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Wannan CMJ, Nelson B, Addington J, Allott K, Anticevic A, Arango C, Baker JT, Bearden CE, Billah T, Bouix S, Broome MR, Buccilli K, Cadenhead KS, Calkins ME, Cannon TD, Cecci G, Chen EYH, Cho KIK, Choi J, Clark SR, Coleman MJ, Conus P, Corcoran CM, Cornblatt BA, Diaz-Caneja CM, Dwyer D, Ebdrup BH, Ellman LM, Fusar-Poli P, Galindo L, Gaspar PA, Gerber C, Glenthøj LB, Glynn R, Harms MP, Horton LE, Kahn RS, Kambeitz J, Kambeitz-Ilankovic L, Kane JM, Kapur T, Keshavan MS, Kim SW, Koutsouleris N, Kubicki M, Kwon JS, Langbein K, Lewandowski KE, Light GA, Mamah D, Marcy PJ, Mathalon DH, McGorry PD, Mittal VA, Nordentoft M, Nunez A, Pasternak O, Pearlson GD, Perez J, Perkins DO, Powers AR, Roalf DR, Sabb FW, Schiffman J, Shah JL, Smesny S, Spark J, Stone WS, Strauss GP, Tamayo Z, Torous J, Upthegrove R, Vangel M, Verma S, Wang J, Rossum IWV, Wolf DH, Wolff P, Wood SJ, Yung AR, Agurto C, Alvarez-Jimenez M, Amminger P, Armando M, Asgari-Targhi A, Cahill J, Carrión RE, Castro E, Cetin-Karayumak S, Mallar Chakravarty M, Cho YT, Cotter D, D’Alfonso S, Ennis M, Fadnavis S, Fonteneau C, Gao C, Gupta T, Gur RE, Gur RC, Hamilton HK, Hoftman GD, Jacobs GR, Jarcho J, Ji JL, Kohler CG, Lalousis PA, Lavoie S, Lepage M, Liebenthal E, Mervis J, Murty V, Nicholas SC, Ning L, Penzel N, Poldrack R, Polosecki P, Pratt DN, Rabin R, Rahimi Eichi H, Rathi Y, Reichenberg A, Reinen J, Rogers J, Ruiz-Yu B, Scott I, Seitz-Holland J, Srihari VH, Srivastava A, Thompson A, Turetsky BI, Walsh BC, Whitford T, Wigman JTW, Yao B, Yuen HP, Ahmed U, Byun A(JS, Chung Y, Do K, Hendricks L, Huynh K, Jeffries C, Lane E, Langholm C, Lin E, Mantua V, Santorelli G, Ruparel K, Zoupou E, Adasme T, Addamo L, Adery L, Ali M, Auther A, Aversa S, Baek SH, Bates K, Bathery A, Bayer JMM, Beedham R, Bilgrami Z, Birch S, Bonoldi I, Borders O, Borgatti R, Brown L, Bruna A, Carrington H, Castillo-Passi RI, Chen J, Cheng N, Ching AE, Clifford C, Colton BL, Contreras P, Corral S, Damiani S, Done M, Estradé A, Etuka BA, Formica M, Furlan R, Geljic M, Germano C, Getachew R, Goncalves M, Haidar A, Hartmann J, Jo A, John O, Kerins S, Kerr M, Kesselring I, Kim H, Kim N, Kinney K, Krcmar M, Kotler E, Lafanechere M, Lee C, Llerena J, Markiewicz C, Matnejl P, Maturana A, Mavambu A, Mayol-Troncoso R, McDonnell A, McGowan A, McLaughlin D, McIlhenny R, McQueen B, Mebrahtu Y, Mensi M, Hui CLM, Suen YN, Wong SMY, Morrell N, Omar M, Partridge A, Phassouliotis C, Pichiecchio A, Politi P, Porter C, Provenzani U, Prunier N, Raj J, Ray S, Rayner V, Reyes M, Reynolds K, Rush S, Salinas C, Shetty J, Snowball C, Tod S, Turra-Fariña G, Valle D, Veale S, Whitson S, Wickham A, Youn S, Zamorano F, Zavaglia E, Zinberg J, Woods SW, Shenton ME. Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ): Rationale and Study Design of the Largest Global Prospective Cohort Study of Clinical High Risk for Psychosis. Schizophr Bull 2024; 50:496-512. [PMID: 38451304 PMCID: PMC11059785 DOI: 10.1093/schbul/sbae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
This article describes the rationale, aims, and methodology of the Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ). This is the largest international collaboration to date that will develop algorithms to predict trajectories and outcomes of individuals at clinical high risk (CHR) for psychosis and to advance the development and use of novel pharmacological interventions for CHR individuals. We present a description of the participating research networks and the data processing analysis and coordination center, their processes for data harmonization across 43 sites from 13 participating countries (recruitment across North America, Australia, Europe, Asia, and South America), data flow and quality assessment processes, data analyses, and the transfer of data to the National Institute of Mental Health (NIMH) Data Archive (NDA) for use by the research community. In an expected sample of approximately 2000 CHR individuals and 640 matched healthy controls, AMP SCZ will collect clinical, environmental, and cognitive data along with multimodal biomarkers, including neuroimaging, electrophysiology, fluid biospecimens, speech and facial expression samples, novel measures derived from digital health technologies including smartphone-based daily surveys, and passive sensing as well as actigraphy. The study will investigate a range of clinical outcomes over a 2-year period, including transition to psychosis, remission or persistence of CHR status, attenuated positive symptoms, persistent negative symptoms, mood and anxiety symptoms, and psychosocial functioning. The global reach of AMP SCZ and its harmonized innovative methods promise to catalyze the development of new treatments to address critical unmet clinical and public health needs in CHR individuals.
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Affiliation(s)
- Cassandra M J Wannan
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Barnaby Nelson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Kelly Allott
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Alan Anticevic
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, Instituto de Salud Carlos III, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Justin T Baker
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Boston, MA, USA
| | - Carrie E Bearden
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tashrif Billah
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sylvain Bouix
- Department of Software Engineering and Information Technology, École de technologie supérieure, Montréal, Canada
| | - Matthew R Broome
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
- Early Intervention for Psychosis Services, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Kate Buccilli
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | | | - Monica E Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | | | - Eric Yu Hai Chen
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Kang Ik K Cho
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jimmy Choi
- Olin Neuropsychiatry Research Center, Hartford Hospital, Hartford, CT, USA
| | - Scott R Clark
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
- Basil Hetzel Institute, Woodville, SA, Australia
| | - Michael J Coleman
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Philippe Conus
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP–Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Cheryl M Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Barbara A Cornblatt
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Covadonga M Diaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, Instituto de Salud Carlos III, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Dominic Dwyer
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Bjørn H Ebdrup
- Centre for Neuropsychiatric Schizophrenia Research, CNSR Mental Health Centre, Glostrup, Copenhagen, Denmark
| | - Lauren M Ellman
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, King’s College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Liliana Galindo
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Pablo A Gaspar
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
| | - Carla Gerber
- Behavioral Health Services, PeaceHealth Medical Group, Eugene, OR, USA
| | - Louise Birkedal Glenthøj
- Copenhagen Research Centre for Mental Health, Mental Health Copenhagen, University of Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Robert Glynn
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health and Harvard Medical School, Boston, MA, USA
| | - Michael P Harms
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Leslie E Horton
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - René S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph Kambeitz
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - John M Kane
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Tina Kapur
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Korea
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Marek Kubicki
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Kerstin Langbein
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Kathryn E Lewandowski
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Boston, MA, USA
| | - Gregory A Light
- Department of Psychiatry, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Health Care System, San Diego, CA, USA
| | - Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | | | - Daniel H Mathalon
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Mental Health Service 116D, Veterans Affairs San Francisco Health Care System, San Francisco, CA, USA
| | - Patrick D McGorry
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health, Mental Health Copenhagen, University of Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Angela Nunez
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Ofer Pasternak
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Godfrey D Pearlson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Olin Neuropsychiatry Research Center, Hartford Hospital, Hartford, CT, USA
| | - Jesus Perez
- CAMEO, Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Department of Medicine, Institute of Biomedical Research (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Albert R Powers
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - David R Roalf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fred W Sabb
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Jai L Shah
- PEPP-Montreal, Douglas Research Centre, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Stefan Smesny
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Jessica Spark
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - William S Stone
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | | | - Zailyn Tamayo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - John Torous
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Rachel Upthegrove
- Department of Software Engineering and Information Technology, École de technologie supérieure, Montréal, Canada
- Birmingham Womens and Childrens, NHS Foundation Trust, Birmingham, UK
| | - Mark Vangel
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Swapna Verma
- Department of Psychosis, Institute of Mental Health, Singapore
| | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Inge Winter-van Rossum
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Daniel H Wolf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Phillip Wolff
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Stephen J Wood
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
- School of Psychology, University of Birmingham, Edgbaston, UK
| | - Alison R Yung
- Institute of Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Carla Agurto
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Paul Amminger
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Marco Armando
- Youth Early Detection/Intervention in Psychosis Platform (Plateforme ERA), Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and The University of Lausanne, Lausanne, Switzerland
| | | | - John Cahill
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Ricardo E Carrión
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Eduardo Castro
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Suheyla Cetin-Karayumak
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Youngsun T Cho
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - David Cotter
- Department Psychiatry, Beaumont Hospital, Dublin 9, Ireland
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Simon D’Alfonso
- School of Computing and Information Systems, The University of Melbourne, Parkville, VIC, Australia
| | - Michaela Ennis
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Boston, MA, USA
| | - Shreyas Fadnavis
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Clara Fonteneau
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Caroline Gao
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Tina Gupta
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Holly K Hamilton
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Gil D Hoftman
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Grace R Jacobs
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Johanna Jarcho
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Jie Lisa Ji
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Christian G Kohler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paris Alexandros Lalousis
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Suzie Lavoie
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Martin Lepage
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Einat Liebenthal
- Program for Specialized Treatment Early in Psychosis (STEP), CMHC, New Haven, CT, USA
| | - Josh Mervis
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Vishnu Murty
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Spero C Nicholas
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | - Lipeng Ning
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Nora Penzel
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Russell Poldrack
- Department of Psychology, Stanford University, Stanford, CA, USA
| | | | - Danielle N Pratt
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Rachel Rabin
- PEPP-Montreal, Douglas Research Centre, Montreal, Quebec, Canada
| | | | - Yogesh Rathi
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Avraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jenna Reinen
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Jack Rogers
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Bernalyn Ruiz-Yu
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Isabelle Scott
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Johanna Seitz-Holland
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Vinod H Srihari
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), CMHC, New Haven, CT, USA
| | - Agrima Srivastava
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew Thompson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Bruce I Turetsky
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara C Walsh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Thomas Whitford
- Orygen, Parkville, VIC, Australia
- School of Psychology, University of New South Wales (UNSW), Kensington, NSW, Australia
| | - Johanna T W Wigman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center,Groningen, Netherlands
| | - Beier Yao
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Boston, MA, USA
| | - Hok Pan Yuen
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | | | - Andrew (Jin Soo) Byun
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Yoonho Chung
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Boston, MA, USA
| | - Kim Do
- Department of Psychiatry, Center for Psychiatric Neuroscience, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience King’s College London, London, UK
| | - Larry Hendricks
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Kevin Huynh
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Clark Jeffries
- Renaissance Computing Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Erlend Lane
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Carsten Langholm
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Eric Lin
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Boston, MA, USA
- Medical Informatics Fellowship, Veteran Affairs Boston Healthcare System, Boston, MA, USA
- Food and Drug Administration, Silver Spring, MD, USA
| | - Valentina Mantua
- Department of Psychiatry, Neurodevelopment & Psychosis Section, University of Pennsylvania, Philadelphia, PA, USA
| | - Gennarina Santorelli
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Kosha Ruparel
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Eirini Zoupou
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Tatiana Adasme
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
| | - Lauren Addamo
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Laura Adery
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Munaza Ali
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Andrea Auther
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Samantha Aversa
- PEPP-Montreal, Douglas Research Centre, Montreal, Quebec, Canada
| | - Seon-Hwa Baek
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Korea
| | - Kelly Bates
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Alyssa Bathery
- Department of Psychiatry, Neurodevelopment & Psychosis Section, University of Pennsylvania, Philadelphia, PA, USA
| | - Johanna M M Bayer
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Rebecca Beedham
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Zarina Bilgrami
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Sonia Birch
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Ilaria Bonoldi
- Department of Psychosis Studies, King’s College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Owen Borders
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Lisa Brown
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alejandro Bruna
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
| | - Holly Carrington
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Rolando I Castillo-Passi
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
- Department of Neurology and Psychiatry, Clínica Alemana—Universidad del Desarrollo, Santiago, Chile
| | - Justine Chen
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Nicholas Cheng
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Ann Ee Ching
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Chloe Clifford
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Beau-Luke Colton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Pamela Contreras
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
| | - Sebastián Corral
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Monica Done
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Andrés Estradé
- Early Psychosis Detection and Clinical Intervention (EPIC) Lab, Department of Psychosis Studies, King’s College London, London, UK
| | - Brandon Asika Etuka
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Melanie Formica
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Rachel Furlan
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Mia Geljic
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Carmela Germano
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Ruth Getachew
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | | | - Anastasia Haidar
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Jessica Hartmann
- Department of Public Mental Health, Central Institute of Mental Health, Heidelberg Univeristy, Mannheim, Germany
| | - Anna Jo
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Omar John
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Kerins
- Early Psychosis Detection and Clinical Intervention (EPIC) Lab, Department of Psychosis Studies, King’s College London, London, UK
| | - Melissa Kerr
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Irena Kesselring
- Department of Psychiatry, Neurodevelopment & Psychosis Section, University of Pennsylvania, Philadelphia, PA, USA
| | - Honey Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Nicholas Kim
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Kyle Kinney
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Marija Krcmar
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Elana Kotler
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Melanie Lafanechere
- School of Psychology, University of Birmingham, Edgbaston, UK
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Clarice Lee
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Joshua Llerena
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | | | | | | | - Aissata Mavambu
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
| | | | - Amelia McDonnell
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Alessia McGowan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Rebecca McIlhenny
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brittany McQueen
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Yohannes Mebrahtu
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Martina Mensi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | | | - Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | - Neal Morrell
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Mariam Omar
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Alice Partridge
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Christina Phassouliotis
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Christian Porter
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Umberto Provenzani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Nicholas Prunier
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Jasmine Raj
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Susan Ray
- Northwell Health, Glen Oaks, NY, USA
| | - Victoria Rayner
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Manuel Reyes
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
- Department of Neurology and Psychiatry, Clínica Alemana—Universidad del Desarrollo, Santiago, Chile
| | - Kate Reynolds
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Sage Rush
- Department of Psychiatry, Neurodevelopment & Psychosis Section, University of Pennsylvania, Philadelphia, PA, USA
| | - Cesar Salinas
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
| | - Jashmina Shetty
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Callum Snowball
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Sophie Tod
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | | | - Daniela Valle
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
| | - Simone Veale
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Whitson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Alana Wickham
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Youn
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Francisco Zamorano
- Unidad de imágenes cuantitativas avanzadas, departamento de imágenes, clínica alemana, universidad del Desarrollo, Santiago, Chile
- Facultad de ciencias para el cuidado de la salud, Universidad San Sebastián, Campus Los Leones, Santiago, Chile
| | - Elissa Zavaglia
- PEPP-Montreal, Douglas Research Centre, Montreal, Quebec, Canada
| | - Jamie Zinberg
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Martha E Shenton
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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2
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Smith WR, Appelbaum PS, Lebowitz MS, Gülöksüz S, Calkins ME, Kohler CG, Gur RE, Barzilay R. The Ethics of Risk Prediction for Psychosis and Suicide Attempt in Youth Mental Health. J Pediatr 2023; 263:113583. [PMID: 37353146 PMCID: PMC10828819 DOI: 10.1016/j.jpeds.2023.113583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/01/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To identify potential clinical utility of polygenic risk scores (PRS) and exposomic risk scores (ERS) for psychosis and suicide attempt in youth and assess the ethical implications of these tools. STUDY DESIGN We conducted a narrative literature review of emerging findings on PRS and ERS for suicide and psychosis as well as a literature review on the ethics of PRS. We discuss the ethical implications of the emerging findings for the clinical potential of PRS and ERS. RESULTS Emerging evidence suggests that PRS and ERS may offer clinical utility in the relatively near future but that this utility will be limited to specific, narrow clinical questions, in contrast to the suggestion that population-level screening will have sweeping impact. Combining PRS and ERS might optimize prediction. This clinical utility would change the risk-benefit balance of PRS, and further empirical assessment of proposed risks would be necessary. Some concerns for PRS, such as those about counseling, privacy, and inequities, apply to ERS. ERS raise distinct ethical challenges as well, including some that involve informed consent and direct-to-consumer advertising. Both raise questions about the ethics of machine-learning/artificial intelligence approaches. CONCLUSIONS Predictive analytics using PRS and ERS may soon play a role in youth mental health settings. Our findings help educate clinicians about potential capabilities, limitations, and ethical implications of these tools. We suggest that a broader discussion with the public is needed to avoid overenthusiasm and determine regulations and guidelines for use of predictive scores.
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Affiliation(s)
- William R Smith
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
| | - Paul S Appelbaum
- Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY; New York State Psychiatric Institute, New York, NY
| | - Matthew S Lebowitz
- Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - Sinan Gülöksüz
- Department of Psychiatry, Yale School of Medicine, New Haven, CT; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Monica E Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Christian G Kohler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA; Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Ran Barzilay
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA; Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
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3
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Jumper MBE, Friedman BR, Becker-Haimes EM, Dong F, Kohler CG, Hurford I, Calkins ME. Implementation of an Adapted Fidelity Scale for Pennsylvania Coordinated Specialty Care Programs for First Episode Psychosis. Prev Sci 2023:10.1007/s11121-023-01607-0. [PMID: 37943446 DOI: 10.1007/s11121-023-01607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/10/2023]
Abstract
Coordinated Specialty Care (CSC) is an evidence-based model for early intervention of first episode psychosis (FEP). Monitoring fidelity to CSC models is essential for proper evaluation of program outcomes and quality improvement. To address variability across CSC programs and fidelity assessment-associated burden, an adapted fidelity scale was developed and implemented statewide in Pennsylvania. This report describes the design and preliminary performance of the adapted scale. The Pennsylvania FEP Fidelity Scale (PA-FEP-FS) assesses adherence to the CSC model by focusing on essential model components of other established fidelity scales, in tandem with program evaluation data. Initial data from fourteen PA-FEP sites from 2018 to 2021 were examined as preliminary validation. Assessment-associated burdens and costs were also estimated. PA-FEP-FS captured essential components of CSC models and proved feasible for implementation across varying program structures, while minimizing burden and cost. Programs utilized annual feedback as CSC benchmarks, evidenced by increased scores over time. PA-FEP-FS provides a model for adapting CSC fidelity scales to meet state- or local-level requirements while reducing assessment burdens and costs that may be associated with existing scales.
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Affiliation(s)
- Megan B E Jumper
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Bess Rose Friedman
- Division of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Emily M Becker-Haimes
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Fanghong Dong
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Christian G Kohler
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Irene Hurford
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Monica E Calkins
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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4
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Didier PR, Moore TM, Calkins ME, Prettyman G, Levinson T, Savage C, de Moraes Leme LFV, Kohler CG, Kable J, Satterthwaite T, Gur RC, Gur RE, Wolf DH. Evaluation of a new intrinsic and extrinsic motivation scale in youth with psychosis spectrum symptoms. Compr Psychiatry 2023; 127:152413. [PMID: 37696094 PMCID: PMC10644398 DOI: 10.1016/j.comppsych.2023.152413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/16/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Impairment in intrinsic motivation (IM), the drive to satisfy internal desires like mastery, may play a key role in disability in psychosis. However, we have limited knowledge regarding relative impairments in IM compared to extrinsic motivation (EM) or general motivation (GM), in part due to limitations in existing measures. METHODS Here we address this gap using a novel Trait Intrinsic and Extrinsic Motivation self-report scale in a sample of n = 243 participants including those with schizophrenia, psychosis-risk, and healthy controls. Each of the 7 IM and 6 EM items used a 7-point Likert scale assessing endorsement of dispositional statements. Bifactor analyses of these items yielded distinct IM, EM, and GM factor scores. Convergent and discriminant validity were examined in relation to General Causality Orientation Scale (GCOS-CP) and Quality of Life 3-item IM measure (QLS-IM). Utility was assessed in relation to psychosis-spectrum (PS) status and CAINS clinical amotivation. RESULTS IM and EM showed acceptable inter-item consistency (IM: α = 0.88; EM: α = 0.66); the bifactor model exhibited fit that varied from good to borderline to inadequate depending on the specific fit metric (SRMR = 0.038, CFI = 0.94, RMSEA = 0.106 ± 0.014). IM scores correlated with established IM measures: GCOS-CP Autonomy (rho = 0.38, p < 0.01) and QLS-IM (rho = 0.29, p < 0.01). Supporting discriminant validity, IM did not correlate with GCOS-CP Control (rho = -0.14, p > 0.05). Two-year stability in an available longitudinal subset (n = 35) was strong (IM: rho = 0.64, p < 0.01; EM: rho = 0.55, p < 0.01). Trait IM was lower in PS youth (t = 4.24, p < 0.01), and correlated with clinical amotivation (rho = -0.36, p < 0.01); EM did not show significant clinical associations. CONCLUSIONS These results demonstrate the clinical relevance of IM in psychosis risk. They also provide preliminary support for the reliability, validity and utility of this new Trait IM-EM scale, which addresses a measurement gap and can facilitate identification of neurobehavioral and clinical correlates of IM deficits.
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Affiliation(s)
- Paige R Didier
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychology, University of Maryland, College Park, MD 20742, USA.
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Greer Prettyman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Tess Levinson
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Lynch School of Education and Human Development, Boston College, Chestnut Hill, MA 02467, USA
| | - Chloe Savage
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Christian G Kohler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joseph Kable
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Theodore Satterthwaite
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Daniel H Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
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5
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Jumper Westfall MBE, Dong F, Becker-Haimes EM, Miao L, Conroy C, Sarpal D, Abegunde C, Bennett M, Kohler CG, Calkins ME. COVID-19 Impacts on Pennsylvania Coordinated Specialty Care for Early Psychosis Participants. Disaster Med Public Health Prep 2023; 17:e488. [PMID: 37697955 DOI: 10.1017/dmp.2023.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVES The coronavirus disease (COVID-19) pandemic produced swift, extensive changes in daily life, including for first-episode psychosis (FEP) clients. This study examined pandemic-related psychosocial impacts to clients while engaged in Coordinated Specialty Care (CSC). We also examined FEP client vaccination rates, as vaccinations can reduce hospitalizations/deaths, and related worries. METHODS Thirty-one clients (45% female; ages 13-39; 26% black, 61% white) from Pennsylvania (PA) CSC outpatient programs completed an online survey evaluating exposure to COVID-19, associated worries, coping, and safety strategies. Descriptive statistics characterized responses and demographic group differences. Additional program evaluation data informed vaccination rates for PA FEP clients. RESULTS Participants reported substantial pandemic-related impacts to daily life. Many clients reported improved safety measures to protect themselves/others from COVID-19. Clients largely denied substantial worries about infection for themselves, reporting greater concern for loved ones. Multiple coping strategies were endorsed, which, with few exceptions, did not differ among demographic groups. FEP clients had a low reported rate of vaccination (28.6%) as of September 2021. CONCLUSIONS Observed prolonged pandemic effects may alter FEP client progress in CSC. Stakeholders should be prepared to adjust FEP treatment accordingly in the event of a similar disaster. Concentrated vaccination efforts may be necessary for this population.
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Affiliation(s)
- Megan B E Jumper Westfall
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fanghong Dong
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily M Becker-Haimes
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lucy Miao
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Catherine Conroy
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Deepak Sarpal
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Courtney Abegunde
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melanie Bennett
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Christian G Kohler
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Monica E Calkins
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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6
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Kohler CG, Wolf DH, Abi-Dargham A, Anticevic A, Cho YT, Fonteneau C, Gil R, Girgis RR, Gray DL, Grinband J, Javitch JA, Kantrowitz JT, Krystal JH, Lieberman JA, Murray JD, Ranganathan M, Santamauro N, Van Snellenberg JX, Tamayo Z, Gur RC, Gur RE, Calkins ME. Illness Phase as a Key Assessment and Intervention Window for Psychosis. Biol Psychiatry Glob Open Sci 2023; 3:340-350. [PMID: 37519466 PMCID: PMC10382701 DOI: 10.1016/j.bpsgos.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022] Open
Abstract
The phenotype of schizophrenia, regardless of etiology, represents the most studied psychotic disorder with respect to neurobiology and distinct phases of illness. The early phase of illness represents a unique opportunity to provide effective and individualized interventions that can alter illness trajectories. Developmental age and illness stage, including temporal variation in neurobiology, can be targeted to develop phase-specific clinical assessment, biomarkers, and interventions. We review an earlier model whereby an initial glutamate signaling deficit progresses through different phases of allostatic adaptation, moving from potentially reversible functional abnormalities associated with early psychosis and working memory dysfunction, and ending with difficult-to-reverse structural changes after chronic illness. We integrate this model with evidence of dopaminergic abnormalities, including cortical D1 dysfunction, which develop during adolescence. We discuss how this model and a focus on a potential critical window of intervention in the early stages of schizophrenia impact the approach to research design and clinical care. This impact includes stage-specific considerations for symptom assessment as well as genetic, cognitive, and neurophysiological biomarkers. We examine how phase-specific biomarkers of illness phase and brain development can be incorporated into current strategies for large-scale research and clinical programs implementing coordinated specialty care. We highlight working memory and D1 dysfunction as early treatment targets that can substantially affect functional outcome.
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Affiliation(s)
- Christian G. Kohler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel H. Wolf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anissa Abi-Dargham
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook
| | - Alan Anticevic
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Youngsun T. Cho
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Clara Fonteneau
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Roberto Gil
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook
| | - Ragy R. Girgis
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - David L. Gray
- Cerevel Therapeutics Research and Development, East Cambridge, Massachusetts
| | - Jack Grinband
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Jonathan A. Javitch
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
- Molecular Pharmacology and Therapeutics, Vagelos College of Physicians and Surgeons, Columbia University, New York
- Division of Molecular Therapeutics, New York State Psychiatric Institute, New York
| | - Joshua T. Kantrowitz
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
- New York State Psychiatric Institute, New York
- Nathan Kline Institute, Orangeburg, New York
| | - John H. Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey A. Lieberman
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - John D. Murray
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Mohini Ranganathan
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Nicole Santamauro
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jared X. Van Snellenberg
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook
| | - Zailyn Tamayo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Ruben C. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raquel E. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Monica E. Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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7
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Dong F, Jumper MBE, Becker-Haimes EM, Vatza C, Miao L, Conroy C, Bennett M, Sarpal DK, Abegunde C, Kohler CG, Calkins ME. Tele-mental Health Transitions for Pennsylvania Coordinated Specialty Care Programs for Early Psychosis During the COVID-19 Pandemic. Psychiatr Q 2023:10.1007/s11126-023-10015-0. [PMID: 36820952 PMCID: PMC9947877 DOI: 10.1007/s11126-023-10015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
This study examined provider and client perspectives of tele-mental health (TMH) in early psychosis care during the COVID-19 pandemic. To achieve this goal, thirty-three mental health providers and 31 clients from Pennsylvania Coordinated Specialty Care (CSC) programs completed web-based surveys assessing TMH usage, experiences, and perceptions between May and September 2020. Three additional TMH-related questions were asked two years later of PA CSC Program Directors between Feb and March 2022. Descriptive statistics characterized responses. Open-ended items were coded and grouped into themes for qualitative synthesis. As early as mid-2020, participants reported extensive use of TMH technologies, including telephone and video visits. Although most providers and clients preferred in-person care to TMH, most clients still found TMH to be comparable to or better than in-person care; 94% of clients indicated interest in future TMH services. Providers also noted more successes than challenges with TMH. Nine themes emerged regarding provider-perceived client characteristics that could benefit from TMH and were grouped into two categories: client-level (access to technology, comfort with technology, transportation, young age, symptom severity, functioning level, motivation for treatment adherence) and interpersonal-level (external support systems and engagement with program prior to the pandemic) characteristics. Two years later, program directors reported continued perceived advantages of TMH in CSCs, although some barriers persisted. Despite the unexpected shift to TMH in early psychosis programs during the COVID-19 pandemic, findings indicated a relatively positive transition to TMH and perceived promise of TMH as a sustained part of routine care.
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Affiliation(s)
- Fanghong Dong
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Megan B. E. Jumper
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Emily M. Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Crystal Vatza
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Lucille(Lucy) Miao
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Catherine Conroy
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Melanie Bennett
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD USA
| | - Deepak K. Sarpal
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Courtney Abegunde
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Christian G. Kohler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Monica E. Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
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8
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Nelson EB, Franco OH, Patton BA, Schmidt LR, Lawley HS, Calkins ME, Kohler CG. Telehealth of Coordinated Specialty Care in Early Psychosis During COVID-19. J Clin Psychiatry 2022; 84. [PMID: 36449475 DOI: 10.4088/jcp.21m14259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: The coronavirus 2019 (COVID-19) pandemic forced health care globally to provide remote services when feasible. In March 2020, psychiatric outpatient services across the United States transitioned to telehealth. Persons with early psychosis (EP) face challenges to maintain connection with care, an important element associated with better outcome. The ongoing pandemic offers the opportunity to review the feasibility of EP services using telehealth and to evaluate implications for continued implementation. Methods: We examined delivery of coordinated specialty care (CSC) for 49 individuals aged 16-30 years enrolled in an EP (first-episode psychosis and clinical high risk) university-affiliated outpatient clinic located in Philadelphia, Pennsylvania, from March 2020 to July 2021, during which most appointments were delivered through telehealth. The services evaluated in this setting include psychotherapy, medication management, employment and educational services, peer support, and multifamily psychoeducation group. We compared completed and missed appointment rates across services and new enrollment rates with in-person versus hybrid telehealth and in-person care pre-COVID-19 and during the pandemic. Results: In 6 months pre-COVID-19 (September 2019-February 2020), the Psychosis Evaluation and Recovery Center enrolled a mean of 4 people/mo compared to during the pandemic (March 2020-July 2021), when a mean of 2.2 people/mo were enrolled. The total number of completed psychology appointments pre-COVID-19 ranged from 51 to 88 and during the pandemic ranged from 72 to 137. The rate of missed psychology appointments ranged from 1.4% to 6.4% pre-COVID-19 and from 3.4% to 11.3% during the pandemic. The total number of completed medication management appointments pre-COVID-19 ranged from 35 to 59 and during the pandemic ranged from 22 to 66. The rate of missed medication management appointments ranged from 2.1% to 8.0% pre-COVID-19 and from 1.7% to 9.1% during the pandemic. The total number of completed supported education and employment services appointments pre-COVID-19 ranged from 5 to 11 and during the pandemic ranged from 3 to 16. Finally, the mean number of family members in attendance at the family psychoeducation group was 8.3 pre-COVID-19 and 17.1 during the pandemic. Conclusions: New and continued engagement across services in EP CSC during the COVID-19 pandemic supports feasibility of telehealth and suggests that offering a hybrid model of in-person and telehealth should be considered once restrictions are lifted.
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Affiliation(s)
- Elisa B Nelson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Beck Institute Center for Recovery-Oriented Cognitive Therapy, Beck Institute for Cognitive Behavior Therapy, Bala Cynwyd, Pennsylvania.,Now also with Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Corresponding author: Elisa B. Nelson, PhD, Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 10 Gates, 3400 Spruce St, Philadelphia, PA 19104
| | - Olivia H Franco
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bridgette A Patton
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lyndsay R Schmidt
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - H Steven Lawley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Monica E Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christian G Kohler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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9
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Franco OH, Calkins ME, Giorgi S, Ungar LH, Gur RE, Kohler CG, Tang SX. Feasibility of Mobile Health and Social Media–Based Interventions for Young Adults With Early Psychosis and Clinical Risk for Psychosis: Survey Study. JMIR Form Res 2022; 6:e30230. [PMID: 35802420 PMCID: PMC9308069 DOI: 10.2196/30230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 03/21/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022] Open
Abstract
Background Digital technology, the internet, and social media are increasingly investigated as promising means for monitoring symptoms and delivering mental health treatment. These apps and interventions have demonstrated preliminary acceptability and feasibility, but previous reports suggest that access to technology may still be limited among individuals with psychotic disorders relative to the general population. Objective We evaluated and compared access to and use of technology and social media in young adults with psychotic disorders (PD), young adults with clinical risk for psychosis (CR), and psychosis-free youths (PF). Methods Participants were recruited through a coordinated specialty care clinic dedicated toward early psychosis as well as ongoing studies. We surveyed 21 PD, 23 CR, and 15 PF participants regarding access to technology and use of social media, specifically Facebook and Twitter. Statistical analyses were conducted in R. Categorical variables were compared among groups using Fisher exact test, continuous variables were compared using 1-way ANOVA, and multiple linear regressions were used to evaluate for covariates. Results Access to technology and social media were similar among PD, CR, and PF participants. Individuals with PD, but not CR, were less likely to post at a weekly or higher frequency compared to PF individuals. We found that decreased active social media posting was unique to psychotic disorders and did not occur with other psychiatric diagnoses or demographic variables. Additionally, variation in age, sex, and White versus non-White race did not affect posting frequency. Conclusions For young people with psychosis spectrum disorders, there appears to be no “technology gap” limiting the implementation of digital and mobile health interventions. Active posting to social media was reduced for individuals with psychosis, which may be related to negative symptoms or impairment in social functioning.
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Affiliation(s)
- Olivia H Franco
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Salvatore Giorgi
- Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Lyle H Ungar
- Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Christian G Kohler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Sunny X Tang
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
- Feinstein Institutes for Medical Research, Northwell Health, Glen Oaks, NY, United States
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10
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Crow AJD, Janssen JM, Marshall C, Moffit A, Brennan L, Kohler CG, Roalf DR, Moberg PJ. A systematic review and meta-analysis of intellectual, neuropsychological, and psychoeducational functioning in neurofibromatosis type 1. Am J Med Genet A 2022; 188:2277-2292. [PMID: 35546306 PMCID: PMC9302478 DOI: 10.1002/ajmg.a.62773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/27/2022] [Accepted: 04/06/2022] [Indexed: 01/07/2023]
Abstract
Neurofibromatosis Type 1 (NF1) is a common genetic disorder frequently associated with cognitive deficits. Despite cognitive deficits being a key feature of NF1, the profile of such impairments in NF1 has been shown to be heterogeneous. Thus, we sought to quantitatively synthesize the extant literature on cognitive functioning in NF1. A random-effects meta-analysis of cross-sectional studies was carried out comparing cognitive functioning of patients with NF1 to typically developing or unaffected sibling comparison subjects of all ages. Analyses included 50 articles (Total NNF1 = 1,522; MAge = 15.70 years, range = 0.52-69.60), yielding 460 effect sizes. Overall moderate deficits were observed [g = -0.64, 95% CI = (-0.69, -0.60)] wherein impairments differed at the level of cognitive domain. Deficits ranged from large [general intelligence: g = -0.95, 95% CI = (-1.12, -0.79)] to small [emotion: g = -0.37, 95% CI = (-0.63, -0.11)]. Moderation analyses revealed nonsignificant contributions of age, sex, educational attainment, and parental level of education to outcomes. These results illustrate that cognitive impairments are diffuse and salient across the lifespan in NF1. Taken together, these results further demonstrate efforts should be made to evaluate and address cognitive morbidity in patients with NF1 in conjunction with existing best practices.
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Affiliation(s)
- Andrew J D Crow
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennica M Janssen
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Carolina Marshall
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Psychology, Hope College, Holland, Michigan, USA
| | - Anne Moffit
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Biology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Christian G Kohler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David R Roalf
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Paul J Moberg
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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11
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Westfall MBE, Kohler CG, Hurford I, Abegunde C, Agosti D, Brinen A, Cadman ML, Conroy C, Ered A, Fooks A, Franco O, Huque ZM, Namowicz D, O'Connor S, Oross M, Payne E, Sarpal DK, Schmidt LR, Swigart A, Wenzel RM, Calkins ME. Pennsylvania coordinated specialty care programs for first-episode psychosis: 6- and 12-month outcomes. Early Interv Psychiatry 2021; 15:1395-1408. [PMID: 33283472 DOI: 10.1111/eip.13084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/16/2020] [Accepted: 11/14/2020] [Indexed: 01/21/2023]
Abstract
AIM Pennsylvania (PA) first-episode psychosis (FEP) program evaluation is a statewide initiative, supported by the PA Office of Mental Health and Substance Abuse Services (PA-OMHSAS) and administered by PA Early Intervention Center/Heads Up, which evaluates fidelity and outcomes of PA Coordinated Specialty Care (CSC) programs. Programs participate in standard computerized measures of CSC outcomes using centralized informatics. The aims of the current report are to describe implementation of this core battery for program evaluation in PA and to present 6- and 12-month outcomes. METHODS Participants (n = 697) from nine PA CSC programs completed the core battery at admission. The battery was re-administered at 6- and 12-month follow-up, and data were analysed for individuals (n = 230) who had completed 12-months of treatment. Domains assessed via clinician report and/or self-report included symptoms, role and social functioning, self-perceived recovery and service utilization. RESULTS PA FEP CSC participants showed improvement over time in several domains, including decreased symptoms, higher role and social functioning, decreased hospitalizations, and improved self-perception of recovery, quality of life, and services satisfaction. Trends towards improvements were observed for participant happiness, hopelessness, and school-enrolment. Nearly all improvements were observed at 6-month follow-up, with earlier gains maintained at 12-months. CONCLUSIONS PA FEP CSC programs demonstrate the ability to assess and improve critical outcomes of coordinated specialty care in PA. Improved outcomes by 12 months in treatment provides evidence of an effective treatment model and supports the continuation of these programs in pursuit of our goal of reducing schizophrenia disease burden on individuals and society.
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Affiliation(s)
- Megan B E Westfall
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian G Kohler
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Irene Hurford
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Courtney Abegunde
- STEP Clinic, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Dominick Agosti
- Connect 2 Empower, CMSU Behavioral Health Services, Danville, Pennsylvania, USA
| | - Aaron Brinen
- Department of Psychiatry, Drexel College of Medicine, Philadelphia, Pennsylvania, USA
| | - Mary Lyn Cadman
- Connect 2 Empower, CMSU Behavioral Health Services, Danville, Pennsylvania, USA
| | - Catherine Conroy
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arielle Ered
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Amanda Fooks
- CAPSTONE, Pennsylvania Psychiatric Institute, Harrisburg, Pennsylvania, USA
| | - Olivia Franco
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zeeshan M Huque
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Denise Namowicz
- Helping to Overcome Psychosis Early (HOPE), Children's Service Center, Wilks-Barre, Pennsylvania, USA
| | - Seamus O'Connor
- On My Way, Child and Family Focus, Inc., Broomall, Pennsylvania, USA
| | - Molly Oross
- ENGAGE, Wesley Family Services, Pittsburgh, Pennsylvania, USA
| | - Elisa Payne
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Deepak K Sarpal
- STEP Clinic, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Lyndsay R Schmidt
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alison Swigart
- CAPSTONE, Pennsylvania Psychiatric Institute, Harrisburg, Pennsylvania, USA
| | | | - Monica E Calkins
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Weiss EM, Kohler CG, Brensinger CM, Bilker WB, Loughead J, Delazer M, Nolan KA. Gender differences in facial emotion recognition in persons with chronic schizophrenia. Eur Psychiatry 2020; 22:116-22. [PMID: 17137757 DOI: 10.1016/j.eurpsy.2006.05.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 05/09/2006] [Accepted: 05/11/2006] [Indexed: 10/23/2022] Open
Abstract
AbstractBackgroundThe aim of the present study was to investigate possible sex differences in the recognition of facial expressions of emotion and to investigate the pattern of classification errors in schizophrenic males and females. Such an approach provides an opportunity to inspect the degree to which males and females differ in perceiving and interpreting the different emotions displayed to them and to analyze which emotions are most susceptible to recognition errors.MethodsFifty six chronically hospitalized schizophrenic patients (38 men and 18 women) completed the Penn Emotion Recognition Test (ER40), a computerized emotion discrimination test presenting 40 color photographs of evoked happy, sad, anger, fear expressions and neutral expressions balanced for poser gender and ethnicity.ResultsWe found a significant sex difference in the patterns of error rates in the Penn Emotion Recognition Test. Neutral faces were more commonly mistaken as angry in schizophrenic men, whereas schizophrenic women misinterpreted neutral faces more frequently as sad. Moreover, female faces were better recognized overall, but fear was better recognized in same gender photographs, whereas anger was better recognized in different gender photographs.ConclusionsThe findings of the present study lend support to the notion that sex differences in aggressive behavior could be related to a cognitive style characterized by hostile attributions to neutral faces in schizophrenic men.
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Affiliation(s)
- Elisabeth M Weiss
- Department of General Psychiatry, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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13
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Tang SX, Seelaus KH, Moore TM, Taylor J, Moog C, O'Connor D, Burkholder M, Kohler CG, Grant PM, Eliash D, Calkins ME, Gur RE, Gur RC. Theatre improvisation training to promote social cognition: A novel recovery-oriented intervention for youths at clinical risk for psychosis. Early Interv Psychiatry 2020; 14:163-171. [PMID: 31177635 PMCID: PMC7446755 DOI: 10.1111/eip.12834] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/19/2019] [Accepted: 04/14/2019] [Indexed: 12/16/2022]
Abstract
AIM Few interventions address social cognition or functioning in individuals at clinical risk (CR) for psychosis. Theatre Improvisation Training to Promote Social Cognition (TIPS) is a manualized intervention based on drama therapy. We aim to describe TIPS, evaluate feasibility and acceptability, and present a preliminary investigation of outcomes in a quasi-experimental design. METHODS Thirty-six CR participants (15-25 years) were ascertained from the Philadelphia Neurodevelopmental Cohort. Twenty-six completed the TIPS protocol: 18 weekly 2-hour group sessions led by a theatre director and actor-assistant. Participants engaged in collaborative acting and improvisation exercises. Baseline and follow-up assessments included the Clinical Assessment Interview for Negative Symptoms (CAINS), Structured Interview for Prodromal Syndromes, Global Assessment of Functioning (GAF) and Penn Computerized Neurocognitive Battery (CNB), which includes social cognitive tests. Acceptability was assessed using focus groups. Preliminary outcomes were compared to CR controls who were not enrolled in the study but completed follow-up assessments using the same methods. RESULTS There were no significant differences in baseline demographics, psychosis symptoms, or cognition between those who did and did not complete the protocol. Overall, TIPS was considered feasible and acceptable among CR. Preliminary outcomes suggest that TIPS may be effective in improving positive and negative psychosis-spectrum symptoms and GAF, but not performance on facial emotion processing. CONCLUSIONS TIPS is a promising and acceptable intervention that may improve symptoms and functioning in CR while providing a framework for participants to develop more empowered and confident ways of relating to others. Larger randomized controlled trials investigating TIPS efficacy are warranted.
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Affiliation(s)
- Sunny X Tang
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.,University of Pennsylvania and Children's Hospital of Philadelphia, Lifespan Brain Institute, Philadelphia, Pennsylvania
| | - Kevin H Seelaus
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.,University of Pennsylvania and Children's Hospital of Philadelphia, Lifespan Brain Institute, Philadelphia, Pennsylvania
| | - Jerome Taylor
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,University of Pennsylvania and Children's Hospital of Philadelphia, Lifespan Brain Institute, Philadelphia, Pennsylvania
| | - Carol Moog
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David O'Connor
- Theater Arts Program, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marla Burkholder
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christian G Kohler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul M Grant
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dvora Eliash
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.,University of Pennsylvania and Children's Hospital of Philadelphia, Lifespan Brain Institute, Philadelphia, Pennsylvania
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,University of Pennsylvania and Children's Hospital of Philadelphia, Lifespan Brain Institute, Philadelphia, Pennsylvania
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,University of Pennsylvania and Children's Hospital of Philadelphia, Lifespan Brain Institute, Philadelphia, Pennsylvania
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14
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Moberg PJ, Turetsky BI, Moberg EA, Kohler CG, Tang SX, Gur RC, Gur RE, Roalf DR. Meta-analysis of olfactory dysfunction in 22q11.2 deletion syndrome. Psychiatry Res 2020; 285:112783. [PMID: 32014626 DOI: 10.1016/j.psychres.2020.112783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 12/13/2022]
Abstract
A quantitative review of literature concerning olfactory function in 22q11.2 deletion syndrome (22q11DS) patients was performed detailing the scope/magnitude of deficits and probing possible moderators. We searched MEDLINE, EMBASE and PubMed to identify studies for inclusion. Effect sizes were based on differences in psychophysical olfactory tests between 22q11DS patients (n = 194) and typically developing comparison subjects (n = 466). 22q11DS patients exhibited marked olfactory dysfunction (d=-1.11, 95% CI=-1.29<δ<-0.92) that was homogeneous (p = 0.86). Diffuse olfactory deficits were seen which were not moderated by age or sex. 22q11DS patients exhibit large/diffuse deficits in olfactory function that are of a similar magnitude to observed neuropsychological impairments.
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Affiliation(s)
- Paul J Moberg
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Otorhinolaryngology: Head & Neck Surgery.
| | - Bruce I Turetsky
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Emily A Moberg
- Markets and Food Research, World Wildlife Fund, Washington D.C, USA
| | - Christian G Kohler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sunny X Tang
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Lifespan Brain Institute (LiBi), University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, PA, USA
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Lifespan Brain Institute (LiBi), University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, PA, USA
| | - David R Roalf
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Lifespan Brain Institute (LiBi), University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, PA, USA
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15
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Quarmley M, Gur RC, Turetsky BI, Watters AJ, Bilker WB, Elliott MA, Calkins ME, Kohler CG, Ruparel K, Rupert P, Gur RE, Wolf DH. Reduced safety processing during aversive social conditioning in psychosis and clinical risk. Neuropsychopharmacology 2019; 44:2247-2253. [PMID: 31112989 PMCID: PMC6898578 DOI: 10.1038/s41386-019-0421-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/29/2019] [Accepted: 05/08/2019] [Indexed: 12/31/2022]
Abstract
Social impairment occurs across the psychosis spectrum, but its pathophysiology remains poorly understood. Here we tested the hypothesis that reduced differential responses (aversive vs. neutral) in neural circuitry underpinning aversive conditioning of social stimuli characterizes the psychosis spectrum. Participants age 10-30 included a healthy control group (HC, analyzed n = 36) and a psychosis spectrum group (PSY, n = 71), including 49 at clinical risk for psychosis and 22 with a frank psychotic disorder. 3T fMRI utilized a passive aversive conditioning paradigm, with neutral faces as conditioned stimuli (CS) and a scream as the unconditioned stimulus. fMRI conditioning was indexed as the activation difference between aversive and neutral trials. Analysis focused on amygdala, ventromedial prefrontal cortex, and anterior insula, regions previously implicated in aversive and social-emotional processing. Ventromedial prefrontal cortex activated more to neutral than aversive CS; this "safety effect" was driven by HC and reduced in PSY, and correlated with subjective emotional ratings following conditioning. Insula showed the expected aversive conditioning effect, and although no group differences were found, its activation in PSY correlated with anxiety severity. Unexpectedly, amygdala did not show aversive conditioning; its activation trended greater for neutral than aversive CS, and did not differ significantly based on group or symptom severity. We conclude that abnormalities in social aversive conditioning are present across the psychosis spectrum including clinical risk, linked to a failure of safety processing. Aversive and safety learning provide translational paradigms yielding insight into pathophysiology of psychosis risk, and providing potential targets for therapeutic and preventative interventions.
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Affiliation(s)
- Megan Quarmley
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Ruben C. Gur
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Bruce I. Turetsky
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Anna J. Watters
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Warren B. Bilker
- 0000 0004 1936 8972grid.25879.31Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Mark A. Elliott
- 0000 0004 1936 8972grid.25879.31Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Monica E. Calkins
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Christian G. Kohler
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Kosha Ruparel
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Petra Rupert
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Raquel E. Gur
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Daniel H. Wolf
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
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16
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Dress EM, Frasso R, Calkins ME, Curry AE, Kohler CG, Schmidt LR, Sisti DA. Comparing Patient, Clinician, and Caregiver Perceptions of Care for Early Psychosis: A Free Listing Study. Narrat Inq Bioeth 2018; 8:157-178. [PMID: 30220700 DOI: 10.1353/nib.2018.0054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Models for early psychosis intervention often involve shared decision-making among patients, their caregivers, and clinicians. However, this process rests on a shared understanding of constructs, experiences, and language. This study examined how various aspects of early psychosis care were conceptualized by those involved in the help-seeking process, and the extent to which their perceptions aligned with one another. We conducted a free listing study to systematically explore perceptions of the help-seeking process and management of psychosis-related symptoms among a sample of 65 patients, caregivers, and clinicians at an early psychosis intervention clinic. Results indicated varying levels of agreement between different roles on getting or giving help, taking medications, factors influencing symptom management, and thoughts regarding the future. These findings highlight important differences and emphasize a need for further exploration of how stakeholder perceptions may influence decisions surrounding the care of individuals experiencing early psychosis.
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Tang SX, Moore TM, Calkins ME, Yi JJ, Savitt A, Kohler CG, Souders MC, Zackai EH, McDonald-McGinn DM, Emanuel BS, Gur RC, Gur RE. The Psychosis Spectrum in 22q11.2 Deletion Syndrome Is Comparable to That of Nondeleted Youths. Biol Psychiatry 2017; 82:17-25. [PMID: 27832840 PMCID: PMC5342951 DOI: 10.1016/j.biopsych.2016.08.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/15/2016] [Accepted: 08/30/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chromosome 22q11.2 deletion syndrome (22q11DS) is a promising model for studying psychosis risk. Direct comparisons of psychosis features between 22q11DS and nondeleted (ND) individuals are limited by inconsistency and small samples. In the largest study to date, we compare 22q11DS to ND in comorbidities, functioning, cognition, and psychosis features across the full range of overall severity. METHODS ND youths (n = 150) ages 9 to 24 years were matched to 22q11DS individuals (n = 150) on age and sex, stratifying for presence of psychosis spectrum disorder. Individuals were evaluated for psychosis using the Structured Interview for Prodromal Syndromes, and for attention-deficit/hyperactivity, substance-related, and mood disorders. Differential item functioning analysis addressed whether 22q11DS differs from ND in the probability of clinically significant ratings while holding constant the overall level of psychosis. RESULTS Onset of psychosis proneness was similar among 22q11DS (mean: 11.0 years) and ND (mean: 12.1 years) individuals. Accounting for higher overall psychosis symptoms, 22q11DS participants were still more likely to manifest impaired stress tolerance, avolition, and ideational richness; ND individuals were more likely to exhibit unusual thoughts, persecutory ideas, and bizarre thinking. Cognition was impaired in 22q11DS, but it did not correlate with symptoms except ideational richness. Comorbid anxiety disorders were more likely in psychosis spectrum 22q11DS; substance-related disorders were more likely in ND. Global assessment of function was similar in 22q11DS and ND individuals, except among those with low total Structured Interview for Prodromal Syndromes scores. CONCLUSIONS Individuals with 22q11DS share overarching similarities with ND individuals in psychosis symptoms and age of onset for psychosis proneness; this continues to support the 22q11DS model as a valuable window into mechanisms contributing to psychosis.
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Affiliation(s)
- Sunny X Tang
- Department of Psychiatry, Philadelphia, Pennsylvania.
| | - Tyler M Moore
- Department of Psychiatry, Philadelphia, Pennsylvania
| | | | - James J Yi
- Department of Psychiatry, Philadelphia, Pennsylvania; Department of Child and Adolescent Psychiatry, Philadelphia, Pennsylvania
| | - Adam Savitt
- Department of Psychiatry, Philadelphia, Pennsylvania
| | | | - Margaret C Souders
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elaine H Zackai
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Donna M McDonald-McGinn
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Beverly S Emanuel
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ruben C Gur
- Department of Psychiatry, Philadelphia, Pennsylvania
| | - Raquel E Gur
- Department of Psychiatry, Philadelphia, Pennsylvania; Department of Child and Adolescent Psychiatry, Philadelphia, Pennsylvania
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18
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Calkins ME, Moore TM, Satterthwaite TD, Wolf DH, Turetsky BI, Roalf DR, Merikangas KR, Ruparel K, Kohler CG, Gur RC, Gur RE. Persistence of psychosis spectrum symptoms in the Philadelphia Neurodevelopmental Cohort: a prospective two-year follow-up. World Psychiatry 2017; 16:62-76. [PMID: 28127907 PMCID: PMC5269480 DOI: 10.1002/wps.20386] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Prospective evaluation of youths with early psychotic-like experiences can enrich our knowledge of clinical, biobehavioral and environmental risk and protective factors associated with the development of psychotic disorders. We aimed to investigate the predictors of persistence or worsening of psychosis spectrum features among US youth through the first large systematic study to evaluate subclinical symptoms in the community. Based on Time 1 screen of 9,498 youth (age 8-21) from the Philadelphia Neurodevelopmental Cohort, a subsample of participants was enrolled based on the presence (N=249) or absence (N=254) of baseline psychosis spectrum symptoms, prior participation in neuroimaging, and current neuroimaging eligibility. They were invited to participate in a Time 2 assessment two years on average following Time 1. Participants were administered the Structured Interview for Prodromal Syndromes, conducted blind to initial screen status, along with the Schizotypal Personality Questionnaire and other clinical measures, computerized neurocognitive testing, and neuroimaging. Clinical and demographic predictors of symptom persistence were examined using logistic regression. At Time 2, psychosis spectrum features persisted or worsened in 51.4% of youths. Symptom persistence was predicted by higher severity of subclinical psychosis, lower global functioning, and prior psychiatric medication at baseline. Youths classified as having psychosis spectrum symptoms at baseline but not at follow-up nonetheless exhibited comparatively higher symptom levels and lower functioning at both baseline and follow-up than typically developing youths. In addition, psychosis spectrum features emerged in a small number of young people who previously had not reported significant symptoms but who had exhibited early clinical warning signs. Together, our findings indicate that varying courses of psychosis spectrum symptoms are evident early in US youth, supporting the importance of investigating psychosis risk as a dynamic developmental process. Neurocognition, brain structure and function, and genomics may be integrated with clinical data to provide early indices of symptom persistence and worsening in youths at risk for psychosis.
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Affiliation(s)
- Monica E. Calkins
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Tyler M. Moore
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Theodore D. Satterthwaite
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Daniel H. Wolf
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Bruce I. Turetsky
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - David R. Roalf
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Kathleen R. Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental HealthBethesdaMDUSA
| | - Kosha Ruparel
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Christian G. Kohler
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Ruben C. Gur
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Raquel E. Gur
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
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19
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Yi JJ, Calkins ME, Tang SX, Kohler CG, McDonald-McGinn DM, Zackai EH, Savitt AP, Bilker WB, Whinna DA, Souders MC, Emanuel BS, Gur RC, Gur RE. Impact of psychiatric comorbidity and cognitive deficit on function in 22q11.2 deletion syndrome. J Clin Psychiatry 2015; 76:e1262-70. [PMID: 26528648 DOI: 10.4088/jcp.14m09197] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 10/22/2014] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Presence of psychiatric comorbidity is associated with poor functioning and is an important consideration in treatment. Many individuals with 22q11.2 deletion syndrome (22q11DS) develop comorbid psychiatric disorders, yet its pattern and impact on functioning have not been formally investigated. In this cross-sectional study, we examined the relationship between comorbid psychopathology and neurocognitive deficits and their association with global functioning. We hypothesized that higher psychiatric burden and psychosis-spectrum features would be associated with reduced functioning and increased neurocognitive deficits. METHOD The cohort included 171 individuals with 22q11DS and mean (SD) age of 17.4 (8.1) years, recruited from a tertiary children's hospital and nationally through social media between September 2010 and December 2013. Psychiatric diagnoses and functioning were assessed using semistructured interviews and the Global Assessment of Functioning (GAF) scale, respectively. On the basis of psychopathology and number of comorbid diagnoses, participants were assigned to unaffected (n = 32), nonpsychosis spectrum (n = 24), nonpsychosis spectrum-plus (n = 15), psychosis spectrum (n = 29), and psychosis spectrum-plus (n = 71) groups. Executive function, episodic memory, complex cognition, social cognition, and praxis speed were assessed using a computerized neurocognitive battery (CNB). Cognitive profile and GAF scores were compared among the groups, and the association of GAF with cognitive performance and psychopathology was examined. RESULTS We observed high rates of comorbid psychiatric disorders. Approximately 50% of the participants had ≥ 2 diagnoses. Psychosis spectrum disorders were most frequently comorbid with other disorders. GAF score was progressively worse with increased psychiatric burden. Mean (SD) GAF score for the unaffected group (81.1 [8.9]) was significantly different from those of nonpsychosis spectrum (68.6 [12.1]), nonpsychosis spectrum-plus (63.4 [8.8]), psychosis spectrum (58.7 [13.1]), or psychosis spectrum-plus (55.5 [13.3]) (P < .05) groups. All groups performed poorly and were comparable to each other on the CNB (P = .273). Notably, verbal memory (P = .003), spatial processing (P = .001), and parent education level (P < .001) were significantly associated with GAF. CONCLUSIONS Individuals with 22q11DS have high rates of comorbid psychiatric disorders and diffuse cognitive deficits regardless of psychiatric burden. Those with psychotic spectrum disorders and comorbid psychiatric disorders are at an increased risk for poor overall functioning.
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Affiliation(s)
- James J Yi
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 10th Floor Gates Pavilion, Philadelphia, PA 19104
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20
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Tang SX, Yi JJ, Moore TM, Calkins ME, Kohler CG, Whinna DA, Souders MC, Zackai EH, McDonald-McGinn DM, Emanuel BS, Bilker WB, Gur RC, Gur RE. Subthreshold psychotic symptoms in 22q11.2 deletion syndrome. J Am Acad Child Adolesc Psychiatry 2014; 53:991-1000.e2. [PMID: 25151422 PMCID: PMC4159384 DOI: 10.1016/j.jaac.2014.05.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/13/2014] [Accepted: 06/16/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Chromosome 22q11.2 deletion syndrome (22q11DS) confers 25% risk for psychosis and is an invaluable window for understanding the neurobiological substrate of psychosis risk. The Structured Interview for Prodromal Syndromes (SIPS) is well validated in nondeleted populations for detecting clinical risk but has only recently been applied to 22q11DS. We assessed the largest 22q11DS cohort to date and report on SIPS implementation and symptoms elicited. METHOD The SIPS, including its 19 subscales, was administered to 157 individuals with 22q11DS aged 8 to 25 years. Youth and caregiver interviews were conducted and rated separately, then compared for agreement. Implementation of the SIPS in 22q11DS was challenging because of the prevalence of developmental delay and comorbid conditions. However, by explaining questions and eliciting examples, we were able to help youths and caregivers understand and respond appropriately. Consensus ratings were formulated and analyzed with itemwise and factor analysis. RESULTS Subthreshold symptoms were common, with 85% of individuals endorsing 1 or more. The most commonly rated items were ideational richness (47%) and trouble with focus and attention (44%). Factor analysis revealed a 3-factor solution with positive, negative, and disorganized components. Youth-caregiver comparisons suggested that youths report greater symptoms of perceptual abnormalities, suspiciousness, trouble with emotional expression, and bizarre thinking. Caregivers reported more impaired tolerance to normal stress, poor hygiene, and inattention. CONCLUSION The SIPS was adapted for 22q11DS through comprehensive and semi-structured administration methods, yielding a high prevalence of subthreshold psychotic symptoms. The significance and predictive validity of these symptoms require future longitudinal analysis.
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Affiliation(s)
- Sunny X Tang
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - James J Yi
- Perelman School of Medicine and the Children's Hospital of Philadelphia
| | - Tyler M Moore
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Monica E Calkins
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Christian G Kohler
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Daneen A Whinna
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Elaine H Zackai
- Perelman School of Medicine and the Children's Hospital of Philadelphia
| | | | - Beverly S Emanuel
- Perelman School of Medicine and the Children's Hospital of Philadelphia
| | - Warren B Bilker
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ruben C Gur
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Raquel E Gur
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
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21
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Kamath V, Turetsky BI, Calkins ME, Kohler CG, Conroy CG, Borgmann-Winter K, Gatto DE, Gur RE, Moberg PJ. Olfactory processing in schizophrenia, non-ill first-degree family members, and young people at-risk for psychosis. World J Biol Psychiatry 2014; 15:209-18. [PMID: 22070564 PMCID: PMC3922881 DOI: 10.3109/15622975.2011.615862] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES While deficits in odor identification and discrimination have been reported in schizophrenia, few studies have examined the relative specificity of these deficits in patients and at-risk youth. METHOD Sniffin' Sticks odor identification and discrimination were assessed in schizophrenia outpatients and non-ill first-degree relatives (Study One), as well as youth at clinical (CR) or genetic (GR) risk for schizophrenia (Study Two). Scores were z-transformed, using the performance of a demographically-matched adult or adolescent comparison group. RESULTS Patients and relatives were impaired on odor identification, but odor discrimination impairment was limited to the patient group. A similar pattern of impairment emerged in at-risk youth. GR youth were impaired on odor identification but not discrimination, while CR youth were impaired on both tasks. In patients, olfactory impairment was correlated with negative symptomatology. CONCLUSIONS To our knowledge, this is the first study to show that CR youth are impaired on both olfactory tasks, as observed in adult schizophrenia patients. GR youth were impaired only on odor identification like their adult counterparts. These data suggest that odor identification impairment, in isolation, may represent a genetic marker of vulnerability for schizophrenia, while odor discrimination deficits may be a biomarker associated with the development of psychosis.
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Affiliation(s)
- Vidyulata Kamath
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA USA,Correspondence to: Vidya Kamath, Ph.D., Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania Medical Center, 3400 Spruce Street, 10 Floor – Gates Building, Philadelphia, PA 19104. Telephone: 215.839.9193 Fax: 215.662.7903
| | - Bruce I. Turetsky
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA USA,Smell and Taste Center, Department of Otorhinolaryngology: Head & Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Monica E. Calkins
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Christian G. Kohler
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Catherine G. Conroy
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Karin Borgmann-Winter
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA USA,Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Dana E. Gatto
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Raquel E. Gur
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA USA,Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Paul J. Moberg
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA USA,Smell and Taste Center, Department of Otorhinolaryngology: Head & Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA USA
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22
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Dickson H, Calkins ME, Kohler CG, Hodgins S, Laurens KR. Misperceptions of facial emotions among youth aged 9-14 years who present multiple antecedents of schizophrenia. Schizophr Bull 2014; 40:460-8. [PMID: 23378011 PMCID: PMC3932074 DOI: 10.1093/schbul/sbs193] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Similar to adults with schizophrenia, youth at high risk for developing schizophrenia present difficulties in recognizing emotions in faces. These difficulties might index vulnerability for schizophrenia and play a role in the development of the illness. Facial emotion recognition (FER) impairments have been implicated in declining social functioning during the prodromal phase of illness and are thus a potential target for early intervention efforts. This study examined 9- to 14-year-old children: 34 children who presented a triad of well-replicated antecedents of schizophrenia (ASz), including motor and/or speech delays, clinically relevant internalizing and/or externalizing problems, and psychotic-like experiences (PLEs), and 34 typically developing (TD) children who presented none of these antecedents. An established FER task (ER40) was used to assess correct recognition of happy, sad, angry, fearful, and neutral expressions, and facial emotion misperception responses were made for each emotion type. Relative to TD children, ASz children presented an overall impairment in FER. Further, ASz children misattributed neutral expressions to face displaying other emotions and also more often mislabeled a neutral expression as sad compared with healthy peers. The inability to accurately discriminate subtle differences in facial emotion and the misinterpretation of neutral expressions as sad may contribute to the initiation and/or persistence of PLEs. Interventions that are effective in teaching adults to recognize emotions in faces could potentially benefit children presenting with antecedents of schizophrenia.
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Affiliation(s)
- Hannah Dickson
- To whom correspondence should be addressed; De Crespigny Park, London, SE5 8AF, UK; tel: + 44 207 848 0754, e-mail:
| | - Monica E. Calkins
- Department of Psychiatry, School of Medicine, University of Pennsylvania, PA
| | - Christian G. Kohler
- Department of Psychiatry, School of Medicine, University of Pennsylvania, PA
| | - Sheilagh Hodgins
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King’s College London, London, UK;,Département de Psychiatrie, Université de Montréal, Montréal, Canada
| | - Kristin R. Laurens
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King’s College London, London, UK;,Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia;,Schizophrenia Research Institute, Sydney, Australia
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23
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Moberg PJ, Kamath V, Marchetto DM, Calkins ME, Doty RL, Hahn CG, Borgmann-Winter KE, Kohler CG, Gur RE, Turetsky BI. Meta-analysis of olfactory function in schizophrenia, first-degree family members, and youths at-risk for psychosis. Schizophr Bull 2014; 40:50-9. [PMID: 23641047 PMCID: PMC3885295 DOI: 10.1093/schbul/sbt049] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Previous research has provided compelling support for olfactory dysfunction in schizophrenia patients, their first-degree relatives, and youth at-risk for psychosis. A previous meta-analysis revealed large effect sizes across olfactory tasks but was limited to 2 olfactory tasks and did not examine moderator variables. Thus, the current meta-analysis was undertaken to incorporate additional studies, risk cohorts, olfactory test domains, and moderator variable analyses. METHOD A meta-analysis was conducted on 67 publications examining olfactory function in schizophrenia patients and 15 publications examining olfactory functioning in youth at-risk for psychosis, first-degree relatives of schizophrenia patients, and individuals with schizotypy. RESULTS Results revealed medium-to-large olfactory deficits in schizophrenia patients though significant heterogeneity was evident. Several variables moderated overall study effects. At-risk youths similarly demonstrated medium-to-large effect sizes, whereas first-degree relatives and individuals with schizotypy showed small effects. CONCLUSIONS Findings suggest robust olfactory deficits in schizophrenia and at-risk youths. In schizophrenia, several variables had significant impact on these deficits and warrant consideration in prospective studies. Our findings also indicate that olfactory measures may be a useful marker of schizophrenia risk status.
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Affiliation(s)
- Paul J. Moberg
- Neuropsychiatry Section, Department of Psychiatry;,Smell and Taste Center, Department of Otorhinolaryngology: Head & Neck Surgery; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA,*To whom correspondence should be addressed; 10 Gates, HUP, 3400 Spruce Street, Philadelphia, PA 19104, US; tel: (215) 615-3608, fax: (215) 662-7903, e-mail:
| | - Vidyulata Kamath
- Neuropsychiatry Section, Department of Psychiatry;,Smell and Taste Center, Department of Otorhinolaryngology: Head & Neck Surgery; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | | | - Richard L. Doty
- Smell and Taste Center, Department of Otorhinolaryngology: Head & Neck Surgery; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | | | | | | | - Bruce I. Turetsky
- Neuropsychiatry Section, Department of Psychiatry;,Smell and Taste Center, Department of Otorhinolaryngology: Head & Neck Surgery; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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24
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Kamath V, Turetsky BI, Calkins ME, Bilker WB, Frishberg N, Borgmann-Winter K, Kohler CG, Conroy CG, Gur RE, Moberg PJ. The effect of odor valence on olfactory performance in schizophrenia patients, unaffected relatives and at-risk youth. J Psychiatr Res 2013; 47:1636-41. [PMID: 23953754 PMCID: PMC4198303 DOI: 10.1016/j.jpsychires.2013.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 06/17/2013] [Accepted: 07/18/2013] [Indexed: 12/11/2022]
Abstract
Given the presence of odor identification impairment in individuals with schizophrenia and recent evidence of aberrant odor hedonic processing, the aim of this investigation was to examine the influence of valence and intensity on odor identification in schizophrenia patients, their first-degree family members, and young persons at clinical risk for psychosis. Participants completed the 16-item Sniffin' Stick Odor Identification Test. A logistic regression was conducted to assess the influence of valence and intensity on odor identification accuracy. Identification performance in the schizophrenia patients and youths at clinical risk for psychosis was significantly influenced by odor valence, but not intensity. Identification accuracy in first-degree family members was not influenced by valence or intensity. These data suggest that abnormalities in odor valence perception may represent an environmentally-mediated marker for hedonic disturbance that could have predictive utility in future conversion to psychosis. Further research examining the utility of odor valence measures as markers for psychosis risk is warranted.
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Affiliation(s)
- Vidyulata Kamath
- Neuropsychiatry Section, Department of Psychiatry, Philadelphia, PA, USA; Smell and Taste Center, Department of Otorhinolaryngology: Head & Neck Surgery, Perelman School of Medicine, Philadelphia, PA, USA; Division of Medical Psychology, Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Bruce I. Turetsky
- Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA, USA,Smell and Taste Center, Department of Otorhinolaryngology: Head & Neck Surgery, Perelman School of Medicine, Philadelphia, PA, USA
| | - Monica E. Calkins
- Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA, USA
| | - Warren B. Bilker
- Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA, USA,Department Biostatistics and Epidemiology, Philadelphia, PA, USA
| | - Nathan Frishberg
- Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA, USA
| | - Karin Borgmann-Winter
- Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA, USA,Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christian G. Kohler
- Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA, USA
| | - Catherine G. Conroy
- Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA, USA
| | - Raquel E. Gur
- Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA, USA
| | - Paul J. Moberg
- Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA, USA,Smell and Taste Center, Department of Otorhinolaryngology: Head & Neck Surgery, Perelman School of Medicine, Philadelphia, PA, USA
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Kamath V, Moberg PJ, Kohler CG, Gur RE, Turetsky BI. Odor hedonic capacity and anhedonia in schizophrenia and unaffected first-degree relatives of schizophrenia patients. Schizophr Bull 2013; 39:59-67. [PMID: 21616912 PMCID: PMC3523921 DOI: 10.1093/schbul/sbr050] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE There is increasing evidence that schizophrenia patients have difficulties in the hedonic appraisal of odors. In a prior study, we assessed olfactory hedonic perception birhinally and found that males with schizophrenia failed to attach the appropriate hedonic valence to a pleasant odor, despite correctly perceiving changes in odor intensity. Female patients, in contrast, exhibited normal responses. The current study extends this work by examining odor valence processing in unaffected first-degree relatives of schizophrenia patients, to determine the extent to which this abnormality may be genetically mediated. We also examine odor valence processing unirhinally, rather than birhinally, to probe possible lateralized differences in patients' hedonic processing deficits. METHOD Individuals with schizophrenia (n = 54), first-degree unaffected family members (n = 22), and demographically matched controls (n = 45) were administered the Suprathreshold Amyl Acetate Odor Intensity and Odor Pleasantness Rating Test. RESULTS In contrast to family members and controls, both male and female schizophrenia probands underevaluated the hedonic characteristics of amyl acetate at lower concentrations and overevaluated its pleasantness at concentrations perceived as unpleasant by both controls and relatives. These patient-specific differences could not be explained by differences in smoking habit, medication use, or subjective ratings of odor intensity. However, they were associated with increased levels of anhedonia/asociality and negative symptomatology. CONCLUSIONS Our findings suggest that both male and female schizophrenia patients have difficulties in the unirhinal appraisal of hedonic valence. Normal responses in unaffected first-degree relatives suggest that this is an environmentally, rather than genetically, mediated abnormality denoting negative symptomatology.
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Affiliation(s)
- Vidyulata Kamath
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| | - Paul J. Moberg
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA,Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Christian G. Kohler
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Raquel E. Gur
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA,Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Bruce I. Turetsky
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA,Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
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26
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Roddy S, Tiedt L, Kelleher I, Clarke MC, Murphy J, Rawdon C, Roche RAP, Calkins ME, Richard JA, Kohler CG, Cannon M. Facial emotion recognition in adolescents with psychotic-like experiences: a school-based sample from the general population. Psychol Med 2012; 42:2157-2166. [PMID: 22370095 DOI: 10.1017/s0033291712000311] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychotic symptoms, also termed psychotic-like experiences (PLEs) in the absence of psychotic disorder, are common in adolescents and are associated with increased risk of schizophrenia-spectrum illness in adulthood. At the same time, schizophrenia is associated with deficits in social cognition, with deficits particularly documented in facial emotion recognition (FER). However, little is known about the relationship between PLEs and FER abilities, with only one previous prospective study examining the association between these abilities in childhood and reported PLEs in adolescence. The current study was a cross-sectional investigation of the association between PLEs and FER in a sample of Irish adolescents. METHOD The Adolescent Psychotic-Like Symptom Screener (APSS), a self-report measure of PLEs, and the Penn Emotion Recognition-40 Test (Penn ER-40), a measure of facial emotion recognition, were completed by 793 children aged 10-13 years. RESULTS Children who reported PLEs performed significantly more poorly on FER (β=-0.03, p=0.035). Recognition of sad faces was the major driver of effects, with children performing particularly poorly when identifying this expression (β=-0.08, p=0.032). CONCLUSIONS The current findings show that PLEs are associated with poorer FER. Further work is needed to elucidate causal relationships with implications for the design of future interventions for those at risk of developing psychosis.
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Affiliation(s)
- S Roddy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
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27
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Kamath V, Moberg PJ, Calkins ME, Borgmann-Winter K, Conroy CG, Gur RE, Kohler CG, Turetsky BI. An odor-specific threshold deficit implicates abnormal cAMP signaling in youths at clinical risk for psychosis. Schizophr Res 2012; 138:280-4. [PMID: 22537567 PMCID: PMC3372687 DOI: 10.1016/j.schres.2012.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 03/23/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND While olfactory deficits have been reported in schizophrenia and youths at-risk for psychosis, few studies have linked these deficits to current pathophysiological models of the illness. There is evidence that disrupted cyclic adenosine 3',5'-monophosphate (cAMP) signaling may contribute to schizophrenia pathology. As cAMP mediates olfactory signal transduction, the degree to which this disruption could manifest in olfactory impairment was ascertained. Odor-detection thresholds to two odorants that differ in the degree to which they activate intracellular cAMP were assessed in clinical risk and low-risk participants. METHOD Birhinal assessments of odor-detection threshold sensitivity to lyral and citralva were acquired in youths experiencing prodromal symptoms (n=17) and controls at low risk for developing psychosis (n=15). Citralva and lyral are odorants that differ in cAMP activation; citralva is a strong cAMP activator and lyral is a weak cAMP activator. RESULTS The overall group-by-odor interaction was statistically significant. At-risk youths showed significantly reduced odor detection thresholds for lyral, but showed intact detection thresholds for citralva. This odor-specific threshold deficit was uncorrelated with deficits in odor identification or discrimination, which were also present. ROC curve analysis revealed that olfactory performance correctly classified at-risk and low-risk youths with greater than 97% accuracy. CONCLUSIONS This study extends prior findings of an odor-specific hyposmia implicating cAMP-mediated signal transduction in schizophrenia and unaffected first-degree relatives to include youths at clinical risk for developing the disorder. These results suggest that dysregulation of cAMP signaling may be present during the psychosis prodrome.
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Affiliation(s)
- Vidyulata Kamath
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Paul J. Moberg
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA,Smell and Taste Center, Department of Otorhinolaryngology: Head & Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Monica E. Calkins
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Karin Borgmann-Winter
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA,Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Catherine G. Conroy
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Raquel E. Gur
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA,Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Christian G. Kohler
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Bruce I. Turetsky
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA,Smell and Taste Center, Department of Otorhinolaryngology: Head & Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
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28
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Pinkham AE, Sasson NJ, Beaton D, Abdi H, Kohler CG, Penn DL. Qualitatively distinct factors contribute to elevated rates of paranoia in autism and schizophrenia. J Abnorm Psychol 2012; 121:767-777. [PMID: 22686868 DOI: 10.1037/a0028510] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A converging body of clinical and empirical reports indicates that autism features elevated rates of paranoia comparable to those of individuals with paranoid schizophrenia. However, the distinct developmental courses and symptom manifestations of these two disorders suggest that the nature of paranoid ideation may differ between them in important and meaningful ways. To evaluate this hypothesis, we compared patterns of responses on the Paranoia Scale between actively paranoid individuals with schizophrenia (SCZP), individuals with schizophrenia who were not actively paranoid (SCZNP), adults with an Autism Spectrum Disorder (ASD), and healthy controls. Despite an overall similar level of heightened paranoia in the ASD and SCZP groups, discriminant correspondence analysis (DiCA) revealed that these groups were characterized by unique underlying factors. Paranoia in the SCZP group was defined by a factor based upon victimization, suspicion, and threat of harm. Whereas paranoia in the ASD group was partially characterized by this factor, it was distinguished from SCZP by an additional pattern of responses reflective of increased social cynicism. These findings indicate that paranoia in ASD is supported by qualitative factors distinct from schizophrenia and highlight mechanistic differences in the formation of paranoid ideation that may inform the development of disorder-specific treatments.
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Affiliation(s)
- Amy E Pinkham
- Department of Psychology, Southern Methodist University
| | - Noah J Sasson
- School of Behavioral and Brain Sciences, The University of Texas at Dallas
| | - Derek Beaton
- School of Behavioral and Brain Sciences, The University of Texas at Dallas
| | - Hervé Abdi
- School of Behavioral and Brain Sciences, The University of Texas at Dallas
| | | | - David L Penn
- Department of Psychology, University of North Carolina at Chapel Hill
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Hamm J, Kohler CG, Gur RC, Verma R. Automated Facial Action Coding System for dynamic analysis of facial expressions in neuropsychiatric disorders. J Neurosci Methods 2011; 200:237-56. [PMID: 21741407 PMCID: PMC3402717 DOI: 10.1016/j.jneumeth.2011.06.023] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 06/14/2011] [Accepted: 06/23/2011] [Indexed: 11/19/2022]
Abstract
Facial expression is widely used to evaluate emotional impairment in neuropsychiatric disorders. Ekman and Friesen's Facial Action Coding System (FACS) encodes movements of individual facial muscles from distinct momentary changes in facial appearance. Unlike facial expression ratings based on categorization of expressions into prototypical emotions (happiness, sadness, anger, fear, disgust, etc.), FACS can encode ambiguous and subtle expressions, and therefore is potentially more suitable for analyzing the small differences in facial affect. However, FACS rating requires extensive training, and is time consuming and subjective thus prone to bias. To overcome these limitations, we developed an automated FACS based on advanced computer science technology. The system automatically tracks faces in a video, extracts geometric and texture features, and produces temporal profiles of each facial muscle movement. These profiles are quantified to compute frequencies of single and combined Action Units (AUs) in videos, and they can facilitate a statistical study of large populations in disorders known to impact facial expression. We derived quantitative measures of flat and inappropriate facial affect automatically from temporal AU profiles. Applicability of the automated FACS was illustrated in a pilot study, by applying it to data of videos from eight schizophrenia patients and controls. We created temporal AU profiles that provided rich information on the dynamics of facial muscle movements for each subject. The quantitative measures of flatness and inappropriateness showed clear differences between patients and the controls, highlighting their potential in automatic and objective quantification of symptom severity.
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Affiliation(s)
- Jihun Hamm
- Department of Radiology, Section of Biomedical Image Analysis, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Christian G. Kohler
- Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ruben C. Gur
- Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, Philadelphia, PA 19104, USA
- Philadelphia Veterans Administration Medical Center, Philadelphia, PA 19104, USA
| | - Ragini Verma
- Department of Radiology, Section of Biomedical Image Analysis, University of Pennsylvania, Philadelphia, PA 19104, USA
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30
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Kohler CG, Hoffman LJ, Eastman LB, Healey K, Moberg PJ. Facial emotion perception in depression and bipolar disorder: a quantitative review. Psychiatry Res 2011; 188:303-9. [PMID: 21601927 DOI: 10.1016/j.psychres.2011.04.019] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 02/07/2011] [Accepted: 04/19/2011] [Indexed: 10/18/2022]
Abstract
A considerable body of literature has reported on emotion perception deficits and the relevance of these impairments in persons with depression and bipolar disorder. Fifty-one studies published between 1981-February 2009 were examined regarding emotion perception abilities between patient and control groups, and potential methodological, demographic and clinical moderators. Studies were identified through a computerized literature search of the MEDLINE, PsychINFO, and PubMed databases. The Meta-analysis Of Observational Studies in Epidemiology (MOOSE) standard (Stroup et al., 2000) was followed in the extraction of relevant studies and data. Data on emotion perception, methodology, demographic and clinical characteristics were compiled and analyzed using Comprehensive Meta-Analysis version 2.0 (Biostat, 2005). The meta-analysis revealed a moderate deficit in emotion perception in both bipolar disorder and major depressive disorder, irrespective of task type, diagnosis, age of onset/duration of illness, sex, and hospitalization status. Several factors that moderated the observed impairment include self-reported depression, age at time of testing, and years of education. Emotion perception impairment in bipolar disorder and major depressive disorder represents a moderate and stable deficit that appears to be moderated by a limited number of demographic and clinical factors.
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Affiliation(s)
- Christian G Kohler
- Schizophrenia Research Center, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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31
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Abstract
Paraneoplastic disorders of the CNS result from immune responses to neuronal proteins expressed by tumors found elsewhere in the body. Limbic encephalitis, one of the most common manifestations of paraneoplastic disorders, is characterized by rapid onset of psychiatric and neurological symptoms that often culminate in severe neurological deterioration. Recent work has described paraneoplastic syndromes with prominent, and sometimes isolated, psychiatric symptoms for which patients are fi rst seen by a psychiatrist. Here the authors review the existing literature on psychiatric and behavioral manifestations of paraneoplastic disorders, the cellular mechanisms underlying these syndromes, and current treatment and outcomes. They also discuss the broad behavioral findings that highlight the need for psychiatrists to be aware of initial presentations of paraneoplastic disorders.
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Affiliation(s)
- Matthew S Kayser
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
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32
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Healey KM, Pinkham AE, Richard JA, Kohler CG. Do we recognize facial expressions of emotions from persons with schizophrenia? Schizophr Res 2010; 122:144-50. [PMID: 20488667 DOI: 10.1016/j.schres.2010.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 04/05/2010] [Accepted: 04/07/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Impaired facial emotion expression is central to schizophrenia. Extensive work has quantified these differences, but it remains unclear how patient expressions are perceived by their healthy peers and other non-trained individuals. This study examined how static facial expressions of posed and evoked emotions of patients and controls are recognized by naïve observers. METHODS Facial photographs of 6 persons with stable schizophrenia and 6 matched healthy controls expressing five universal emotions (happy, sad, anger, fear, and disgust) and neutral were selected from a previous data set. Untrained raters (N=420) viewed each photo and identified the expressed emotion. Repeated measures ANOVAs were used to assess differences in accuracy and error patterns between patient and control expressions. RESULTS Expressions from healthy individuals were more accurately identified than those from schizophrenia patients across all conditions, except for posed sadness and evoked neutral faces, in which groups did not differ, and posed fear, in which patient expressions were more accurately identified than control expressions. Analysis of incorrect responses revealed misidentifications as neutral were most common across both groups but significantly more likely among patients. CONCLUSION Present findings demonstrate that patient expressions of emotion are poorly perceived by naïve observers and support the concept of affective flattening in schizophrenia. These results highlight the real world implications of impairments in emotion expression and may shed light on potential mechanisms of impaired social functioning in schizophrenia.
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Affiliation(s)
- Kristin M Healey
- The Schizophrenia Research Center, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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Abstract
OBJECTIVES A considerable body of literature has reported on emotion perception deficits and the relevance to clinical symptoms and social functioning in schizophrenia. Studies published between 1970-2007 were examined regarding emotion perception abilities between patient and control groups and potential methodological, demographic, and clinical moderators. DATA SOURCES AND REVIEW: Eighty-six studies were identified through a computerized literature search of the MEDLINE, PsychINFO, and PubMed databases. A quality of reporting of meta-analysis standard was followed in the extraction of relevant studies and data. Data on emotion perception, methodology, demographic and clinical characteristics, and antipsychotic medication status were compiled and analyzed using Comprehensive Meta-analysis Version 2.0 (Borenstein M, Hedges L, Higgins J and Rothstein H. Comprehensive Meta-analysis. 2. Englewood, NJ: Biostat; 2005). RESULTS The meta-analysis revealed a large deficit in emotion perception in schizophrenia, irrespective of task type, and several factors that moderated the observed impairment. Illness-related factors included current hospitalization and--in part--clinical symptoms and antipsychotic treatment. Demographic factors included patient age and gender in controls but not race. CONCLUSION Emotion perception impairment in schizophrenia represents a robust finding in schizophrenia that appears to be moderated by certain clinical and demographic factors. Future directions for research on emotion perception are discussed.
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Affiliation(s)
- Christian G Kohler
- Schizophrenia Research Center, Department of Psychiatry, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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34
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Satterthwaite TD, Wolf DH, Loughead J, Ruparel K, Valdez JN, Siegel SJ, Kohler CG, Gur RE, Gur RC. Association of enhanced limbic response to threat with decreased cortical facial recognition memory response in schizophrenia. Am J Psychiatry 2010; 167:418-26. [PMID: 20194482 PMCID: PMC4243460 DOI: 10.1176/appi.ajp.2009.09060808] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recognition memory of faces is impaired in patients with schizophrenia, as is the neural processing of threat-related signals, but how these deficits interact to produce symptoms is unclear. The authors used an affective face recognition paradigm to examine possible interactions between cognitive and affective neural systems in schizophrenia. METHOD Blood-oxygen-level-dependent response was examined by means of functional magnetic resonance imaging (3 Tesla) in healthy comparison subjects (N=21) and in patients with schizophrenia (N=12) or schizoaffective disorder, depressed type (N=4), during a two-choice recognition task that used images of human faces. Each target face, previously displayed with a threatening or nonthreatening affect, was displayed with neutral affect. Responses to successful recognition and responses to the effect of previously threatening versus nonthreatening affect were evaluated, and correlations with symptom severity (total Brief Psychiatric Rating Scale score) were examined. Functional connectivity analyses examined the relationship between activation in the amygdala and cortical regions involved in recognition memory. RESULTS Patients performed the task more slowly than healthy comparison subjects. Comparison subjects recruited the expected cortical regions to a greater degree than patients, and patients with more severe symptoms demonstrated proportionally less recruitment. Increased symptoms were also correlated with augmented amygdala and orbitofrontal cortex response to threatening faces. Comparison subjects exhibited a negative correlation between activity in the amygdala and cortical regions involved in cognition, while patients showed weakening of this relationship. CONCLUSION Increased symptoms were related to an enhanced threat response in limbic regions and a diminished recognition memory response in cortical regions, supporting a link between these two brain systems that are often examined in isolation. This finding suggests that abnormal processing of threat-related signals in the environment may exacerbate cognitive impairment in schizophrenia.
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Affiliation(s)
- Theodore D. Satterthwaite
- Department of Psychiatry, University of Pennsylvania, Philadelphia PA 19104, USA,Philadelphia Veterans Administration Medical Center, Philadelphia PA 19104, USA
| | - Daniel H. Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia PA 19104, USA
| | - James Loughead
- Department of Psychiatry, University of Pennsylvania, Philadelphia PA 19104, USA
| | - Kosha Ruparel
- Department of Psychiatry, University of Pennsylvania, Philadelphia PA 19104, USA
| | - Jeffrey N. Valdez
- Department of Psychiatry, University of Pennsylvania, Philadelphia PA 19104, USA
| | - Steven J. Siegel
- Department of Psychiatry, University of Pennsylvania, Philadelphia PA 19104, USA
| | - Christian G. Kohler
- Department of Psychiatry, University of Pennsylvania, Philadelphia PA 19104, USA
| | - Raquel E. Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia PA 19104, USA,Department of Radiology, University of Pennsylvania, Philadelphia PA 19104, USA,Philadelphia Veterans Administration Medical Center, Philadelphia PA 19104, USA
| | - Ruben C. Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia PA 19104, USA,Department of Radiology, University of Pennsylvania, Philadelphia PA 19104, USA,Philadelphia Veterans Administration Medical Center, Philadelphia PA 19104, USA
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35
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Leitman DI, Wolf DH, Loughead J, Valdez JN, Kohler CG, Brensinger C, Elliott MA, Turetsky BI, Gur RE, Gur RC. Ventrolateral prefrontal cortex and the effects of task demand context on facial affect appraisal in schizophrenia. Soc Cogn Affect Neurosci 2010; 6:66-73. [PMID: 20212004 DOI: 10.1093/scan/nsq018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Schizophrenia patients display impaired performance and brain activity during facial affect recognition. These impairments may reflect stimulus-driven perceptual decrements and evaluative processing abnormalities. We differentiated these two processes by contrasting responses to identical stimuli presented under different contexts. Seventeen healthy controls and 16 schizophrenia patients performed an fMRI facial affect detection task. Subjects identified an affective target presented amongst foils of differing emotions. We hypothesized that targeting affiliative emotions (happiness, sadness) would create a task demand context distinct from that generated when targeting threat emotions (anger, fear). We compared affiliative foil stimuli within a congruent affiliative context with identical stimuli presented in an incongruent threat context. Threat foils were analysed in the same manner. Controls activated right orbitofrontal cortex (OFC)/ventrolateral prefrontal cortex (VLPFC) more to affiliative foils in threat contexts than to identical stimuli within affiliative contexts. Patients displayed reduced OFC/VLPFC activation to all foils, and no activation modulation by context. This lack of context modulation coincided with a 2-fold decrement in foil detection efficiency. Task demands produce contextual effects during facial affective processing in regions activated during affect evaluation. In schizophrenia, reduced modulation of OFC/VLPFC by context coupled with reduced behavioural efficiency suggests impaired ventral prefrontal control mechanisms that optimize affective appraisal.
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Affiliation(s)
- David I Leitman
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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36
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Abstract
OBJECTIVES A considerable body of literature has reported on emotion perception deficits and the relevance to clinical symptoms and social functioning in schizophrenia. Studies published between 1970-2007 were examined regarding emotion perception abilities between patient and control groups and potential methodological, demographic, and clinical moderators. DATA SOURCES AND REVIEW: Eighty-six studies were identified through a computerized literature search of the MEDLINE, PsychINFO, and PubMed databases. A quality of reporting of meta-analysis standard was followed in the extraction of relevant studies and data. Data on emotion perception, methodology, demographic and clinical characteristics, and antipsychotic medication status were compiled and analyzed using Comprehensive Meta-analysis Version 2.0 (Borenstein M, Hedges L, Higgins J and Rothstein H. Comprehensive Meta-analysis. 2. Englewood, NJ: Biostat; 2005). RESULTS The meta-analysis revealed a large deficit in emotion perception in schizophrenia, irrespective of task type, and several factors that moderated the observed impairment. Illness-related factors included current hospitalization and--in part--clinical symptoms and antipsychotic treatment. Demographic factors included patient age and gender in controls but not race. CONCLUSION Emotion perception impairment in schizophrenia represents a robust finding in schizophrenia that appears to be moderated by certain clinical and demographic factors. Future directions for research on emotion perception are discussed.
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Affiliation(s)
- Christian G Kohler
- Schizophrenia Research Center, Department of Psychiatry, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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37
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Turetsky BI, Bilker WB, Siegel SJ, Kohler CG, Gur RE. Profile of auditory information-processing deficits in schizophrenia. Psychiatry Res 2009; 165:27-37. [PMID: 18990453 PMCID: PMC2652872 DOI: 10.1016/j.psychres.2008.04.013] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 01/16/2008] [Accepted: 04/14/2008] [Indexed: 10/21/2022]
Abstract
Schizophrenia patients exhibit abnormalities in several different auditory event-related potential (ERP) measures. It is unclear how these abnormalities relate to each other, since multiple measures are rarely acquired from the same sample. This study addressed two related questions: 1) Are specific auditory ERP measures differentially impaired in schizophrenia? 2) Do abnormalities co-aggregate within the same patients? Nine auditory ERP measures were acquired in a single testing session from 23 schizophrenia patients and 22 healthy subjects. Hierarchical oblique factor analysis revealed that these measures aggregated into four factors, with each loading primarily on a single factor. Patient deficits were observed for two independent factors: N100/mismatch negativity (MMN) and P3a/P3b. N100/MMN abnormalities were associated with symptoms of alogia and formal thought disorder. P3a/P3b abnormalities were associated with avolition, attentional disturbances and delusions. We conclude that deficits in different ERP measures of early sensory processing at the level of the auditory cortex co-occur in patients. These likely represent a single differential deficit indexing the physiological abnormality underlying impaired language and verbal processing. This is relatively independent of a higher cortical deficit that mediates cognitive stimulus evaluation and underlies deficits in motivation, attention and reality testing. Such multidimensional profiling of ERP abnormalities may help to clarify the clinical and genetic heterogeneity of schizophrenia.
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Affiliation(s)
- Bruce I. Turetsky
- Department of Psychiatry, University of Pennsylvania Philadelphia, PA, USA,Correspondence: Bruce I. Turetsky, M.D., Neuropsychiatry Division, Department of Psychiatry, 10th Floor, Gates Building, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104. Tel: (215) 615-3607. Fax: (215) 662-7903., E-mail:
| | - Warren B. Bilker
- Department Biostatistics and Epidemiology, University of Pennsylvania Philadelphia, PA, USA
| | - Steven J. Siegel
- Department of Psychiatry, University of Pennsylvania Philadelphia, PA, USA
| | | | - Raquel E. Gur
- Department of Psychiatry, University of Pennsylvania Philadelphia, PA, USA
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Kohler CG, Martin EA, Milonova M, Wang P, Verma R, Brensinger CM, Bilker W, Gur RE, Gur RC. Dynamic evoked facial expressions of emotions in schizophrenia. Schizophr Res 2008; 105:30-9. [PMID: 18793827 PMCID: PMC2879330 DOI: 10.1016/j.schres.2008.05.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 05/23/2008] [Accepted: 05/26/2008] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Impaired facial expressions of emotions have been described as characteristic symptoms of schizophrenia. Previous investigations of dynamic facial expressions have reported on global assessment of positive and negative emotion expressions. In this study, we examined facial expression differences based on duration and frequencies of emotion expressions. METHODS 12 persons with stable schizophrenia and matched healthy controls underwent a standardized procedure for evoked facial expressions of five universal emotions, including happy, sad, anger, fear, and disgust expressions. Subjects completed self-ratings of their emotion experience. Reliable raters coded evoked facial expressions according to the Facial Expression Coding System. For each emotion, facial expressions were coded as target, non-target or neutral expressions. Logistic regression analyses examined group differences in duration and frequencies of facial expressions. RESULTS Comparing overall duration of and frequencies of emotion expressions revealed affective flattening and inappropriate affect in patients, as evidenced by neutral and non-target expressions. Separated by emotion, impaired emotion expression was found in happy, sad and anger expression, but not for fear and disgust in which expressions were not well recognized. CONCLUSION In matched groups of participants, we found evidence for altered expressions in schizophrenia but equal subjective experience. Both affective flattening and inappropriate affect comprise abnormal facial expressions but may differ with respect to interpersonal communication and engagement. Future directions may include automated measurement, remediation of expressions and early detection of schizophrenia.
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Affiliation(s)
- Christian G Kohler
- Neuropsychiatry Division, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, United States.
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Kohler CG, Martin EA, Stolar N, Barrett FS, Verma R, Brensinger C, Bilker W, Gur RE, Gur RC. Static posed and evoked facial expressions of emotions in schizophrenia. Schizophr Res 2008; 105:49-60. [PMID: 18789845 PMCID: PMC5048468 DOI: 10.1016/j.schres.2008.05.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 04/28/2008] [Accepted: 05/01/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Impaired facial expressions of emotions have been described as characteristic symptoms of schizophrenia. Differences regarding individual facial muscle changes associated with specific emotions in posed and evoked expressions remain unclear. This study examined static facial expressions of emotions for evidence of flattened and inappropriate affect in persons with stable schizophrenia. METHODS 12 persons with stable schizophrenia and matched healthy controls underwent a standardized procedure for posed and evoked facial expressions of five universal emotions, including happy, sad, anger, fear, and disgust expressions, at three intensity levels. Subjects completed self-ratings of their emotion experience. Certified raters coded images of facial expressions for presence of action units (AUs) according to the Facial Action Coding System. Logistic regression analyses were used to examine differences in the presence of AUs and emotion experience ratings by diagnosis, condition and intensity of expression. RESULTS Patient and control groups experienced similar intensities of emotions, however, the difference between posed and evoked emotions was less pronounced in patients. Differences in expression of frequent and infrequent AUs support clinical observations of flattened and inappropriate affect in schizophrenia. Specific differences involve the Duchenne smile for happy expressions and decreased furrowed brows in all negative emotion expressions in schizophrenia. CONCLUSION While patterns of facial expressions were similar between groups, general and emotion specific differences support the concept of impaired facial expressions in schizophrenia. Expression of emotions in schizophrenia could not be explained by impaired experience. Future directions may include automated measurement, remediation of expressions and early detection of schizophrenia.
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Affiliation(s)
- Christian G Kohler
- Neuropsychiatry Division, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, United States.
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Turetsky BI, Kohler CG, Gur RE, Moberg PJ. Olfactory physiological impairment in first-degree relatives of schizophrenia patients. Schizophr Res 2008; 102:220-9. [PMID: 18457935 PMCID: PMC2504534 DOI: 10.1016/j.schres.2008.03.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 03/10/2008] [Accepted: 03/17/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND Efforts to characterize genetic vulnerability to schizophrenia are increasingly focused on the identification of endophenotypes--neurobiological abnormalities that are evident in individuals at risk. Behavioral studies have demonstrated olfactory impairments in odor detection and identification in unaffected 1st-degree relatives of schizophrenia patients, suggesting that abnormalities in this simple sensory system may serve as candidate endophenotypes. It is unclear, however, whether these behavioral abnormalities reflect basic olfactory sensory processing deficits or nonspecific disruptions of attention and cognition. METHOD Unirhinal chemosensory olfactory evoked potentials were acquired from 14 unaffected 1st-degree relatives of schizophrenia patients and 20 healthy individuals with equivalent age and gender distributions, using 3 different concentrations of hydrogen sulfide. Subjects were also assessed behaviorally for ability to detect and identify odors. RESULTS Family members exhibited left nostril olfactory detection impairments and bilateral olfactory identification abnormalities. They had reduced evoked potential response amplitudes for the initial N1 component in the left nostril. The subsequent P2 evoked potential response was reduced bilaterally. The pattern and magnitude of family member deficits were comparable to those previously observed for schizophrenia patients. CONCLUSION 1st-degree relatives of schizophrenia patients exhibit specific neurophysiological impairments in early olfactory sensory processing. The presence of these neurophysiological abnormalities in both schizophrenia patients and their unaffected 1st-degree relatives suggests that these represent genetically mediated vulnerability markers or endophenotypes of the illness.
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Affiliation(s)
- Bruce I Turetsky
- Neuropsychiatry Division, Department of Psychiatry, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
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Leitman DI, Loughead J, Wolf DH, Ruparel K, Kohler CG, Elliott MA, Bilker WB, Gur RE, Gur RC. Abnormal superior temporal connectivity during fear perception in schizophrenia. Schizophr Bull 2008; 34:673-8. [PMID: 18550592 DOI: 10.1093/schbul/sbn052] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patients with schizophrenia have difficulty in decoding facial affect. A study using event-related functional neuroimaging indicated that errors in fear detection in schizophrenia are associated with paradoxically higher activation in the amygdala and an associated network implicated in threat detection. Furthermore, this exaggerated activation to fearful faces correlated with severity of flat affect. These findings suggest that abnormal threat detection processing may reflect disruptions between nodes that comprise the affective appraisal circuit. Here we examined connectivity within this network by determining the pattern of intercorrelations among brain regions (regions of interest) significantly activated during fear identification in both healthy controls and patients using a novel procedure CORANOVA. This analysis tests differences in the interregional correlation strength between schizophrenia and healthy controls. Healthy subjects' task activation was principally characterized by robust correlations between medial structures like thalamus (THA) and amygdala (AMY) and middle frontal (MF), inferior frontal (IF), and prefrontal cortical (PFC) regions. In contrast, schizophrenia patients displayed no significant correlations between the medial regions and either MF or IF. Further, patients had significantly higher correlations between occipital lingual gyrus and superior temporal gyrus than healthy subjects. These between-group connectivity differences suggest that schizophrenia threat detection impairment may stem from abnormal stimulus integration. Such abnormal integration may disrupt the evaluation of threat within fronto-cortical regions.
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Affiliation(s)
- David I Leitman
- Department of Psychiatry-Neuropsychiatry Program, Brain Behavior Laboratory, University of Pennsylvania, Philadelphia, PA 19104-4283, USA.
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Ragland JD, Moelter ST, Bhati MT, Valdez JN, Kohler CG, Siegel SJ, Gur RC, Gur RE. Effect of retrieval effort and switching demand on fMRI activation during semantic word generation in schizophrenia. Schizophr Res 2008; 99:312-23. [PMID: 18155880 PMCID: PMC2383319 DOI: 10.1016/j.schres.2007.11.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 10/31/2007] [Accepted: 11/07/2007] [Indexed: 10/22/2022]
Abstract
Verbal fluency deficits in schizophrenia are difficult to interpret because the tasks are multi-factorial and groups differ in total words generated. We manipulated retrieval and switching demands by requiring alternation between over-learned sequences in which retrieval is relatively automatic (OS) and semantic categories requiring increased retrieval effort (SC). Controlled processing was also manipulated by including switching and non-switching conditions, and formal thought disorder (FTD) was assessed with the communication disorders index (CDI). The OS/SC semantic fluency paradigm was administered during fMRI to 13 patients with schizophrenia and 14 matched controls. Images were acquired on a 3 Tesla Siemens scanner using compressed image acquisition to allow for cued overt word production. Subjects alternated between OS, SC, OS-switch, SC-switch, and baseline blocks. Images were pre-processed in SPM-2, and a two-stage random effects analysis tested within and between group contrasts. There were no group performance differences. fMRI analysis did not reveal any group differences during the OS non-switching condition. Both groups produced expected activation in bilateral prefrontal and inferior parietal regions. However, during the SC condition patients had greater activation than controls in left prefrontal, right anterior cingulate, right superior temporal, bilateral thalamus, and left parietal regions. There was also evidence of patient over-activation in prefrontal, superior temporal, superior parietal, and visual association areas when a switching component was added. FTD was negatively correlated with BOLD response in the right anterior cingulate, cuneus and superior frontal gyrus during increased retrieval demand, and positively correlated with fMRI activation in the left lingual gyrus, right fusiform gyrus and left superior parietal lobule during increased switching demand. These results indicate that patients are able to successfully perform effortful semantic fluency tasks during non-speeded conditions. When retrieval is relatively automatic there does not appear to be an effect of schizophrenia on fMRI response. However, when retrieval and controlled processing demands increase, patients have greater activation than controls despite unimpaired task performance. This inefficient BOLD response may explain why patients are slower and less accurate on standard self-paced fluency tasks.
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Affiliation(s)
- JD Ragland
- University of California at Davis, Dept. Psychiatry & Behavioral Sciences, 4701 X Street, Sacramento, CA, 95817, USA,Corresponding Author:J. Daniel Ragland, Ph.D., University of California at Davis, Imaging Research Center, 4701 X Street, Sacramento, CA 95817, Phone: (916) 734-5802, FAX: (916) 734-8750,
| | - ST Moelter
- University of the Sciences in Philadelphia, Health Psychology Program, 600 South 43rd Street, Philadelphia, PA, 19104, USA
| | - MT Bhati
- University of Pennsylvania, Schizophrenia Center, Dept. Psychiatry, 3400 Spruce St., 10th Floor Gates Bldg. / HUP, Philadelphia, PA, 19104, USA
| | - JN Valdez
- University of Pennsylvania, Schizophrenia Center, Dept. Psychiatry, 3400 Spruce St., 10th Floor Gates Bldg. / HUP, Philadelphia, PA, 19104, USA
| | - CG Kohler
- University of Pennsylvania, Schizophrenia Center, Dept. Psychiatry, 3400 Spruce St., 10th Floor Gates Bldg. / HUP, Philadelphia, PA, 19104, USA
| | - SJ Siegel
- University of Pennsylvania, Schizophrenia Center, Dept. Psychiatry, 3400 Spruce St., 10th Floor Gates Bldg. / HUP, Philadelphia, PA, 19104, USA
| | - RC Gur
- University of Pennsylvania, Schizophrenia Center, Dept. Psychiatry, 3400 Spruce St., 10th Floor Gates Bldg. / HUP, Philadelphia, PA, 19104, USA
| | - RE Gur
- University of Pennsylvania, Schizophrenia Center, Dept. Psychiatry, 3400 Spruce St., 10th Floor Gates Bldg. / HUP, Philadelphia, PA, 19104, USA
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Gur RE, Loughead J, Kohler CG, Elliott MA, Lesko K, Ruparel K, Wolf DH, Bilker WB, Gur RC. Limbic activation associated with misidentification of fearful faces and flat affect in schizophrenia. ACTA ACUST UNITED AC 2008; 64:1356-66. [PMID: 18056543 DOI: 10.1001/archpsyc.64.12.1356] [Citation(s) in RCA: 189] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Deficits in emotion processing are prominent in schizophrenia, and flat affect is resistant to treatment and portends poor outcome. Investigation of the underlying neural circuitry can elucidate affective dysfunction. OBJECTIVE To examine the brain circuitry for facial emotion processing, dissecting response to task demands from effects of the appearance of facial expressions. DESIGN A facial emotion identification task was presented during high-field (4-T) magnetic resonance imaging. Blood oxygenation level-dependent changes were contrasted for task compared with a scrambled face baseline (blocked analysis) and for the appearance of each of the following 4 target expressions compared with neutral faces (event related): happy, sad, anger, and fear. SETTING Participants from the Schizophrenia Research Center underwent a functional magnetic resonance imaging study at the University of Pennsylvania Medical Center. PARTICIPANTS Patients with DSM-IV-defined schizophrenia (n = 16) and healthy controls (n = 17) were recruited from the community. MAIN OUTCOME MEASURES The percentage of signal change for each contrast and performance and clinical symptom severity ratings. RESULTS Patients showed reduced limbic activation compared with controls for the emotion identification task. However, event-related analysis revealed that whereas in controls greater amygdala activation was associated with correct identifications of threat-related (anger and fear) expressions, patients showed the opposite effect of greater limbic activation, portending misidentifications. Furthermore, greater amygdala activation to the presentation of fearful faces was highly correlated with greater severity of flat affect. CONCLUSIONS Abnormal amygdala activation in schizophrenia in response to presentation of fearful faces is paradoxically associated with failure to recognize the emotion and with more severe flat affect. This finding suggests that flat affect in schizophrenia relates to overstimulation of the limbic system.
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Affiliation(s)
- Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Kohler CG, Martin EA, Kujawski E, Bilker W, Gur RE, Gur RC. No effect of donepezil on neurocognition and social cognition in young persons with stable schizophrenia. Cogn Neuropsychiatry 2007; 12:412-21. [PMID: 17690999 DOI: 10.1080/13546800701307263] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cognitive dysfunction is common in schizophrenia and linked with psychosocial dysfunction. We examined the possible effect of a 16-week trial of donepezil on cognition in young persons with stable schizophrenia. METHOD Twenty-six outpatients who met criteria for age, duration of illness, clinical stability, and medications were randomly assigned to 16-week treatment with donepezil or placebo using a double blind design. At beginning and conclusion of the trial, participants completed standardised computerised assessment of neurocognition and social cognition. Symptomatology and functioning were assessed using standard rating scales for negative and positive symptoms, depression and mania, and quality of life. RESULTS No treatment effects were found on any cognitive functions or clinical symptoms in placebo or donepezil groups. CONCLUSION Similar to other studies using acetylcholinesterase inhibitors in more heterogeneous and symptomatic groups of patients with schizophrenia, donepezil does not appear to enhance cognitive abilities. Persistent cognitive impairment in schizophrenia with pervasive effects on psychosocial functioning and outcome, urge the search for agents that may offer improvement.
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Affiliation(s)
- Christian G Kohler
- Schizophrenia Research Center, Neuropsychiatry Section, University of Pennsylvania, Philadelphia, PA 19104, USA.
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45
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Weiss EM, Stadelmann E, Kohler CG, Brensinger CM, Nolan KA, Oberacher H, Parson W, Pitterl F, Niederstätter H, Kemmler G, Hinterhuber H, Marksteiner J. Differential effect of catechol-O-methyltransferase Val158Met genotype on emotional recognition abilities in healthy men and women. J Int Neuropsychol Soc 2007; 13:881-7. [PMID: 17517149 DOI: 10.1017/s1355617707070932] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 02/28/2007] [Accepted: 03/02/2007] [Indexed: 11/07/2022]
Abstract
The catechol-O-methyltransferase (COMT) Val158Met polymorphism modulates executive functions and working memory and recent neuroimaging studies implicate an association with emotional processing. We examined the relationship between the COMT Val158Met polymorphism and facial emotion recognition and differentiation in 100 healthy individuals. Compared to Met homozygosity, Val homozygosity was associated with better and faster recognition of negative facial expressions such as anger and sad. Our study provides evidence for a possible influence of the COMT polymorphism on emotion recognition abilities in healthy subjects. Additional research is needed to further define the neurocognitive phenotypes associated with COMT polymorphisms.
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Affiliation(s)
- Elisabeth M Weiss
- Department of General Psychiatry, Innsbruck Medical, Innsbruck, Austria.
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Turetsky BI, Kohler CG, Indersmitten T, Bhati MT, Charbonnier D, Gur RC. Facial emotion recognition in schizophrenia: when and why does it go awry? Schizophr Res 2007; 94:253-63. [PMID: 17583481 PMCID: PMC2571079 DOI: 10.1016/j.schres.2007.05.001] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 04/27/2007] [Accepted: 05/01/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Schizophrenia patients demonstrate impaired emotional processing that may be due, in part, to impaired facial emotion recognition. This study examined event-related potential (ERP) responses to emotional faces in schizophrenia patients and controls to determine when, in the temporal processing stream, patient abnormalities occur. METHOD 16 patients and 16 healthy control participants performed a facial emotion recognition task. Very sad, somewhat sad, neutral, somewhat happy, and very happy faces were each presented for 100 ms. Subjects indicated whether each face was "Happy", "Neutral", or "Sad". Evoked potential data were obtained using a 32-channel EEG system. RESULTS Controls performed better than patients in recognizing facial emotions. In patients, better recognition of happy faces correlated with less severe negative symptoms. Four ERP components corresponding to the P100, N170, N250, and P300 were identified. Group differences were noted for the N170 "face processing" component that underlies the structural encoding of facial features, but not for the subsequent N250 "affect modulation" component. Higher amplitude of the N170 response to sad faces was correlated with less severe delusional symptoms. Although P300 abnormalities were found, the variance of this component was explained by the earlier N170 response. CONCLUSION Patients with schizophrenia demonstrate abnormalities in early visual encoding of facial features that precedes the ERP response typically associated with facial affect recognition. This suggests that affect recognition deficits, at least for happy and sad discrimination, are secondary to faulty structural encoding of faces. The association of abnormal face encoding with delusions may denote the physiological basis for clinical misidentification syndromes.
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Affiliation(s)
- Bruce I Turetsky
- Neurophysiology and Brain Imaging Laboratory, Department of Psychiatry 10th Floor, Gates Building, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Turetsky BI, Glass CA, Abbazia J, Kohler CG, Gur RE, Moberg PJ. Reduced posterior nasal cavity volume: a gender-specific neurodevelopmental abnormality in schizophrenia. Schizophr Res 2007; 93:237-44. [PMID: 17433628 PMCID: PMC2692622 DOI: 10.1016/j.schres.2007.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Revised: 02/20/2007] [Accepted: 02/26/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We previously reported that men with schizophrenia had reduced volumes of the posterior nasal cavity bilaterally. Since the nasal cavities develop in conjunction with both the palate and ventral forebrain, this could represent a simple marker of embryological dysmorphogenesis contributing to schizophrenia. The current study expands on this finding by examining a larger sample of both male and female patients and unaffected 1st-degree relatives, to determine the gender distribution of this abnormality and the extent to which it may be genetically mediated. METHOD A measurement of nasal volume and geometry was acquired by acoustic rhinometry for 85 schizophrenia patients, 25 unaffected 1st-degree relatives of schizophrenia probands and 66 healthy comparison subjects. RESULTS Male patients had smaller posterior nasal volumes than both male control subjects and male relatives. However, female patients did not differ from either female controls or female family members. Unaffected 1st-degree relatives did not differ from same-sex control subjects. These findings persisted after covarying for height and smoking history, and were unrelated to clinical symptomatology or antipsychotic medication usage. CONCLUSION Posterior nasal cavity volume decrement appears to be a specific developmental craniofacial abnormality that may reflect an early disruption in embryological development in males with schizophrenia. Although further study is needed, this may be a marker of a "second hit" that distinguishes genetically vulnerable men who go on to develop the illness from those who do not.
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Affiliation(s)
- Bruce I Turetsky
- Schizophrenia Research Center, Department of Psychiatry, 10th Floor, Gates Building, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, Pennsylvania, 19104, USA.
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Abstract
The authors examine facial emotion recognition and unirhinal olfactory performance in 19 schizophrenia patients and 14 comparison subjects. In patients, right nostril odor identification performance was positively related to overall emotion recognition accuracy, specifically, sad facial expressions. Olfactory and emotion recognition abilities appear significantly linked in schizophrenia.
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Affiliation(s)
- Christian G Kohler
- Schizophrenia Research Center, University of Pennsylvania, Department of Psychiatry, 10th Floor, Gates Building, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Moberg PJ, McGue C, Kanes SJ, Roalf DR, Balderston CC, Gur RE, Kohler CG, Turetsky BI. Phenylthiocarbamide (PTC) perception in patients with schizophrenia and first-degree family members: relationship to clinical symptomatology and psychophysical olfactory performance. Schizophr Res 2007; 90:221-8. [PMID: 17208411 PMCID: PMC1862680 DOI: 10.1016/j.schres.2006.11.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 11/18/2006] [Accepted: 11/26/2006] [Indexed: 11/27/2022]
Abstract
The inability to taste phenylthiocarbamide (PTC; "taste-blindness") has been associated with a number of medical and neurological illnesses not typically related to taste. We examined PTC sensitivity in 67 schizophrenia patients, 30 healthy controls, and 30 first-degree relatives to determine whether taster status could represent a simple vulnerability marker. A higher prevalence of non-tasters was seen in patients and family members relative to healthy controls. Among patients, non-tasters exhibited increased levels of negative and first-rank symptoms as well as poorer right nostril odor identification skills relative to PTC tasters. These differences were not explained by age, sex, education, smoking, or intensity differences. Phenotypic variation in PTC sensitivity is thought to be genetic in origin and suggests greater illness risk for those subjects with recessive taster alleles.
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Affiliation(s)
- Paul J Moberg
- Schizophrenia Research Center, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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Moberg PJ, Arnold SE, Doty RL, Gur RE, Balderston CC, Roalf DR, Gur RC, Kohler CG, Kanes SJ, Siegel SJ, Turetsky BI. Olfactory functioning in schizophrenia: relationship to clinical, neuropsychological, and volumetric MRI measures. J Clin Exp Neuropsychol 2006; 28:1444-61. [PMID: 17050269 DOI: 10.1080/13803390500434409] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Deficits in odor identification and detection threshold sensitivity have been observed in schizophrenia but their relationship to clinical, cognitive, and biologic measures have not been clearly established. Our objectives were to examine the relationship between measures of odor identification and detection threshold sensitivity and clinical, neuropsychological, and anatomic brain measures. Twenty-one patients with schizophrenia and 20 healthy controls were administered psychophysical tests of odor identification and detection threshold sensitivity to phenyl ethyl alcohol. In addition, clinical symptom ratings, neuropsychological measures of frontal and temporal lobe function and whole brain MRIs were concurrently obtained. Patients exhibited significant deficits in odor identification but normal detection threshold sensitivity. Poorer odor identification scores were associated with longer duration of illness, increased negative and disorganized symptoms, and the deficit syndrome, as well as impairments in verbal and nonverbal memory. Better odor detection thresholds were specifically associated with first-rank or productive symptoms. Larger left temporal lobe volumes with MRI were associated with better odor identification in controls but not in patients. Given the relevance of the neural substrate, and the evidence of performance deficits, psychophysical probes of the integrity of the olfactory system hold special promise for illuminating aspects of the neurobiology underlying schizophrenia.
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Affiliation(s)
- Paul J Moberg
- Schizophrenia Research Center, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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