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Dong X, Shovestul B, Saxena A, Dudek E, Reda S, Lamberti JS, Dodell-Feder D. Decision-making under risk and its correlates in schizophrenia. Schizophr Res Cogn 2024; 37:100314. [PMID: 38764743 PMCID: PMC11101893 DOI: 10.1016/j.scog.2024.100314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/21/2024]
Abstract
Schizophrenia spectrum disorders (SSD) are associated with pervasive cognitive impairments, including deficits in decision-making under risk. However, there is inconclusive evidence regarding specific mechanisms underlying altered decision-making patterns. In this study, participants (33 SSD and 28 non-SSD) completed the Columbia Card Task, an explicit risk-taking task, to better understand risk preference and adjustment in dynamic decision-making. We found that while there is no group difference in overall risk-taking, risk preference, or optimal decision-making, risk adjustment to contextual factors (e.g., loss probability) is blunted in SSD. We also found associations between risk-taking/suboptimal decision-making and disorganized symptoms, excited symptoms, and role functioning, but no associations between decision-making and working memory. These results suggest that during a complex, dynamic risk-taking task, individuals with SSD exhibit less adaption to changing information about risk, which may reflect risk imperception.
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Affiliation(s)
- Xiaoyu Dong
- Department of Psychology, University of Rochester, 500 Joseph C. Wilson Blvd, Rochester, NY 14627, United States of America
| | - Bridget Shovestul
- Department of Psychology, University of Rochester, 500 Joseph C. Wilson Blvd, Rochester, NY 14627, United States of America
| | - Abhishek Saxena
- Department of Psychology, University of Rochester, 500 Joseph C. Wilson Blvd, Rochester, NY 14627, United States of America
| | - Emily Dudek
- Department of Psychology, University of Houston, Houston, TX 77204, United States of America
| | - Stephanie Reda
- Department of Psychology, University of Rochester, 500 Joseph C. Wilson Blvd, Rochester, NY 14627, United States of America
| | - J. Steven Lamberti
- Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, United States of America
| | - David Dodell-Feder
- Department of Psychology, University of Rochester, 500 Joseph C. Wilson Blvd, Rochester, NY 14627, United States of America
- Department of Neuroscience, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, United States of America
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Correll CU, Arango C, Fagiolini A, Giordano GM, Leucht S, Salazar de Pablo G. Finding the Right Setting for the Right Treatment During the Acute Treatment of Individuals with Schizophrenia: A Narrative Review and Clinical Practice Guideline. Neuropsychiatr Dis Treat 2024; 20:1293-1307. [PMID: 38911102 PMCID: PMC11194005 DOI: 10.2147/ndt.s459450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Background Schizophrenia is most times a chronic and often debilitating illness associated with poor mental health outcomes. Early and effective treatment of schizophrenia in the most appropriate setting can make a significant difference in the long-term recovery. The aim of this narrative review was to provide suggestions and recommendations for effectively managing patients with schizophrenia during acute exacerbations and to enhance awareness and skills related to personalized medicine. Methods A panel of academics and clinicians with experience in the field of psychosis met virtually on July 13th 2023 to narratively review and discuss the research evidence and their clinical experience about the most appropriate acute treatments for patients with schizophrenia. This manuscript represents a synthesis of the panel analysis and discussion. Results First contact is very important for service users, as is finding the most adequate treatment setting. If patients present to the emergency department, which may be a traumatic setting for service users, a dedicated environment with adequate space and specialized mental health support, including personnel trained in de-escalation techniques, is recommended. A well-connected continuum of care is strongly recommended, possibly with seamless links between inpatient units, day hospital services, outpatient facilities and rehabilitation services. Ideally, this should be structured as part of a coordinated step-down service line. Treatment challenges include suboptimal response, side effects, and nonadherence, which is reduced by the use of long-acting injectable antipsychotics. Conclusion Individual circumstances, including age, gender, and presence of hostility/aggression or self-harm, cognitive impairment and negative symptoms, comorbidities (depression, substance use disorders) or associated symptoms (anxiety, insomnia), should be considered when selecting the most appropriate treatment for the acute phase of schizophrenia. Efficacy and feasibility, as well as acceptability and tolerability of treatments, require joint consideration from the early stages of schizophrenia, thereby enhancing the possibility of improved short- and long-term outcomes.
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Affiliation(s)
- Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Andrea Fagiolini
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy
| | | | - Stefan Leucht
- German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
- Child and Adolescent Mental Health Services (CAMHS) South London and Maudsley NHS Foundation Trust London, London, UK
- Department of Child and Adolescent Psychiatry Institute of Psychiatry, Psychology & Neuroscience King’s College London, London, UK
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González-Arias C, Sánchez-Ruiz A, Esparza J, Sánchez-Puelles C, Arancibia L, Ramírez-Franco J, Gobbo D, Kirchhoff F, Perea G. Dysfunctional serotonergic neuron-astrocyte signaling in depressive-like states. Mol Psychiatry 2023; 28:3856-3873. [PMID: 37773446 PMCID: PMC10730416 DOI: 10.1038/s41380-023-02269-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
Astrocytes play crucial roles in brain homeostasis and are regulatory elements of neuronal and synaptic physiology. Astrocytic alterations have been found in Major Depressive Disorder (MDD) patients; however, the consequences of astrocyte Ca2+ signaling in MDD are poorly understood. Here, we found that corticosterone-treated juvenile mice (Cort-mice) showed altered astrocytic Ca2+ dynamics in mPFC both in resting conditions and during social interactions, in line with altered mice behavior. Additionally, Cort-mice displayed reduced serotonin (5-HT)-mediated Ca2+ signaling in mPFC astrocytes, and aberrant 5-HT-driven synaptic plasticity in layer 2/3 mPFC neurons. Downregulation of astrocyte Ca2+ signaling in naïve animals mimicked the synaptic deficits found in Cort-mice. Remarkably, boosting astrocyte Ca2+ signaling with Gq-DREADDS restored to the control levels mood and cognitive abilities in Cort-mice. This study highlights the important role of astrocyte Ca2+ signaling for homeostatic control of brain circuits and behavior, but also reveals its potential therapeutic value for depressive-like states.
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Affiliation(s)
- Candela González-Arias
- Cajal Institute, CSIC, 28002, Madrid, Spain
- PhD Program in Neuroscience, Autonoma de Madrid University-Cajal Institute, Madrid, 28029, Spain
| | - Andrea Sánchez-Ruiz
- Cajal Institute, CSIC, 28002, Madrid, Spain
- PhD Program in Neuroscience, Autonoma de Madrid University-Cajal Institute, Madrid, 28029, Spain
| | | | | | | | - Jorge Ramírez-Franco
- Institut de Neurosciences de la Timone, Aix-Marseille Université (AMU) & CNRS, UMR7289, 13005, Marseille, France
| | - Davide Gobbo
- Molecular Physiology, Center for Integrative Physiology and Molecular Medicine, University of Saarland, 66421, Homburg, Germany
| | - Frank Kirchhoff
- Molecular Physiology, Center for Integrative Physiology and Molecular Medicine, University of Saarland, 66421, Homburg, Germany
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Marcu GM, Radu AM, Bucuță MD, Fleacă RS, Tanasescu C, Roman MD, Boicean A, Bacilă CI. Cognitive and Behavioral Factors Predicting the Decision to Vaccinate against COVID-19 in Clinical Psychiatric Population-A Cross-Sectional Survey. Vaccines (Basel) 2023; 11:vaccines11020441. [PMID: 36851318 PMCID: PMC9961952 DOI: 10.3390/vaccines11020441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
The spread of the COVID-19 virus created more than a medical crisis, while it also negatively affected the mental health of the general population. This context increased the vulnerability of the psychiatric population. While research interest highly targeted vaccine hesitancy and acceptance, many studies focused on trust issues-both in vaccine efficacy and in communication with authorities. Less is known about the psychological underpinnings of the COVID vaccination decision, specifically in the high-uncertainty circumstances due to the novelty of the virus. In a cross-sectional study, we investigated the predictive value of several cognitive (perceived risk, vulnerability, uncertainty, and trust in one's decision) and behavioral (previous vaccinations, social media use, and practicing preventive behavior) factors, for the vaccination decision against COVID-19, for 252 psychiatric inpatients (data collected between September 2021 and February 2022). Demographics and diagnostics were also considered. We found a significant relationship between the "Perceived risk of vaccination" and the choice of vaccination (χ2(2, N = 252) = 58.59, p ≤ 0.001), and between the "Trust in own decision to vaccinate" and the decision to vaccinate (χ2(2, N = 252) = 31,5, p ≤ 0.001). The overall regression model was statistically significant (χ2 (9, N = 252) = 97.1, p < 0.001), with between 30% and 45% of the variance in the odds of a positive decision explained by the predictor set. The model coefficients analysis showed that an individual with a psychiatric disorder but with higher confidence in their decision had significant (p < 0.001) increased odds of the decision to vaccinate against COVID-19 by 893%. A former voluntary vaccination did not significantly associate with the decision to vaccinate against COVID-19 (χ2(1, N = 252) = 2.74, p > 0.05) in this special population. No other behavioral factors, diagnosis, or demographics were significant as predictors, for the clinical psychiatric population surveyed, except the educational level. Implications for future vaccination acceptance of this special population are discussed.
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Affiliation(s)
- Gabriela Mariana Marcu
- Department of Psychology, Faculty of Social Sciences and Humanities, “Lucian Blaga” University of Sibiu, 550201 Sibiu, Romania
- Collective of Scientific Research in Neurosciences of the Clinical Psychiatry Hospital “Dr. Gheorghe Preda”, 550082 Sibiu, Romania
- Division of Physiology and Neuroscience, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ana Maria Radu
- Department of Psychology, Faculty of Social Sciences and Humanities, “Lucian Blaga” University of Sibiu, 550201 Sibiu, Romania
- Psychology Department, Faculty of Sociology and Psychology, West University of Timișoara, 300223 Timișoara, Romania
- Correspondence:
| | - Mihaela Dana Bucuță
- Department of Psychology, Faculty of Social Sciences and Humanities, “Lucian Blaga” University of Sibiu, 550201 Sibiu, Romania
| | - Radu Sorin Fleacă
- Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania
| | - Ciprian Tanasescu
- Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania
| | - Mihai Dan Roman
- Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania
| | - Adrian Boicean
- Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania
| | - Ciprian Ionuț Bacilă
- Collective of Scientific Research in Neurosciences of the Clinical Psychiatry Hospital “Dr. Gheorghe Preda”, 550082 Sibiu, Romania
- Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania
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Purcell JR, Herms EN, Morales J, Hetrick WP, Wisner KM, Brown JW. A review of risky decision-making in psychosis-spectrum disorders. Clin Psychol Rev 2022; 91:102112. [PMID: 34990988 PMCID: PMC8754677 DOI: 10.1016/j.cpr.2021.102112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/29/2021] [Accepted: 12/16/2021] [Indexed: 02/03/2023]
Abstract
The investigation of risky decision-making has a prominent place in clinical science, with sundry behavioral tasks aimed at empirically quantifying the psychological construct of risk-taking. However, use of differing behavioral tasks has resulted in lack of agreement on risky decision-making within psychosis-spectrum disorders, as findings fail to converge upon the typical, binary conceptualization of increased risk-seeking or risk-aversion. The current review synthesizes the behavioral, risky decision-making literature to elucidate how specific task parameters may contribute to differences in task performance, and their associations with psychosis symptomatology and cognitive functioning. A paring of the literature suggests that: 1) Explicit risk-taking may be characterized by risk imperception, evidenced by less discrimination between choices of varying degrees of risk, potentially secondary to cognitive deficits. 2) Ambiguous risk-taking findings are inconclusive with few published studies. 3) Uncertain risk-taking findings, consistently interpreted as more risk-averse, have not parsed risk attitudes from confounding processes that may impact decision-making (e.g. risk imperception, reward processing, motivation). Thus, overgeneralized interpretations of task-specific risk-seeking/aversion should be curtailed, as they may fail to appropriately characterize decision-making phenomena. Future research in psychosis-spectrum disorders would benefit from empirically isolating contributions of specific processes during risky decision-making, including the newly hypothesized risk imperception.
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Affiliation(s)
- John R Purcell
- Indiana University, Department of Psychological & Brain Sciences, USA; Indiana University, Program in Neuroscience, USA.
| | - Emma N Herms
- Indiana University, Department of Psychological & Brain Sciences, USA
| | - Jaime Morales
- Indiana University, Department of Psychological & Brain Sciences, USA; Indiana University, Program in Neuroscience, USA
| | - William P Hetrick
- Indiana University, Department of Psychological & Brain Sciences, USA; Indiana University, Program in Neuroscience, USA
| | - Krista M Wisner
- Indiana University, Department of Psychological & Brain Sciences, USA; Indiana University, Program in Neuroscience, USA
| | - Joshua W Brown
- Indiana University, Department of Psychological & Brain Sciences, USA; Indiana University, Program in Neuroscience, USA
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