nickl-Jockschat
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, Iowa; Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Juan Zhou
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Medical School, Singapore
| | - André Aleman
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Iris E Sommer
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Edith J Liemburg
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Felix Hoffstaedter
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany; Jülich Aachen Research Alliance-Institute Brain Structure Function Relationship, Research Center Jülich, and RWTH Aachen University, Aachen, Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Xiaojin Liu
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jona M Fischer
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Lydia Kogler
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Christina Regenbogen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany; Jülich Aachen Research Alliance-Institute Brain Structure Function Relationship, Research Center Jülich, and RWTH Aachen University, Aachen, Germany
| | - Vaibhav A Diwadkar
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University, Detroit, Michigan
| | - Jeffrey A Stanley
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University, Detroit, Michigan
| | - Valentin Riedl
- Department of Neuroradiology, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Renaud Jardri
- University of Lille, National Centre for Scientific Research, UMR 9193, SCALab and CHU Lille, Fontan Hospital, CURE platform, Lille, France
| | - Oliver Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Aristeidis Sotiras
- Department of Radiology and Institute for Informatics, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, Section of Biomedical Image Analysis, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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24
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The Prevalence and Correlates of Social Anxiety Symptoms among People with Schizophrenia in Ethiopia: An Institution-Based Cross-Sectional Study. SCHIZOPHRENIA RESEARCH AND TREATMENT 2020; 2020:3934680. [PMID: 32274213 PMCID: PMC7132590 DOI: 10.1155/2020/3934680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/26/2020] [Accepted: 03/12/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The comorbidity of social anxiety disorder is very common in schizophrenia patients and affects almost all age groups. This social anxiety disorder negatively impacts the quality of life, medication adherence, and treatment outcomes of people with schizophrenia. It is not well recognized in clinical settings. Therefore, assessing social anxiety symptoms and its associated factors was significant to early intervention and management of schizophrenia patients in Ethiopia. METHODS An institution-based cross-sectional study was conducted at Amanuel Mental Specialized Hospital in Addis Ababa, Ethiopia. Data collectors randomly recruited 423 schizophrenic patients by using the systematic sampling technique. A face-to-face interviewer-administered questionnaire was used to collect data. The standardized Liebowitz Social Anxiety Scale (LSAS) was employed to assess individual social anxiety symptoms. We computed bivariate and multivariate binary logistic regressions to identify factors associated with social anxiety symptoms. Statistical significance was declared at p < 0.05. RESULTS The prevalence of social anxiety symptoms was 36.2% (95% CI: 31.50, 40.80). Male sex (AOR = 2.03, 95% CI: 1.20, 3.44), age of onset of schizophrenia (AOR = 1.91, 95% CI:1.17, 3.12), positive symptoms (AOR = 0.75, 95% CI:0.67, 0.83), depression/anxiety symptoms (AOR = 1.29, 95% CI: 1.18, 1.41), number of hospitalizations (AOR = 2.80, 95% CI:1.32, 5.80), and suicidal ideation (AOR = 0.44, 95% CI: 0.26, 0.74) were factors significantly associated with social anxiety symptoms at p < 0.05. p < 0.05. CONCLUSION The prevalence of social anxiety symptoms among schizophrenia patients was found to be high. Timely treatment of positive and depression/anxiety symptoms and suicide risk assessments and interventions need to be done to manage the problems.
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25
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Pothier W, Cellard C, Corbière M, Villotti P, Achim AM, Lavoie A, Turcotte M, Vallières C, Roy MA. Determinants of occupational outcome in recent-onset psychosis: The role of cognition. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 18:100158. [PMID: 31463205 PMCID: PMC6710235 DOI: 10.1016/j.scog.2019.100158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 01/18/2023]
Abstract
Working or studying is a common goal among people with recent-onset psychosis. Cognitive deficits have been reported to influence occupational outcome, but to date few studies have evaluated if cognitive deficits independently predict occupational outcome when taking into account other important determinants, such as self-esteem, motivation, length of time absent from employment/school, job/school search behaviours, subjective cognitive complaints and psychotic symptoms. Hence, this longitudinal study aimed to evaluate the role of cognition, as well as other key factors relevant to occupational outcome, to predict occupational status six months after baseline in people with recent-onset psychosis. A total of 27 participants receiving treatment in rehabilitation programs were included in the study. Neuropsychological, psychological, clinical and occupational measures were administered at baseline, and occupational status was collected six months later. Ordinal regression indicated that working memory and length of time absent from employment/school at baseline predicted 48.1% of the variance of occupational status at six months, with both variables showing a unique significant contribution to the model. These results suggest that working memory could be integrated in comprehensive models of occupational outcome in people with recent-onset psychosis. In addition, supported employment and education programs could target cognitive deficits and length of time absent from employment/school to help these individuals to acquire a job or return to school given their strong predictive value on occupational outcome.
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Affiliation(s)
- William Pothier
- École de psychologie de l'Université Laval, 2325 Allée des Bibliothèques, G1V 0A6 Québec, Canada.,Centre de recherche CERVO, 2601 Chemin de la Canardière, G1J 2G3 Québec, Canada
| | - Caroline Cellard
- École de psychologie de l'Université Laval, 2325 Allée des Bibliothèques, G1V 0A6 Québec, Canada.,Centre de recherche CERVO, 2601 Chemin de la Canardière, G1J 2G3 Québec, Canada
| | - Marc Corbière
- Université du Québec à Montréal (UQÀM), 405 Rue Sainte-Catherine Est, H2L 2C4, Montréal, Canada.,Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7401 Rue Hochelaga, Pavillon Riel, Aile 228, H1N 3M5 Montréal, Canada
| | - Patrizia Villotti
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7401 Rue Hochelaga, Pavillon Riel, Aile 228, H1N 3M5 Montréal, Canada
| | - Amélie M Achim
- Centre de recherche CERVO, 2601 Chemin de la Canardière, G1J 2G3 Québec, Canada
| | - Andréanne Lavoie
- École de psychologie de l'Université Laval, 2325 Allée des Bibliothèques, G1V 0A6 Québec, Canada.,Centre de recherche CERVO, 2601 Chemin de la Canardière, G1J 2G3 Québec, Canada
| | - Mélissa Turcotte
- École de psychologie de l'Université Laval, 2325 Allée des Bibliothèques, G1V 0A6 Québec, Canada.,Centre de recherche CERVO, 2601 Chemin de la Canardière, G1J 2G3 Québec, Canada
| | - Chantal Vallières
- Centre de recherche CERVO, 2601 Chemin de la Canardière, G1J 2G3 Québec, Canada
| | - Marc-André Roy
- Centre de recherche CERVO, 2601 Chemin de la Canardière, G1J 2G3 Québec, Canada.,Département de psychiatrie et neurosciences de l'Université Laval, 1050 avenue de la Médecine, G1V 0A6 Québec, Canada
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26
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Shafer A, Dazzi F. Meta-analysis of the positive and Negative Syndrome Scale (PANSS) factor structure. J Psychiatr Res 2019; 115:113-120. [PMID: 31128501 DOI: 10.1016/j.jpsychires.2019.05.008] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/05/2019] [Accepted: 05/09/2019] [Indexed: 11/16/2022]
Abstract
A meta-analysis of the results of 45 factor analyses (n = 22,812) of the Positive and Negative Syndrome Scale (PANSS) was conducted. Meta-analyses of the PANSS was conducted using both a co-occurrence similarity matrix and reproduced correlations. Both methods produced similar results. Five factors (Positive Symptoms, Negative Symptoms, Disorganization, Affect and Resistance) emerged clearly across both analyses. The factors and the items defining them were Positive Symptoms (P1 Delusions, G9 Unusual thought content, P3 Hallucinatory behavior, P6 Suspiciousness and persecution, P5 Grandiosity), Negative Symptoms (N2 Emotional withdrawal, N1 Blunted affect, N4 Passive apathetic social withdrawal, N6 Lack of spontaneity, N3 Poor rapport, G7 Motor retardation, G16 Active social avoidance), Disorganization often termed Cognitive (P2 Conceptual disorganization, G11 Poor attention, N5 Difficulty in abstract thinking, G13 Disturbance of volition, N7 Stereotyped thinking, G5 Mannerisms/posturing, G15 Preoccupation, G10 Disorientation), Affect often termed Depression-Anxiety (G2 Anxiety, G6 Depression, G3 Guilt feelings, G4 Tension, G1 Somatic concern) and a small fifth factor that might be characterized as Resistance or Excitement/Activity (P7 Hostility, G14 Poor impulse control, P4 Excitement, G8 Uncooperativeness). Items G1, G4, G10, P5, G5, G15 may not be core items for the PANSS factors and G12 lack of judgment is not a core item. Results of the PANSS meta-analyses were relatively similar to those for meta-analysis of both the BPRS and BPRS-E all of which contain the original 18 BPRS items. The PANSS is distinguished by a much larger number of items to clearly define and measure Negative Symptoms as well as a sufficient number of items to much more clearly identify a Disorganization factor than the BPRS or BPRS-E.
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Affiliation(s)
| | - Federico Dazzi
- Department of Human Sciences, Lumsa University, Rome, Italy
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Seow LSE, Tan THG, Abdin E, Chong SA, Subramaniam M. Comparing disease-specific and generic quality of life measures in patients with schizophrenia. Psychiatry Res 2019; 273:387-393. [PMID: 30682561 DOI: 10.1016/j.psychres.2019.01.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/12/2022]
Abstract
The current study aimed to compare the use of a disease-specific and a generic quality of life (QOL) measure in a group 251 outpatients with a schizophrenia spectrum disorder by examining their relationships with symptoms of schizophrenia, psychiatric and medical comorbidities, and other factors, as well as to determine which of these factors will be associated with the measurement discrepancy between the two measures. QOL was assessed with the generic Healthy Utility Index Mark 3 (HUI3) and disease-specific Schizophrenia Quality of Life Scale (SQLS), and symptom severity was determined using the Positive and Negative Syndrome Scale (PANSS). Symptom severity predicted both SQLS and HUI3, while psychiatric comorbidity predicted only the HUI3. Ethnicity, employment and PANSS depression factor were significantly associated with the measurement discrepancy. Using domain scores of the two QOL measures, the HUI3 appears to be superior in discriminating PANSS cognitive factor scores and medical comorbidity status compared to SQLS. Although the use of disease-specific QOL is generally preferred to track treatment progress in clinical settings, the two types of instruments measure non-overlapping aspects of QOL and the generic scales may better reflect QOL impairment due to overall clinical presentation.
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Affiliation(s)
- Lee Seng Esmond Seow
- Research Division, Institute of Mental Health, Singapore, Buangkok Green Medical Park, 10 Buangkok View, Singapore.
| | - Tee Hng Gregory Tan
- Research Division, Institute of Mental Health, Singapore, Buangkok Green Medical Park, 10 Buangkok View, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Buangkok Green Medical Park, 10 Buangkok View, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Buangkok Green Medical Park, 10 Buangkok View, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore, Buangkok Green Medical Park, 10 Buangkok View, Singapore
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Comparison of original and revised reinforcement sensitivity theory in clinically-stable schizophrenia and bipolar disorder patients. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2018.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Faay MDM, van Os J. Aggressive Behavior, Hostility, and Associated Care Needs in Patients With Psychotic Disorders: A 6-Year Follow-Up Study. Front Psychiatry 2019; 10:934. [PMID: 31998154 PMCID: PMC6961536 DOI: 10.3389/fpsyt.2019.00934] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/25/2019] [Indexed: 01/13/2023] Open
Abstract
Background: Hostility and aggressive behavior in patients with psychotic disorders are associated with demographic and clinical risk factors, as well as with childhood adversity and neglect. Care needs are an essential concept in clinical practice; care needs in the domain of safety for others reflect the actual problem the patient has. Hostility, aggressive behavior, and associated care needs, however, are often studied in retrospect. Method: In a sample of 1,119 patients with non-affective psychotic disorders, who were interviewed three times over a period of 6 years, we calculated the incidence of hostility, self-reported maltreatment to others and care needs associated with safety for other people (safety-to-others). Regression analysis was used to analyze the association between these outcomes and risk factors. The population attributable fraction (PAF) was used to calculate the proportion of the outcome that could potentially be prevented if previous expressions of adverse behavior were eliminated. Results: The yearly incidence of hostility was 2.8%, for safety-to-others 0.8% and for maltreatment this was 1.8%. Safety-to-others was associated with previous hostility and vice versa, but, assuming causality, only 18% of the safety-to-others needs was attributable to previous hostility while 26% was attributable to impulsivity. Hostility, maltreatment and safety-to-others were all associated with number of unmet needs, suicidal ideation and male sex. Hostility and maltreatment, but not safety-to-others, were associated with childhood adversity. Neither safety-to-others, maltreatment nor hostility were associated with premorbid adjustment problems. Conclusion: The incidence of hostility, self-reported aggressive behaviors, and associated care needs is low and linked to childhood adversity. Known risk factors for prevalence also apply to incidence and for care needs associated with safety for other people. Clinical symptoms can index aggressive behaviors years later, providing clinicians with some opportunity for preventing future incidents.
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Affiliation(s)
- Margo D M Faay
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jim van Os
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, King's College London, King's Health Partners, London, United Kingdom
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Long Non-Coding RNAs Associated with Heterochromatin Function in Immune Cells in Psychosis. Noncoding RNA 2018; 4:ncrna4040043. [PMID: 30567388 PMCID: PMC6316406 DOI: 10.3390/ncrna4040043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/30/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022] Open
Abstract
Psychosis is associated with chronic immune dysregulation. Many long non-coding RNAs (lncRNAs) display abnormal expression during activation of immune responses, and play a role in heterochromatic regulation of gene promoters. We have measured lncRNAs MEG3, PINT and GAS5, selected for their previously described association with heterochromatin. Peripheral blood mononuclear cells (PBMCs) were isolated from blood samples collected from 86 participants with a diagnosis of psychosis and 44 control participants. Expression was assessed in relation to diagnosis, illness acuity status, and treatment with antipsychotic medication. We observed diagnostic differences with MEG3, PINT and GAS5, and symptom acuity effect with MEG3 and GAS5. Medication effects were evident in those currently on treatment with antipsychotics when compared to drug-naïve participants. We observed that clinical diagnosis and symptom acuity predict selected lncRNA expression. Particular noteworthy is the differential expression of MEG3 in drug naïve participants compared to those treated with risperidone. Additionally, an in vitro cell model using M2tol macrophages was used to test the effects of the antipsychotic drug risperidone on the expression of these lncRNAs using quantitative real-time PCR (qRT-PCR). Significant but differential effects of risperidone were observed in M2tol macrophages indicating a clear ability of antipsychotic medications to modify lncRNA expression.
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Tibber MS, Kirkbride JB, Joyce EM, Mutsatsa S, Harrison I, Barnes TRE, Huddy V. The component structure of the scales for the assessment of positive and negative symptoms in first-episode psychosis and its dependence on variations in analytic methods. Psychiatry Res 2018; 270:869-879. [PMID: 30551337 PMCID: PMC6299359 DOI: 10.1016/j.psychres.2018.10.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 12/20/2022]
Abstract
A secondary analysis was undertaken on Scales for the Assessment of Positive and Negative Symptoms (SAPS/SANS) data from 345 first-episode psychosis (FEP) patients gathered in the West London FEP study. The purpose of this study was to determine: (i) the component structure of these measures in FEP (primary analyses), and (ii) the dependence of any findings in these primary analyses on variations in analytic methods. Symptom ratings were exposed to data reduction methods and the effects of the following manipulations ascertained: (i) level of analysis (individual symptom vs. global symptom severity ratings), (ii) extraction method (principal component vs. exploratory factor analysis) and (iii) retention method (scree test vs. Kaiser criterion). Whilst global ratings level analysis rendered the classic triad of psychotic syndromes (positive, negative and disorganisation), symptom level analyses revealed a hierarchical structure, with 11 first-order components subsumed by three second-order components, which also mapped on to this syndrome triad. These results were robust across data reduction but not component retention methods, suggesting that discrepancies in the literature regarding the component structure of the SAPS/SANS partly reflect the level of analysis and component retention method used. Further, they support a hierarchical symptom model, the implications of which are discussed.
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Affiliation(s)
- Marc S Tibber
- Department of Clinical, Educational and Health Psychology, UCL, London, UK.
| | | | | | | | | | | | - Vyv Huddy
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, UK.
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Yang Z, Lim K, Lam M, Keefe R, Lee J. Factor structure of the positive and negative syndrome scale (PANSS) in people at ultra high risk (UHR) for psychosis. Schizophr Res 2018; 201:85-90. [PMID: 29804925 DOI: 10.1016/j.schres.2018.05.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/29/2018] [Accepted: 05/13/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Positive and Negative Syndrome Scale (PANSS), a comprehensive psychopathology assessment scale used in the evaluation of psychopathology in schizophrenia, is also often used in the Ultra-High-Risk (UHR) population. This paper examined the dimensional structure of the PANSS in a UHR sample. METHODS A total of 168 individuals assessed to be at UHR for psychosis on the Comprehensive Assessment of At-Risk Mental States (CAARMS) were evaluated on the PANSS, Calgary Depression Scale for Schizophrenia (CDSS), Beck Anxiety Inventory (BAI), Brief Assessment of Cognition in Schizophrenia (BACS), and Global Assessment of Functioning (GAF). Exploratory factor analysis (EFA) of the PANSS was performed to identify the factorial structure. Convergent validity was explored with the CAARMS, CDSS, BAI and BACS. RESULTS EFA of the PANSS yielded five symptom factors - Positive, Negative, Cognition/Disorganization, Anxiety/Depression, and Hostility. This 5-factor solution showed good convergent validity with the CAARMS composite score, CDSS, BAI, and BACS. Positive, Negative and Anxiety/Depression factors were associated with functioning. CONCLUSION The reported PANSS factor structure may serve to improve the understanding and measurement of clinical symptom dimensions manifested in people with UHR for future research and clinical setting.
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Affiliation(s)
- Zixu Yang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Keane Lim
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Max Lam
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Richard Keefe
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, USA
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore; Department of Psychosis, Institute of Mental Health, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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Rosen C, McCarthy-Jones S, Jones N, Chase KA, Sharma RP. Negative voice-content as a full mediator of a relation between childhood adversity and distress ensuing from hearing voices. Schizophr Res 2018; 199:361-366. [PMID: 29580740 PMCID: PMC6151289 DOI: 10.1016/j.schres.2018.03.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/14/2018] [Accepted: 03/17/2018] [Indexed: 01/12/2023]
Abstract
A key predictor of whether or not an individual who hears voices (auditory verbal hallucinations; AVH) meets criteria for a psychiatric diagnosis is the level of negative content of the voices (e.g., threats, criticism, abuse). Yet the factors that contribute to negative voice-content are still not well understood. This study aimed to test the hypotheses that levels of childhood adversity would predict levels of negative voice-content, and that negative voice-content would partially mediate a relation between childhood adversity and voice-related distress. These hypotheses were tested in a clinical sample of 61 patients with formally diagnosed psychotic disorders (48 schizophrenia, 13 bipolar). We found evidence consistent with negative voice-content fully (not partially) mediating the relation between childhood adversity and voice-related distress. Although bivariate analyses found depression to be associated with both negative voice-content and voice-related distress, we found no evidence of an indirect effect of childhood adversity on either negative voice-content or voice-related distress via depression. Alternative study designs are now needed to test if our findings are replicable and causal. Should they be, it will be necessary for psychological therapies to devise ways to reduce negative voice-content itself, rather than just changing beliefs about voices. A number of techniques are discussed (Avatar Therapy, Compassion Focused Therapy, voice-dialogue) that already show promise for this.
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Affiliation(s)
- Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
| | | | - Nev Jones
- Department of Mental Health Law & Policy, University of South Florida, Florida, USA
| | - Kayla A Chase
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Rajiv P Sharma
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA; Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA
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Effect of aripiprazole lauroxil in patients with acute schizophrenia as assessed by the Positive and Negative Syndrome Scale-supportive analyses from a Phase 3 study. CNS Spectr 2018. [PMID: 28625204 DOI: 10.1017/s1092852917000396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Aripiprazole lauroxil (AL) is a long-acting injectable atypical antipsychotic that was evaluated for the treatment of schizophrenia in a randomized, placebo-controlled, Phase 3 study. Here, we present exploratory analyses of supportive efficacy endpoints. METHODS Patients experiencing an acute exacerbation of schizophrenia received AL 441 mg intramuscularly (IM), AL 882 mg IM, or matching placebo IM monthly. Supportive endpoints included changes from baseline at subsequent time points in Clinical Global Impression-Severity (CGI-S) scale score; Positive and Negative Syndrome Scale (PANSS) Total score; PANSS Positive, Negative, and General Psychopathology subscale scores; PANSS Marder factors (post hoc); and PANSS responder rate. Overall response rate, based on PANSS Total score and Clinical Global Impression-Improvement (CGI-I) scale score, was also analyzed. RESULTS Of 622 patients who were randomized, 596 had ≥1 post-baseline PANSS score. Patients were markedly ill at baseline (mean PANSS Total scores 92-94). Compared with placebo, CGI-S scores; PANSS Positive, Negative, and General Psychopathology subscale scores; and PANSS Marder factors were all significantly (p<0.001) improved by Day 85 with both AL doses, with significantly lower scores starting from Day 8 in most instances. Treatment response rates were significantly (p<0.001) greater with both doses of AL vs placebo. CONCLUSION AL demonstrated robust efficacy on CGI-S score, PANSS subscale scores, PANSS Marder factors, and response rates. Study limitations included use of a fixed dose for initial oral aripiprazole and fixed monthly AL doses without the option to individualize the oral initiation dosing or injection frequency for efficacy, tolerability, or safety.
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Anderson AE, Mansolf M, Reise SP, Savitz A, Salvadore G, Li Q, Bilder RM. Measuring pathology using the PANSS across diagnoses: Inconsistency of the positive symptom domain across schizophrenia, schizoaffective, and bipolar disorder. Psychiatry Res 2017; 258:207-216. [PMID: 28899614 PMCID: PMC5681392 DOI: 10.1016/j.psychres.2017.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/25/2022]
Abstract
Although the Positive and Negative Syndrome Scale (PANSS) was developed for use in schizophrenia (SZ), antipsychotic drug trials use the PANSS to measure symptom change also for bipolar (BP) and schizoaffective (SA) disorder, extending beyond its original indications. If the dimensions measured by the PANSS are different across diagnoses, then the same score change for the same drug condition may have different meanings depending on which group is being studied. Here, we evaluated whether the factor structure in the PANSS was consistent across schizophrenia (n = 3647), bipolar disorder (n = 858), and schizoaffective disorder (n = 592). Along with congruency coefficients, Hancock's H, and Jaccard indices, we used target rotations and statistical tests of invariance based on confirmatory factor models. We found the five symptom dimensions measured by the 30-item PANSS did not generalize well to schizoaffective and bipolar disorders. A model based on an 18-item version of the PANSS generalized better across SZ and BP groups, but significant problems remained in generalizing some of the factors to the SA sample. Schizophrenia and bipolar disorder showed greater similarity in factor structure than did schizophrenia and schizoaffective disorder. The Anxiety/Depression factor was the most consistent across disorders, while the Positive factor was the least consistent.
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Affiliation(s)
- Ariana E Anderson
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA; University of California, Los Angeles, Department of Statistics, Los Angeles, CA, USA.
| | - Maxwell Mansolf
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Steven P Reise
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Adam Savitz
- Janssen Scientific Affairs, Titusville, NJ, USA
| | | | - Qingqin Li
- Janssen Scientific Affairs, Titusville, NJ, USA
| | - Robert M Bilder
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA; University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
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Oxytocin effects in schizophrenia: Reconciling mixed findings and moving forward. Neurosci Biobehav Rev 2017; 80:36-56. [PMID: 28506922 DOI: 10.1016/j.neubiorev.2017.05.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 05/06/2017] [Accepted: 05/09/2017] [Indexed: 12/22/2022]
Abstract
Schizophrenia is a severe mental illness that causes major functional impairment. Current pharmacologic treatments are inadequate, particularly for addressing negative and cognitive symptoms of the disorder. Oxytocin, a neuropeptide known to moderate social behaviors, has been investigated as a potential therapeutic for schizophrenia in recent years. Results have been decidedly mixed, leading to controversy regarding oxytocin's utility. In this review, we outline several considerations for interpreting the extant literature and propose a focused agenda for future work that builds on the most compelling findings regarding oxytocin effects in schizophrenia to date. Specifically, we examine underlying causes of heterogeneity in randomized clinical trials (RCTs) conducted thus far and highlight the complexity of the human oxytocin system. We then review evidence of oxytocin's effects on specific deficits in schizophrenia, arguing for further study using objective, precise outcome measures in order to determine whether oxytocin has the potential to improve functional impairment in schizophrenia.
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Bodapati AS, Jenkins LM, Sharma RP, Rosen C. Visual memory uniquely predicts anhedonia in schizophrenia but not bipolar disorder. J Neuropsychol 2017; 13:136-146. [PMID: 28419772 DOI: 10.1111/jnp.12124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/15/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Deficits in memory have been suggested as an influential mechanism of anhedonia, because while pleasant experiences may be enjoyed in-the-moment, the cognitive processes involved in reporting anticipated or remembered enjoyable experiences is thought to be impaired. This study will determine whether any aspects of memory, including visual memory, verbal memory or working memory, are significantly predictive of anhedonia in a sample of schizophrenia, psychotic bipolar disorder and healthy controls. METHODS The study included 38 individuals with schizophrenia, 19 individuals with bipolar disorder with psychosis, and 43 age-matched healthy controls. All participants completed a self-report social and physical anhedonia questionnaire along with a cognitive screening battery, which assessed the domains of attention/vigilance, working memory, verbal learning, visual learning, and reasoning and problem-solving. RESULTS Anhedonia scores were regressed onto domain scores to determine which areas of cognition uniquely predicted level of anhedonia in each group. For the schizophrenia group, physical anhedonia was significantly predicted by worse visual memory performance. The regression models did not find significant cognitive predictors of physical or social anhedonia in the bipolar disorder or control groups. CONCLUSIONS This study found a significant relationship between visual memory and physical anhedonia in schizophrenia patients that was not present in a sample of psychotic bipolar patients or healthy controls, adding to an accumulating body of evidence that visual memory is related to anhedonia in schizophrenia. This relationship may be explained by underlying abnormalities in the orbitofrontal cortex in schizophrenia.
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Affiliation(s)
- Anjuli S Bodapati
- Department of Psychology, University of Illinois at Chicago, Illinois, USA
| | - Lisanne M Jenkins
- Department of Psychiatry, University of Illinois at Chicago, Illinois, USA
| | - Rajiv P Sharma
- Department of Psychiatry, University of Illinois at Chicago, Illinois, USA.,Department of Psychiatry, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA
| | - Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Illinois, USA
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Rosen C, Jones N, Chase KA, Melbourne JK, Grossman LS, Sharma RP. Immersion in altered experience: An investigation of the relationship between absorption and psychopathology. Conscious Cogn 2017; 49:215-226. [PMID: 28219788 DOI: 10.1016/j.concog.2017.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/10/2016] [Accepted: 01/13/2017] [Indexed: 12/20/2022]
Abstract
Understanding alterations in perceptual experiences as a component of the basic symptom structure of psychosis may improve early detection and the identification of subtle shifts that can precede symptom onset or exacerbation. We explored the phenomenological construct of absorption and psychotic experiences in both clinical (bipolar psychosis and schizophrenia spectrum) and non-clinical participants. Participants with psychosis endorsed significantly higher absorption compared to the non-clinical group. Absorption was positively correlated with all types of hallucinations and multiple types of delusions. The analysis yielded two distinct cluster groups that demarcated a distinction along the continuum of self-disturbance: on characterized by attenuated ego boundaries and the other stable ego boundaries. The study suggests that absorption is a potentially important but under-researched component of psychosis that overlaps with, but is not identical to the more heavily theorized constructs of aberrant salience and hyperreflexivity.
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Affiliation(s)
- Cherise Rosen
- University of Illinois at Chicago, Department of Psychiatry, 1601 W. Taylor St., Chicago, IL 60612, United States.
| | - Nev Jones
- Felton Institute, 1500 Franklin Street, San Francisco, CA 94109, United States
| | - Kayla A Chase
- University of California, Department of Psychiatry, 9500 Gilman Drive, MC 8505, La Jolla, CA 92037, United States
| | - Jennifer K Melbourne
- University of Illinois at Chicago, Department of Psychiatry, 1601 W. Taylor St., Chicago, IL 60612, United States
| | - Linda S Grossman
- University of Illinois at Chicago, Department of Psychiatry, 1601 W. Taylor St., Chicago, IL 60612, United States
| | - Rajiv P Sharma
- University of Illinois at Chicago, Department of Psychiatry, 1601 W. Taylor St., Chicago, IL 60612, United States; Jesse Brown Veterans Affairs Medical Center, 820 South Damen Avenue, Chicago, IL 60612, United States
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Improving Theory of Mind in Schizophrenia by Targeting Cognition and Metacognition with Computerized Cognitive Remediation: A Multiple Case Study. SCHIZOPHRENIA RESEARCH AND TREATMENT 2017; 2017:7203871. [PMID: 28246557 PMCID: PMC5299218 DOI: 10.1155/2017/7203871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/15/2016] [Indexed: 12/28/2022]
Abstract
Schizophrenia is associated with deficits in theory of mind (ToM) (i.e., the ability to infer the mental states of others) and cognition. Associations have often been reported between cognition and ToM, and ToM mediates the relationship between impaired cognition and impaired functioning in schizophrenia. Given that cognitive deficits could act as a limiting factor for ToM, this study investigated whether a cognitive remediation therapy (CRT) that targets nonsocial cognition and metacognition could improve ToM in schizophrenia. Four men with schizophrenia received CRT. Assessments of ToM, cognition, and metacognition were conducted at baseline and posttreatment as well as three months and 1 year later. Two patients reached a significant improvement in ToM immediately after treatment whereas at three months after treatment all four cases reached a significant improvement, which was maintained through 1 year after treatment for all three cases that remained in the study. Improvements in ToM were accompanied by significant improvements in the most severely impaired cognitive functions at baseline or by improvements in metacognition. This study establishes that a CRT program that does not explicitly target social abilities can improve ToM.
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Rosen C, Jones N, Longden E, Chase KA, Shattell M, Melbourne JK, Keedy SK, Sharma RP. Exploring the Intersections of Trauma, Structural Adversity, and Psychosis among a Primarily African-American Sample: A Mixed-Methods Analysis. Front Psychiatry 2017; 8:57. [PMID: 28469582 PMCID: PMC5395710 DOI: 10.3389/fpsyt.2017.00057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/29/2017] [Indexed: 01/27/2023] Open
Abstract
Traumatic life events (TLEs) have been associated with multiple psychiatric diagnoses, including anxiety disorders, major depression, PTSD, and psychosis. To advance our understanding of the complex interactions between forms of adversity as they manifest across the lifespan, psychosis, and symptom content, we undertook a mixed-methods investigation of TLEs and psychosis. Our research explored the association between cumulative exposures, type of TLE, and proximity to the traumatic event and psychosis; the association between TLEs and clinical symptomology including specific types of delusions and/or hallucinations; and how qualitative data further inform understanding of complex relationships and patterns of past trauma and symptoms as they unfold over time. There were a total of 97 participants in the quantitative study sample, 51 participants with present state psychosis and 46 non-clinical. There were a total of 34 qualitative study participants, all of whom were experiencing psychosis. The quantitative analysis showed that when comparing persons with psychosis to the non-clinical group, there were no group differences in the overall total score of TLEs. However, there was a significant difference in cumulative TLEs that "Happened," demonstrating that as the number of TLEs increased, the likelihood of clinical psychosis also increased. We also found a correlation between lifetime cumulative TLEs that "Happened" and PANSS five-factor analysis: positive, excitement, depression, thought disorder, activation, and paranoia scores. The qualitative analysis further built on these finding by providing rich narratives regarding the timing of trauma-related onset, relationships between trauma and both trauma-related and religious-spiritual content, and trauma and hallucinatory modality. Analysis of participant narratives suggests the central role of localized cultural and sociopolitical influences on onset, phenomenology, and coping and contributes to a growing literature calling for strengths-based, client-driven approaches to working with distressing voices and beliefs that centers the exploration of the personal and social meaning of such experiences including links to life narratives. Findings also underscore the clinical importance of trauma assessment and trauma-informed care.
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Affiliation(s)
- Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Nev Jones
- Felton Institute, San Francisco, CA, USA
| | - Eleanor Longden
- Greater Manchester West Mental Health NHS Foundation Trust, Psychosis Research Unit, Manchester, UK
| | - Kayla A Chase
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Mona Shattell
- Department of Community, Systems, and Mental Health Nursing, Rush University, Chicago, IL, USA
| | | | - Sarah K Keedy
- Department of Psychiatry, University of Chicago, Chicago, IL, USA
| | - Rajiv P Sharma
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.,Department of Psychiatry, Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA
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Chase KA, Feiner B, Rosen C, Gavin DP, Sharma RP. Characterization of peripheral cannabinoid receptor expression and clinical correlates in schizophrenia. Psychiatry Res 2016; 245:346-353. [PMID: 27591408 DOI: 10.1016/j.psychres.2016.08.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 08/16/2016] [Accepted: 08/19/2016] [Indexed: 01/13/2023]
Abstract
The relationship between cannabinoid receptor signaling and psychosis vulnerability requires further exploration. The endocannabinoid signaling system is extensive, with receptors exerting regulatory functions in both immune and central nervous systems. In the brain, cannabinoid receptors (CBR) directly modulate neurotransmitter systems. In the peripheral lymphocyte, CBRs mediate cytokine release, with dysregulated cytokine levels demonstrated in schizophrenia. mRNA levels of CBRs were measured in human peripheral blood mononuclear cells (PBMCs) obtained from 70 participants (35 non-clinical controls, 35 participants with schizophrenia), who were recruited for the absence of marijuana use/abuse by self-report. Changes in mRNA expression were measured using qRT-PCR. Clinical measurements collected included the MATRICS Cognitive Battery and the Positive and Negative Syndrome Scale. Levels of CB1R and CB2R mRNA in PBMCs were significantly higher in participants with schizophrenia compared to the non-clinical controls. Additionally, CB1R and CB2R mRNA levels correlated with impairments in cognitive processing and clinical symptom severity in multiple domains. These results continue to support dysregulation of particular aspects of the endocannabinoid signaling system in participants with schizophrenia selected for the self-reported absence of marijuana abuse/dependence.
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Affiliation(s)
- Kayla A Chase
- The Psychiatric Institute, University of Illinois at Chicago, 1601 W. Taylor St, Chicago, IL 60612, USA; University of California, Department of Psychiatry, 9500 Gilman Drive, MC 8505, La Jolla, San Diego, CA 92037, USA
| | - Benjamin Feiner
- The Psychiatric Institute, University of Illinois at Chicago, 1601 W. Taylor St, Chicago, IL 60612, USA
| | - Cherise Rosen
- The Psychiatric Institute, University of Illinois at Chicago, 1601 W. Taylor St, Chicago, IL 60612, USA
| | - David P Gavin
- The Psychiatric Institute, University of Illinois at Chicago, 1601 W. Taylor St, Chicago, IL 60612, USA; Jesse Brown Veterans Affairs Medical Center, 820 South Damen Avenue (M/C 151), Chicago, IL 60612, USA
| | - Rajiv P Sharma
- The Psychiatric Institute, University of Illinois at Chicago, 1601 W. Taylor St, Chicago, IL 60612, USA; Jesse Brown Veterans Affairs Medical Center, 820 South Damen Avenue (M/C 151), Chicago, IL 60612, USA.
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Rosen C, Chase KA, Jones N, Grossman LS, Gin H, Sharma RP. Listening to Schneiderian Voices: A Novel Phenomenological Analysis. Psychopathology 2016; 49:163-71. [PMID: 27304081 PMCID: PMC4990463 DOI: 10.1159/000446546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 05/02/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND/AIMS This paper reports on analyses designed to elucidate phenomenological characteristics, content and experience specifically targeting participants with Schneiderian voices conversing/commenting (VC) while exploring differences in clinical presentation and quality of life compared to those with voices not conversing (VNC). METHODS This mixed-method investigation of Schneiderian voices included standardized clinical metrics and exploratory phenomenological interviews designed to elicit in-depth information about the characteristics, content, meaning, and personification of auditory verbal hallucinations. RESULTS The subjective experience shows a striking pattern of VC, as they are experienced as internal at initial onset and during the longer-term course of illness when compared to VNC. Participants in the VC group were more likely to attribute the origin of their voices to an external source such as God, telepathic communication, or mediumistic sources. VC and VNC were described as characterological entities that were distinct from self (I/we vs. you). We also found an association between VC and the positive, cognitive, and depression symptom profile. However, we did not find a significant group difference in overall quality of life. CONCLUSIONS The clinical portrait of VC is complex, multisensory, and distinct, and suggests a need for further research into the biopsychosocial interface between subjective experience, socioenvironmental constraints, individual psychology, and the biological architecture of intersecting symptoms.
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Affiliation(s)
- Cherise Rosen
- University of Illinois at Chicago, The Psychiatric Institute, Department of Psychiatry, 1601 W. Taylor St., Chicago, IL 60612
| | - Kayla A. Chase
- University of California, Department of Psychiatry, 9500 Gilman Drive, MC 8505, La Jolla, CA 92037, San Diego, USA
| | - Nev Jones
- Stanford University, Department of Anthropology, 450 Serra Mall, Stanford, CA 94305
| | - Linda S. Grossman
- University of Illinois at Chicago, Neuropsychiatric Institute, Department of Psychiatry, 912 S. Wood St., Chicago, IL 60612
| | - Hannah Gin
- University of Illinois at Chicago, The Psychiatric Institute, Department of Psychiatry, 1601 W. Taylor St., Chicago, IL 60612
| | - Rajiv P. Sharma
- University of Illinois at Chicago, The Psychiatric Institute, Department of Psychiatry, 1601 W. Taylor St., Chicago, IL 60612
- Jesse Brown Veterans Affairs Medical Center, 820 South Damen Avenue (M/C 151), Chicago, IL 60612
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Rosen C, Jones N, Chase KA, Gin H, Grossman LS, Sharma RP. The intrasubjectivity of self, voices and delusions: A phenomenological analysis. PSYCHOSIS 2016; 8:357-368. [PMID: 27829870 PMCID: PMC5098808 DOI: 10.1080/17522439.2016.1162839] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To advance the area of phenomenology of voices and their interrelatedness to forms of delusions this study investigated the prevalence and interrelatedness of co-occurring auditory verbal hallucinations (AVHs) and delusions. Additionally we explored the characterization of distinct sub-categories/clusters of AVHs and delusions. Ninety-two participants experiencing psychosis were administered standardized clinical measures. We found a significant diagnostic difference with increased prevalence of co-occurring AVHs and delusions within the schizophrenia group compared to the bipolar with psychosis group. Regardless of diagnosis, there was a significant positive correlation between AVHs and delusions of reference, persecution, control, thought insertion, thought withdrawal and thought broadcasting. However, no significant relationship was found between AVHs and grandiose, somatic, religious, guilty or jealousy-themed delusions. Cluster analysis yielded two distinct cluster groups. Cluster One: Voices and Thought Delusions, and Cluster Two: Voices and Thematic Delusions. Cluster One participants showed elevated disorganized, cognitive and depressive symptoms, but not negative symptoms or excitement. This study underscores the need for expanded clinical and phenomenological research into the intersection of AVHs and delusions, including work that seeks to deconstruct conventional divisions between ostensible symptoms of perception' (hallucinations) and belief' (delusions).
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Affiliation(s)
- Cherise Rosen
- University of Illinois at Chicago, Psychiatric Institute, Department of Psychiatry, 1601 W. Taylor St., Chicago, IL 60612
| | - Nev Jones
- Stanford University, Department of Anthropology, 450 Serra Mall, Stanford, CA 94305
| | - Kayla A. Chase
- University of California, Department of Psychiatry, 9500 Gilman Drive, MC 8505, La Jolla, CA 92037, San Diego, USA
| | - Hannah Gin
- University of Illinois at Chicago, Psychiatric Institute, Department of Psychiatry, 1601 W. Taylor St., Chicago, IL 60612
| | - Linda S. Grossman
- University of Illinois at Chicago, Psychiatric Institute, Department of Psychiatry, 1601 W. Taylor St., Chicago, IL 60612
| | - Rajiv P. Sharma
- University of Illinois at Chicago, Psychiatric Institute, Department of Psychiatry, 1601 W. Taylor St., Chicago, IL 60612
- Jesse Brown Veterans Affairs Medical Center, 820 South Damen Avenue (M/C 151), Chicago, IL 60612
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Best MW, Grossman M, Oyewumi LK, Bowie CR. Examination of the Positive and Negative Syndrome Scale factor structure and longitudinal relationships with functioning in early psychosis. Early Interv Psychiatry 2016; 10:165-70. [PMID: 25277757 DOI: 10.1111/eip.12190] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/19/2014] [Indexed: 11/28/2022]
Abstract
AIM We examined the factor structure of the Positive and Negative Syndrome Scale (PANSS) in early-episode psychosis and its relationships with functioning at baseline and follow-up. METHODS A total of 240 consecutive admissions to an early intervention in psychosis clinic were assessed at intake to the program with the PANSS, Global Assessment of Functioning (GAF) and Social and Occupational Functioning Assessment Scale (SOFAS). Seventy individuals were reassessed at follow-up. A maximum likelihood factor analysis was conducted on baseline PANSS scores and the ability of each factor to predict baseline and follow-up GAF and SOFAS was examined. RESULTS A five-factor model with varimax rotation was the best fit to our data and was largely congruent with factors found previously. The negative symptom factor was the best predictor of GAF and SOFAS at baseline and follow-up. CONCLUSION Negative symptoms are the best symptomatic predictor of functioning in individuals with early psychosis and are an important treatment target to improve recovery.
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Affiliation(s)
- Michael W Best
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Michael Grossman
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - L Kola Oyewumi
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Christopher R Bowie
- Department of Psychology, Queen's University, Kingston, Ontario, Canada.,Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
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Thokagevistk K, Millier A, Lenert L, Sadikhov S, Moreno S, Toumi M. Validation of disease states in schizophrenia: comparison of cluster analysis between US and European populations. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2016; 4:30725. [PMID: 27386054 PMCID: PMC4916257 DOI: 10.3402/jmahp.v4.30725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/23/2016] [Accepted: 05/30/2016] [Indexed: 05/12/2023]
Abstract
BACKGROUND There is controversy as to whether use of statistical clustering methods to identify common disease patterns in schizophrenia identifies patterns generalizable across countries. OBJECTIVE The goal of this study was to compare disease states identified in a published study (Mohr/Lenert, 2004) considering US patients to disease states in a European cohort (EuroSC) considering English, French, and German patients. METHODS Using methods paralleling those in Mohr/Lenert, we conducted a principal component analysis (PCA) on Positive and Negative Syndrome Scale items in the EuroSC data set (n=1,208), followed by k-means cluster analyses and a search for an optimal k. The optimal model structure was compared to Mohr/Lenert by assigning discrete severity levels to each cluster in each factor based on the cluster center. A harmonized model was created and patients were assigned to health states using both approaches; agreement rates in state assignment were then calculated. RESULTS Five factors accounting for 56% of total variance were obtained from PCA. These factors corresponded to positive symptoms (Factor 1), negative symptoms (Factor 2), cognitive impairment (Factor 3), hostility/aggression (Factor 4), and mood disorder (Factor 5) (as in Mohr/Lenert). The optimal number of cluster states was six. The kappa statistic (95% confidence interval) for agreement in state assignment was 0.686 (0.670-0.703). CONCLUSION The patterns of schizophrenia effects identified using clustering in two different data sets were reasonably similar. Results suggest the Mohr/Lenert health state model is potentially generalizable to other populations.
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Affiliation(s)
| | - Aurélie Millier
- Creativ-Ceutical, Paris, France
- Correspondence to: Aurélie Millier, Creativ-Ceutical, 215 rue du Faubourg Saint-Honoré, FR-75008 Paris, France,
| | - Leslie Lenert
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Mondher Toumi
- Faculté de Médecine, Laboratoire de Santé Publique, Aix-Marseille University, Marseille, France
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Watanabe K, Miura I, Kanno-Nozaki K, Horikoshi S, Mashiko H, Niwa SI, Yabe H. Associations between five-factor model of the Positive and Negative Syndrome Scale and plasma levels of monoamine metabolite in patients with schizophrenia. Psychiatry Res 2015; 230:419-23. [PMID: 26416588 DOI: 10.1016/j.psychres.2015.09.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 09/01/2015] [Accepted: 09/18/2015] [Indexed: 11/19/2022]
Abstract
The five-factor model of the Positive and Negative Syndrome Scale (PANSS) for schizophrenia symptoms is the most common multiple-factor model used in analyses; its use may improve evaluation of symptoms in schizophrenia patients. Plasma monoamine metabolite levels are possible indicators of clinical symptoms or response to antipsychotics in schizophrenia. We investigated the association between five-factor model components and plasma monoamine metabolites levels to explore the model's biological basis. Plasma levels of homovanillic acid (HVA), 3-methoxy-4-hydroxyphenylglycol (MHPG), and 5-hydroxyindoleacetic acid (5-HIAA) were measured using high-performance liquid chromatography in 65 Japanese patients with schizophrenia. Significant negative correlation between plasma 5-HIAA levels and the depression/anxiety component was found. Furthermore, significant positive correlation was found between plasma MHPG levels and the excitement component. Plasma HVA levels were not correlated with any five-factor model component. These results suggest that the five-factor model of the PANSS may have a biological basis, and may be useful for elucidating the psychopathology of schizophrenia. Assessment using the five-factor model may enable understanding of monoaminergic dysfunction, possibly allowing more appropriate medication selection. Further studies of a larger number of first-episode schizophrenia patients are needed to confirm and extend these results.
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Affiliation(s)
- Kenya Watanabe
- Department of Pharmacy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Itaru Miura
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan.
| | - Keiko Kanno-Nozaki
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Sho Horikoshi
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Hirobumi Mashiko
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Shin-Ichi Niwa
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan; Department of Neuropsychiatry, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Fukushima, Japan
| | - Hirooki Yabe
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
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Are negative symptoms really related to cognition in schizophrenia? Psychiatry Res 2015; 230:377-82. [PMID: 26454405 DOI: 10.1016/j.psychres.2015.09.022] [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] [Received: 03/17/2015] [Revised: 07/15/2015] [Accepted: 09/12/2015] [Indexed: 12/27/2022]
Abstract
Previous studies have generally found a relationship between negative and cognitive symptoms in schizophrenia. The present study investigated the relationship between the 5 PANSS factors of a recent consensus model developed by NIMH researchers, and cognitive performance as assessed with the MATRICS Consensus Cognitive Battery (MCCB) in 80 patients with schizophrenia using correlation and regression analyses. The PANSS Cognitive factor showed a small to moderate significant association with MCCB Speed of processing, Working memory, Verbal learning, the Neurocognitive composite score, and the Overall composite score. Notably, however, no relationship was found between the PANSS Negative factor and any of the MCCB scores. The Positive, Excited and Depressed factors also did not show associations with the MCCB. These results highlight the need for refined assessment instruments and support the relative independence of cognition from other domains of psychopathology, including negative symptoms, in patients with schizophrenia.
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Sutliff S, Roy MA, Achim AM. Social anxiety disorder in recent onset schizophrenia spectrum disorders: The relation with symptomatology, anxiety, and social rank. Psychiatry Res 2015; 227:39-45. [PMID: 25818255 DOI: 10.1016/j.psychres.2015.02.017] [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] [Received: 07/04/2014] [Revised: 01/02/2015] [Accepted: 02/19/2015] [Indexed: 01/08/2023]
Abstract
Social anxiety disorder (SAD) represents a common comorbidity in schizophrenia, but questions remain regarding how this comorbidity is related to symptomatology and self-perceptions. Forty-two patients with recent-onset schizophrenia were evaluated for SAD, and assessed with the Positive and Negative Syndrome Scale (PANSS), as well as the Social Comparison Scale (SCS), which assessed how participants perceived themselves in relation with others (i.e., social rank). Eighteen patients met criteria for SAD (SZ+) while 24 patients did not (SZ-). Analysis of symptoms using a five-factor model of the PANSS revealed that the SZ- group had more severe symptoms than SZ+ on the Cognitive/Disorganization factor. Further analyses of individual symptoms demonstrated that the SZ- group was more affected in attention, abstract thinking, and cognitive disorganization (Cognitive/Disorganization symptoms), while the SZ+ group was more severely affected in anxiety, suspiciousness/persecution, and active social avoidance. Interestingly, severity of social anxiety symptom ratings correlated with certain PANSS symptoms only in the SZ- group. Perception of social rank, which was reduced in SZ+, displayed a trend level correlation with the positive symptoms in SZ-. Overall, the results suggest that SZ+ and SZ- may have different clinical profiles that could be important to consider when tailoring treatments for these patients.
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Affiliation(s)
- Stephanie Sutliff
- Département de Psychiatrie et neurosciences, Université Laval, Centre de Recherche de l׳Institut Universitaire en Santé Mentale de Québec, Canada, 2601 Chemin de la Canardière, Québec, QC G1J 2G3
| | - Marc-André Roy
- Département de Psychiatrie et neurosciences, Université Laval, Centre de Recherche de l׳Institut Universitaire en Santé Mentale de Québec, Canada, 2601 Chemin de la Canardière, Québec, QC G1J 2G3
| | - Amélie M Achim
- Département de Psychiatrie et neurosciences, Université Laval, Centre de Recherche de l׳Institut Universitaire en Santé Mentale de Québec, Canada, 2601 Chemin de la Canardière, Québec, QC G1J 2G3.
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Anderson A, Wilcox M, Savitz A, Chung H, Li Q, Salvadore G, Wang D, Nuamah I, Riese SP, Bilder RM. Sparse factors for the positive and negative syndrome scale: which symptoms and stage of illness? Psychiatry Res 2015; 225:283-90. [PMID: 25613662 PMCID: PMC4346367 DOI: 10.1016/j.psychres.2014.12.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 12/06/2014] [Accepted: 12/14/2014] [Indexed: 10/24/2022]
Abstract
The Positive and Negative Syndrome Scale (PANSS) is frequently described with five latent factors, yet published factor models consistently fail to replicate across samples and related disorders. We hypothesize that (1) a subset of the PANSS, instead of the entire PANSS scale, would produce the most replicable five-factor models across samples, and that (2) the PANSS factor structure may be different depending on the treatment phase, influenced by the responsiveness of the positive symptoms to treatment. Using exploratory factor analysis, confirmatory factor analysis and cross validation on baseline and post-treatment observations from 3647 schizophrenia patients, we show that five-factor models fit best across samples when substantial subsets of the PANSS items are removed. The optimal model at baseline (five factors) omits 12 items: Motor Retardation, Grandiosity, Somatic Concern, Lack of Judgment and Insight, Difficulty in Abstract Thinking, Mannerisms and Posturing, Disturbance of Volition, Preoccupation, Disorientation, Excitement, Guilt Feelings and Depression. The PANSS factor models fit differently before and after patients have been treated. Patients with larger treatment response in positive symptoms have larger variations in factor structure across treatment stage than the less responsive patients. Negative symptom scores better predict the positive symptoms scores after treatment than before treatment. We conclude that sparse factor models replicate better on new samples, and the underlying disease structure of Schizophrenia changes upon treatment.
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Affiliation(s)
- Ariana Anderson
- Department of Psychiatry and Biobehavioral Sciences, University of California, 760 Westwood Plaza, C8-739 Semel Institute, Los Angeles, CA, USA,Correspondence to: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza, C8-739 Semel Institute, Los Angeles, CA 90095, Tel.: +1 310 254 5680, fax: +1 310 206 1866
| | - Marsha Wilcox
- Janssen Research and Development, Titusville, NJ, USA
| | - Adam Savitz
- Janssen Research and Development, Titusville, NJ, USA
| | | | - Qingqin Li
- Janssen Research and Development, Titusville, NJ, USA
| | | | - Dai Wang
- Janssen Research and Development, Titusville, NJ, USA
| | - Isaac Nuamah
- Janssen Research and Development, Titusville, NJ, USA
| | - Steven P. Riese
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Robert M. Bilder
- Department of Psychiatry and Biobehavioral Sciences, University of California, 760 Westwood Plaza, C8-739 Semel Institute, Los Angeles, CA, USA
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Stefanovics EA, Elkis H, Zhening L, Zhang XY, Rosenheck RA. A cross-national factor analytic comparison of three models of PANSS symptoms in schizophrenia. Psychiatry Res 2014; 219:283-9. [PMID: 24930581 DOI: 10.1016/j.psychres.2014.04.041] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 04/07/2014] [Accepted: 04/27/2014] [Indexed: 01/04/2023]
Abstract
The 30-item Positive and Negative Syndrome Scale (PANSS) is used worldwide in the assessment of symptom severity in schizophrenia. The present study uses confirmatory factor analysis (CFA) to compare three different factorial models and to evaluate the best-fitting representation of schizophrenia symptom structure on the PANSS across four samples of patients diagnosed with schizophrenia from the US (the CATIE schizophrenia trial), São Paulo, Brazil, and from Beijing and Changsha, China. We examine the goodness of fit of several previously proposed models. The traditional trifactorial model for the PANSS and two five-factor models were evaluated using absolute and incremental indices. Single group CFA found that the five-factor model proposed by NIMH researchers based on an extensive literature review demonstrates the best fit in each of the four samples. This model used 20 of the 30 PANSS items grouped into five factors: positive, negative, disorganized, excited, and depressed symptoms. Subgroups defined by age, gender, nationality, hospitalization status, and severity of illness also did not differ in overall symptom structure as assessed by several standard indices. Our findings suggest that the five factor NIMH model showed the best representation among all four samples from different countries and potentially contrasting cultures.
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Affiliation(s)
- Elina A Stefanovics
- VA New England Mental Illness Research and Education Center, West Haven, CT 06516, United States; Yale Medical School, New Haven, CT 06511, United States.
| | - Helio Elkis
- Department and Institute of Psychiatry University of São Paulo Medical School, São Paulo, Brazil
| | - Liu Zhening
- Mental Health Institute, Second Xiangya Hospital, Changsha, China
| | - Xiang Y Zhang
- Center for Biological Psychiatry, Beijing Hui Long Guan Hospital, Beijing, China
| | - Robert A Rosenheck
- VA New England Mental Illness Research and Education Center, West Haven, CT 06516, United States; Yale Medical School, New Haven, CT 06511, United States
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