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Sarpal DK, Cole ES, Gannon JM, Li J, Adair DK, Chengappa KNR, Donohue JM. Variation of Clozapine Use for Treatment of Schizophrenia: Evidence from Pennsylvania Medicaid and Dually Eligible Enrollees. Community Ment Health J 2024; 60:743-753. [PMID: 38294579 DOI: 10.1007/s10597-023-01226-7] [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: 09/20/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024]
Abstract
While clozapine is the most effective antipsychotic treatment for treatment-resistant schizophrenia, it remains underutilized across the United States, warranting a more comprehensive understanding of variation in use at the county level, as well as characterization of existing prescribing patterns. Here, we examined both Medicaid and Medicare databases to (1) characterize temporal and geographic variation in clozapine prescribing and, (2) identify patient-level characteristics associated with clozapine use. We included Medicaid and Fee for Service Medicare data in the state of Pennsylvania from January 1, 2013, through December 31, 2019. We focused on individuals with continuous enrollment, schizophrenia diagnosis, and multiple antipsychotic trials. Geographic variation was examined across counties of Pennsylvania. Regression models were constructed to determine demographic and clinical characteristics associated with clozapine use. Out of 8,255 individuals who may benefit from clozapine, 642 received treatment. We observed high medication burden, overall, including multiple antipsychotic trials. We also identified variation in clozapine use across regions in Pennsylvania with a disproportionate number of prescribers in urban areas and several counties with no identified clozapine prescribers. Finally, demographic, and clinical determinants of clozapine use were observed including less use in people identified as non-Hispanic Black, Hispanic, or with a substance use disorder. In addition, greater medical comorbidity was associated with increased clozapine use. Our work leveraged both Medicaid and Medicare data to characterize and surveil clozapine prescribing. Our findings support efforts monitor disparities and opportunities for the optimization of clozapine within municipalities to enhance clinical outcomes.
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Affiliation(s)
- Deepak K Sarpal
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Evan S Cole
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica M Gannon
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jie Li
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dale K Adair
- Office of Mental Health and Substance Abuse Services, Pennsylvania Department of Human Services, Harrisburg, PA, USA
| | - K N Roy Chengappa
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julie M Donohue
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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2
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Wood HJ, Jones N, Eack SM, Chengappa KNR, Prasad KM, Kelly C, Montrose D, Schooler NR, Ganguli R, Carter CS, Keshavan MS, Sarpal DK. Over 30 years of STEP: The Pittsburgh experience with first-episode psychosis. Early Interv Psychiatry 2024. [PMID: 38637133 DOI: 10.1111/eip.13536] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
AIMS For over 30 years, combined research and treatment settings in the US have been critical to conceptualizing care for first-episode psychosis (FEP). Here we describe an early example of such a context, the Services for the Treatment of Early Psychosis (STEP) clinic, which is affiliated with the University of Pittsburgh. METHODS We describe STEP's historical roots and establishment in the early 1990s; STEP's research and treatment contributions, alongside its growth and ongoing leadership. RESULTS Research-based clinics, like STEP, preceded and helped pave the way for the Recovery After an Initial Schizophrenia Episode project in the US and the ensuing Coordinated Specialty Care (CSC) approach, now widely adopted in the US. Early clinic-based research at STEP helped establish protocols for psychopharmacology, the relevance of effective early treatment, including psychosocial approaches, and highlighted disparities in treatment outcomes across race/ethnicity. Multidisciplinary collaboration and dialogue with consumers contributed to early treatment, combining psychosocial and pharmacological approaches. STEP adopted CSC and is situated within a bi-state Learning Health System. STEP has retained a relatively unique 5-year treatment model and exists within continuum of care ideally suited to studying psychotic illness and treatment outcomes. CONCLUSIONS STEP remains the largest academic FEP clinic in Pennsylvania. Academic FEP clinics like STEP will have a critical role within Learning Health Systems nationally to model participatory approaches, sustain early intervention treatment quality and ongoing treatment developments.
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Affiliation(s)
- Helen J Wood
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Nev Jones
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shaun M Eack
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - K N Roy Chengappa
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Konasale M Prasad
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christian Kelly
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Debra Montrose
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Nina R Schooler
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Rohan Ganguli
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cameron S Carter
- Department of Psychiatry, University of California, Irvine, California, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Deepak K Sarpal
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Szmulewicz AG, Martínez-Alés G, Logan R, Ferrara M, Kelly C, Fredrikson D, Gago J, Conderino S, Díaz-Caneja CM, Galvañ J, Thorpe L, Srihari V, Yatham L, Sarpal DK, Shinn AK, Arango C, Öngür D, Hernán MA, Fep-Causal Collaboration OBOT. Antipsychotic drugs in first-episode psychosis: A target trial emulation in the FEP-CAUSAL Collaboration. Am J Epidemiol 2024:kwae029. [PMID: 38576166 DOI: 10.1093/aje/kwae029] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 02/06/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024] Open
Abstract
Good adherence to antipsychotic therapy helps prevent relapses in First Episode Psychosis (FEP). We used data from the FEP-CAUSAL Collaboration, an international consortium of observational cohorts to emulate a target trial comparing antipsychotics with treatment discontinuation as the primary outcome. Other outcomes included all-cause hospitalization. We benchmarked our results to estimates from EUFEST, a randomized trial conducted in the 2000s. We included 1097 patients with a psychotic disorder and less than 2 years since psychosis onset. Inverse probability weighting was used to control for confounding. The estimated 12-month risks of discontinuation for aripiprazole, first-generation agents, olanzapine, paliperidone, quetiapine, and risperidone (95% CI) were: 61.5% (52.5-70.6), 73.5% (60.5-84.9), 76.8% (67.2-85.3), 58.4% (40.4-77.4), 76.5% (62.1-88.5), and 74.4% (67.0-81.2) respectively. Compared with aripiprazole, the 12-month risk differences (95% CI) were -15.3% (-30.0, 0.0) for olanzapine, -12.8% (-25.7, -1.0) for risperidone, and 3.0% (-21.5, 30.8) for paliperidone. The 12-month risks of hospitalization were similar between agents. Our estimates support use of aripiprazole and paliperidone as first-line therapies for FEP. Benchmarking yielded similar results for discontinuation and absolute risks of hospitalization as in the original trial, suggesting that data from the FEP-CAUSAL Collaboration data sufficed to approximately remove confounding for these clinical questions.
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Affiliation(s)
| | | | - Roger Logan
- CAUSALab, Department of Epidemiology, Harvard TH Chan School of Public Health
| | - Maria Ferrara
- USA Department of Psychiatry, Yale School of Medicine, USA
| | - Christian Kelly
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Juan Gago
- Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, USA
| | - Sarah Conderino
- Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, USA
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Joaquín Galvañ
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Lorna Thorpe
- Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, USA
| | - Vinod Srihari
- USA Department of Psychiatry, Yale School of Medicine, USA
| | | | - Deepak K Sarpal
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ann K Shinn
- McLean Hospital, Belmont, Massachusetts, USA Department of Psychiatry
- Harvard Medical School, Boston, MA, USA
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Dost Öngür
- McLean Hospital, Belmont, Massachusetts, USA Department of Psychiatry
- Harvard Medical School, Boston, MA, USA
| | - Miguel A Hernán
- CAUSALab, Department of Epidemiology, Harvard TH Chan School of Public Health
- Department of Biostatistics, Harvard T.H. Chan School of Public Health
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Voineskos AN, Hawco C, Neufeld NH, Turner JA, Ameis SH, Anticevic A, Buchanan RW, Cadenhead K, Dazzan P, Dickie EW, Gallucci J, Lahti AC, Malhotra AK, Öngür D, Lencz T, Sarpal DK, Oliver LD. Functional magnetic resonance imaging in schizophrenia: current evidence, methodological advances, limitations and future directions. World Psychiatry 2024; 23:26-51. [PMID: 38214624 PMCID: PMC10786022 DOI: 10.1002/wps.21159] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Functional neuroimaging emerged with great promise and has provided fundamental insights into the neurobiology of schizophrenia. However, it has faced challenges and criticisms, most notably a lack of clinical translation. This paper provides a comprehensive review and critical summary of the literature on functional neuroimaging, in particular functional magnetic resonance imaging (fMRI), in schizophrenia. We begin by reviewing research on fMRI biomarkers in schizophrenia and the clinical high risk phase through a historical lens, moving from case-control regional brain activation to global connectivity and advanced analytical approaches, and more recent machine learning algorithms to identify predictive neuroimaging features. Findings from fMRI studies of negative symptoms as well as of neurocognitive and social cognitive deficits are then reviewed. Functional neural markers of these symptoms and deficits may represent promising treatment targets in schizophrenia. Next, we summarize fMRI research related to antipsychotic medication, psychotherapy and psychosocial interventions, and neurostimulation, including treatment response and resistance, therapeutic mechanisms, and treatment targeting. We also review the utility of fMRI and data-driven approaches to dissect the heterogeneity of schizophrenia, moving beyond case-control comparisons, as well as methodological considerations and advances, including consortia and precision fMRI. Lastly, limitations and future directions of research in the field are discussed. Our comprehensive review suggests that, in order for fMRI to be clinically useful in the care of patients with schizophrenia, research should address potentially actionable clinical decisions that are routine in schizophrenia treatment, such as which antipsychotic should be prescribed or whether a given patient is likely to have persistent functional impairment. The potential clinical utility of fMRI is influenced by and must be weighed against cost and accessibility factors. Future evaluations of the utility of fMRI in prognostic and treatment response studies may consider including a health economics analysis.
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Affiliation(s)
- Aristotle N Voineskos
- Campbell Family Mental Health Research Institute and Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Colin Hawco
- Campbell Family Mental Health Research Institute and Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicholas H Neufeld
- Campbell Family Mental Health Research Institute and Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jessica A Turner
- Department of Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Stephanie H Ameis
- Campbell Family Mental Health Research Institute and Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression and McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alan Anticevic
- Interdepartmental Neuroscience Program, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristin Cadenhead
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Erin W Dickie
- Campbell Family Mental Health Research Institute and Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Julia Gallucci
- Campbell Family Mental Health Research Institute and Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Adrienne C Lahti
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anil K Malhotra
- Institute for Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, NY, USA
| | - Dost Öngür
- McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - Todd Lencz
- Institute for Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, NY, USA
| | - Deepak K Sarpal
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lindsay D Oliver
- Campbell Family Mental Health Research Institute and Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Rubio JM, Lencz T, Cao H, Kraguljac N, Dhamala E, Homan P, Horga G, Sarpal DK, Argyelan M, Gallego J, Cholewa J, Barber A, Kane JM, Malhotra AK. Replication of a neuroimaging biomarker for striatal dysfunction in psychosis. Mol Psychiatry 2024:10.1038/s41380-023-02381-9. [PMID: 38177349 DOI: 10.1038/s41380-023-02381-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024]
Abstract
To bring biomarkers closer to clinical application, they should be generalizable, reliable, and maintain performance within the constraints of routine clinical conditions. The functional striatal abnormalities (FSA), is among the most advanced neuroimaging biomarkers in schizophrenia, trained to discriminate diagnosis, with post-hoc analyses indicating prognostic properties. Here, we attempt to replicate its diagnostic capabilities measured by the area under the curve (AUC) in receiver operator characteristic curves discriminating individuals with psychosis (n = 101) from healthy controls (n = 51) in the Human Connectome Project for Early Psychosis. We also measured the test-retest (run 1 vs 2) and phase encoding direction (i.e., AP vs PA) reliability with intraclass correlation coefficients (ICC). Additionally, we measured effects of scan length on classification accuracy (i.e., AUCs) and reliability (i.e., ICCs). Finally, we tested the prognostic capability of the FSA by the correlation between baseline scores and symptom improvement over 12 weeks of antipsychotic treatment in a separate cohort (n = 97). Similar analyses were conducted for the Yeo networks intrinsic connectivity as a reference. The FSA had good/excellent diagnostic discrimination (AUC = 75.4%, 95% CI = 67.0-83.3%; in non-affective psychosis AUC = 80.5%, 95% CI = 72.1-88.0%, and in affective psychosis AUC = 58.7%, 95% CI = 44.2-72.0%). Test-retest reliability ranged between ICC = 0.48 (95% CI = 0.35-0.59) and ICC = 0.22 (95% CI = 0.06-0.36), which was comparable to that of networks intrinsic connectivity. Phase encoding direction reliability for the FSA was ICC = 0.51 (95% CI = 0.42-0.59), generally lower than for networks intrinsic connectivity. By increasing scan length from 2 to 10 min, diagnostic classification of the FSA increased from AUC = 71.7% (95% CI = 63.1-80.3%) to 75.4% (95% CI = 67.0-83.3%) and phase encoding direction reliability from ICC = 0.29 (95% CI = 0.14-0.43) to ICC = 0.51 (95% CI = 0.42-0.59). FSA scores did not correlate with symptom improvement. These results reassure that the FSA is a generalizable diagnostic - but not prognostic - biomarker. Given the replicable results of the FSA as a diagnostic biomarker trained on case-control datasets, next the development of prognostic biomarkers should be on treatment-response data.
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Affiliation(s)
- Jose M Rubio
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, NY, USA.
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, USA.
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA.
| | - Todd Lencz
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA
| | - Hengyi Cao
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA
| | - Nina Kraguljac
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Elvisha Dhamala
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA
| | - Philipp Homan
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, 8057, Zurich, Switzerland
| | - Guillermo Horga
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY, USA
| | - Deepak K Sarpal
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Miklos Argyelan
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA
| | - Juan Gallego
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA
| | - John Cholewa
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA
| | - Anita Barber
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA
| | - John M Kane
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA
| | - Anil K Malhotra
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA
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6
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Wood HJ, Babusci C, Bendall S, Sarpal DK, Jones N. Trauma and Trauma-Informed Care in Early Intervention in Psychosis: State of Implementation and Provider Views on Challenges. Psychiatr Serv 2023; 74:1240-1246. [PMID: 37194314 DOI: 10.1176/appi.ps.20220624] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE Although trauma is increasingly recognized as a major risk factor for psychosis and for its link to treatment outcomes, the landscape of trauma-related practices in specialized early psychosis services in the United States and other countries remains only poorly characterized. Research documenting the perspectives of frontline providers is also lacking. The primary goals of this study were to document the state of trauma-related policy implementation in early intervention in psychosis (EIP) programs and to gather provider perspectives. METHODS This was a mixed-methods project involving an international EIP provider survey, followed by in-depth provider interviews. The survey was disseminated in Australia, Canada, Chile, the United Kingdom, and the United States. In total, 164 providers, representing 110 unique sites, completed the survey. Frequencies were calculated for responses to survey items, and open-ended responses were analyzed with a systematic content analysis. RESULTS The survey findings suggested low implementation rates for a variety of assessment and support practices related to trauma and trauma-informed care. Coding of open-ended responses revealed numerous concerns and uncertainties among providers regarding the relationship between trauma and psychosis and the state of the EIP field. CONCLUSIONS An expansion of research and service development aimed at better meeting the trauma-related needs of young people with psychosis is essential, with implications for EIP outcomes and service user and staff experiences.
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Affiliation(s)
- Helen J Wood
- Services for the Treatment of Early Psychosis, UPMC Western Psychiatric Hospital, Pittsburgh (Wood, Sarpal); School of Social Work (Babusci, Jones) and Department of Psychiatry (Sarpal), University of Pittsburgh, Pittsburgh; Centre for Youth Mental Health, University of Melbourne, and Orygen, Melbourne (Bendall)
| | - Christina Babusci
- Services for the Treatment of Early Psychosis, UPMC Western Psychiatric Hospital, Pittsburgh (Wood, Sarpal); School of Social Work (Babusci, Jones) and Department of Psychiatry (Sarpal), University of Pittsburgh, Pittsburgh; Centre for Youth Mental Health, University of Melbourne, and Orygen, Melbourne (Bendall)
| | - Sarah Bendall
- Services for the Treatment of Early Psychosis, UPMC Western Psychiatric Hospital, Pittsburgh (Wood, Sarpal); School of Social Work (Babusci, Jones) and Department of Psychiatry (Sarpal), University of Pittsburgh, Pittsburgh; Centre for Youth Mental Health, University of Melbourne, and Orygen, Melbourne (Bendall)
| | - Deepak K Sarpal
- Services for the Treatment of Early Psychosis, UPMC Western Psychiatric Hospital, Pittsburgh (Wood, Sarpal); School of Social Work (Babusci, Jones) and Department of Psychiatry (Sarpal), University of Pittsburgh, Pittsburgh; Centre for Youth Mental Health, University of Melbourne, and Orygen, Melbourne (Bendall)
| | - Nev Jones
- Services for the Treatment of Early Psychosis, UPMC Western Psychiatric Hospital, Pittsburgh (Wood, Sarpal); School of Social Work (Babusci, Jones) and Department of Psychiatry (Sarpal), University of Pittsburgh, Pittsburgh; Centre for Youth Mental Health, University of Melbourne, and Orygen, Melbourne (Bendall)
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7
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Sarpal DK, Suh K, Bian K, Ko P, Gannon JM, Jhon P, Chengappa KNR. Community-Based Service Use After Clozapine Treatment: A Mirror-Image Analysis of Public Claims Data. Psychiatr Serv 2023; 74:1104-1107. [PMID: 37016827 DOI: 10.1176/appi.ps.20220471] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Although clozapine demonstrates unique efficacy for treatment-resistant schizophrenia, its impact on community-based services remains largely underexplored. The authors examined changes in use of community-based services after clozapine treatment among a sample of 163 patients with schizophrenia by using public claims data in Allegheny County, Pennsylvania. Mirror-image analyses of service utilization were used to compare the 180-day period before treatment initiation with the 180-day period that began after 6 months of adherent treatment, accounting for age, race, and gender. Across demographic variables, clozapine treatment was associated with increased use of community-based services and decreased use of psychiatric inpatient services (p<0.05, Bonferroni corrected), suggesting that clozapine treatment shifts service needs from emergency care to community-based care and recovery.
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Affiliation(s)
- Deepak K Sarpal
- Department of Psychiatry (Sarpal, Gannon, Chengappa) and Department of Pharmacy and Therapeutics (Suh), University of Pittsburgh, Pittsburgh; Allegheny County Department of Human Services, Pittsburgh (Bian, Ko, Jhon)
| | - Kangho Suh
- Department of Psychiatry (Sarpal, Gannon, Chengappa) and Department of Pharmacy and Therapeutics (Suh), University of Pittsburgh, Pittsburgh; Allegheny County Department of Human Services, Pittsburgh (Bian, Ko, Jhon)
| | - Kaiqi Bian
- Department of Psychiatry (Sarpal, Gannon, Chengappa) and Department of Pharmacy and Therapeutics (Suh), University of Pittsburgh, Pittsburgh; Allegheny County Department of Human Services, Pittsburgh (Bian, Ko, Jhon)
| | - Pingjui Ko
- Department of Psychiatry (Sarpal, Gannon, Chengappa) and Department of Pharmacy and Therapeutics (Suh), University of Pittsburgh, Pittsburgh; Allegheny County Department of Human Services, Pittsburgh (Bian, Ko, Jhon)
| | - Jessica M Gannon
- Department of Psychiatry (Sarpal, Gannon, Chengappa) and Department of Pharmacy and Therapeutics (Suh), University of Pittsburgh, Pittsburgh; Allegheny County Department of Human Services, Pittsburgh (Bian, Ko, Jhon)
| | - Peter Jhon
- Department of Psychiatry (Sarpal, Gannon, Chengappa) and Department of Pharmacy and Therapeutics (Suh), University of Pittsburgh, Pittsburgh; Allegheny County Department of Human Services, Pittsburgh (Bian, Ko, Jhon)
| | - K N Roy Chengappa
- Department of Psychiatry (Sarpal, Gannon, Chengappa) and Department of Pharmacy and Therapeutics (Suh), University of Pittsburgh, Pittsburgh; Allegheny County Department of Human Services, Pittsburgh (Bian, Ko, Jhon)
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Myers N, Hutnyan M, Daley TC, Bello I, Chacon M, Currie A, Davis BJ, Dixon LB, George PE, Giannicchi A, Kwashie AN, McCormick KA, Meyer-Kalos P, Nagendra A, Nayar S, Sarpal DK, Sepahpour TY, Shapiro DI, Taylor-Zoghby J. Pathways Through Early Psychosis Care for U.S. Youths From Ethnically and Racially Minoritized Groups: A Systematic Review. Psychiatr Serv 2023; 74:859-868. [PMID: 36789610 PMCID: PMC10425565 DOI: 10.1176/appi.ps.20220121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/16/2023]
Abstract
OBJECTIVE The authors of this systematic review examined service utilization and outcomes among youths from ethnoracially minoritized groups after the youths initiated treatment for a psychotic disorder-that is, the youths' "pathway through care." Also examined were potential moderating variables in pathways through care for these youths at the clinic, family, and cultural levels. The goal was to describe methodologies, summarize relevant findings, highlight knowledge gaps, and propose future research on pathways through care for young persons from ethnoracially minoritized groups who experience early psychosis. METHODS The PubMed, PsycInfo, and Web of Science literature databases were systematically searched for studies published between January 1, 2010, and June 1, 2021. Included articles were from the United States and focused on young people after they initiated treatment for early psychosis. Eighteen studies met inclusion criteria. RESULTS Sixteen of the 18 studies were published in the past 5 years, and 11 had an explicit focus on race and ethnicity as defined by the studies' authors. Studies varied in terminology, outcomes measures, methodologies, and depth of analysis. Being an individual from an ethnoracially minoritized group appeared to affect care utilization and outcomes. Insufficient research was found about potential moderating variables at the clinic, family, and cultural levels. CONCLUSIONS Studies of pathways through care for persons from minoritized groups warrant further funding and attention.
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Affiliation(s)
- Neely Myers
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Matthew Hutnyan
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Tamara C Daley
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Iruma Bello
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Marne Chacon
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Ariel Currie
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Beshaun J Davis
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Lisa B Dixon
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Preethy E George
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Anna Giannicchi
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Anita N Kwashie
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Katie A McCormick
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Piper Meyer-Kalos
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Arundati Nagendra
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Swati Nayar
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Deepak K Sarpal
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Tiana Y Sepahpour
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Daniel I Shapiro
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Jessica Taylor-Zoghby
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
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Rubio JM, Lencz T, Cao H, Kraguljac N, Dhamala E, Homan P, Horga G, Sarpal DK, Argyelan M, Gallego J, Cholewa J, Barber A, Kane J, Malhotra A. Replication of a neuroimaging biomarker for striatal dysfunction in psychosis. medRxiv 2023:2023.07.17.23292779. [PMID: 37503088 PMCID: PMC10371185 DOI: 10.1101/2023.07.17.23292779] [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] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
To bring biomarkers closer to clinical application, they should be generalizable, reliable, and maintain performance within the constraints of routine clinical conditions. The functional striatal abnormalities (FSA), is among the most advanced neuroimaging biomarkers in schizophrenia, trained to discriminate diagnosis, with post-hoc analyses indicating prognostic properties. Here, we attempt to replicate its diagnostic capabilities measured by the area under the curve (AUC) in receiver operator characteristic curves discriminating individuals with psychosis (n=101) from healthy controls (n=51) in the Human Connectome Project for Early Psychosis. We also measured the test-retest (run 1 vs 2) and phase encoding direction (i.e., AP vs PA) reliability with intraclass correlation coefficients (ICC). Additionally, we measured effects of scan length on classification accuracy (i.e., AUCs) and reliability (i.e., ICCs). Finally, we tested the prognostic capability of the FSA by the correlation between baseline scores and symptom improvement over 12 weeks of antipsychotic treatment in a separate cohort (n=97). Similar analyses were conducted for the Yeo networks intrinsic connectivity as a reference. The FSA had good/excellent diagnostic discrimination (AUC=75.4%, 95%CI=67.0%-83.3%; in non-affective psychosis AUC=80.5%, 95%CI=72.1-88.0%, and in affective psychosis AUC=58.7%, 95%CI=44.2-72.0%). Test-retest reliability ranged between ICC=0.48 (95%CI=0.35-0.59) and ICC=0.22 (95%CI=0.06-0.36), which was comparable to that of networks intrinsic connectivity. Phase encoding direction reliability for the FSA was ICC=0.51 (95%CI=0.42-0.59), generally lower than for networks intrinsic connectivity. By increasing scan length from 2 to 10 minutes, diagnostic classification of the FSA increased from AUC=71.7% (95%CI=63.1%-80.3%) to 75.4% (95%CI=67.0%-83.3%) and phase encoding direction reliability from ICC=0.29 (95%CI=0.14-0.43) to ICC=0.51 (95%CI=0.42-0.59). FSA scores did not correlate with symptom improvement. These results reassure that the FSA is a generalizable diagnostic - but not prognostic - biomarker. Given the replicable results of the FSA as a diagnostic biomarker trained on case-control datasets, next the development of prognostic biomarkers should be on treatment-response data.
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Affiliation(s)
- Jose M Rubio
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, USA
| | - Todd Lencz
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, USA
| | - Hengyi Cao
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, USA
| | - Nina Kraguljac
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio
| | - Elvisha Dhamala
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, USA
| | - Philipp Homan
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, 8057, Zurich, Switzerland
| | - Guillermo Horga
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, USA
| | - Deepak K Sarpal
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Miklos Argyelan
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, USA
| | - Juan Gallego
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, USA
| | - John Cholewa
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, USA
| | - Anita Barber
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, USA
| | - John Kane
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, USA
| | - Anil Malhotra
- Donald and Barbara Zucker School of Medicine at Hofstra University - Northwell Health, New York, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, New York, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, USA
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10
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Sarpal DK. Monitoring Performance Monitors: Leveraging Neurocognitive Precision to Advance Illness Prevention. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:488-489. [PMID: 37150582 DOI: 10.1016/j.bpsc.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 05/09/2023]
Affiliation(s)
- Deepak K Sarpal
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
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11
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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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12
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Mayeli A, Clancy KJ, Sonnenschein S, Sarpal DK, Ferrarelli F. A narrative review of treatment interventions to improve cognitive performance in schizophrenia, with an emphasis on at-risk and early course stages. Psychiatry Res 2022; 317:114926. [PMID: 36932470 PMCID: PMC10729941 DOI: 10.1016/j.psychres.2022.114926] [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: 07/19/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 10/31/2022]
Abstract
Cognitive dysfunction is a core feature of schizophrenia (SCZ), which unfavorably affects SCZ patients' daily functioning and overall clinical outcome. An increasing body of evidence has shown that cognitive deficits are present not only at the beginning of the illness but also several years before the onset of psychosis. Nonetheless, the majority of treatment interventions targeting cognitive dysfunction in SCZ, using both pharmacological and nonpharmacological approaches, have focused on chronic patients rather than individuals at high risk or in the early stages of the disease. In this article, we provide a narrative review of cognitive interventions in SCZ patients, with a particular focus on pre-emptive interventions in at-risk/early course individuals when available. Furthermore, we discuss current challenges for these pre-emptive treatment interventions and provide some suggestions on how future work may ameliorate cognitive dysfunction in these individuals.
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Affiliation(s)
- Ahmad Mayeli
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Ave, Suite 456, Pittsburgh, PA 15213, USA
| | - Kevin J Clancy
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Ave, Suite 456, Pittsburgh, PA 15213, USA
| | - Susan Sonnenschein
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Ave, Suite 456, Pittsburgh, PA 15213, USA
| | - Deepak K Sarpal
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Ave, Suite 456, Pittsburgh, PA 15213, USA
| | - Fabio Ferrarelli
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Ave, Suite 456, Pittsburgh, PA 15213, USA.
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13
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Sonnenschein SF, Mayeli A, Yushmanov VE, Blazer A, Calabro FJ, Perica M, Foran W, Luna B, Hetherington HP, Ferrarelli F, Sarpal DK. A longitudinal investigation of GABA, glutamate, and glutamine across the insula during antipsychotic treatment of first-episode schizophrenia. Schizophr Res 2022; 248:98-106. [PMID: 36029656 PMCID: PMC10018530 DOI: 10.1016/j.schres.2022.08.008] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/29/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022]
Abstract
Individuals with first-episode schizophrenia (FES) typically present with acute psychotic symptoms. Though antipsychotic drugs are the mainstay for treatment, the neurobiology underlying successful treatment remains largely elusive. Recent evidence from functional connectivity studies highlights the insula as a key structure in the neural mechanism of response. However, molecular contributions to response across insular regions remain largely unknown. We used 7-Tesla magnetic resonance spectroscopic imaging (MRSI) to measure glutamate (Glu), Glutamine (Gln), and GABA from anterior and posterior regions of the insula across antipsychotic treatment. A total of 36 participants were examined, including 15 individuals with FES and moderate to severe psychosis who were scanned at two time points, while starting and after 6 weeks of antipsychotic treatment. Symptoms were carefully monitored across the study period to characterize treatment response. GABA, Glu, and Gln levels were calculated relative to creatine in anterior and posterior insular regions, bilaterally. In relation to psychotic symptom reduction, we observed a significant increase in Glu across all insular regions with (p < 0.001), but no corresponding changes in Gln or GABA. In group analyses, the FES cohort showed lower levels of Glu (p < 0.001) and GABA (p = 0.02) at baseline. Finally, in exploratory analyses, treatment remitters demonstrated a normalization of lower insular Glu levels across treatment, unlike non-remitters. Overall, these findings contribute to our understating of molecular changes associated with antipsychotic response and demonstrate abnormalities specific to the insula in FES.
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Affiliation(s)
| | - Ahmad Mayeli
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Annie Blazer
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Finnegan J Calabro
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maria Perica
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - William Foran
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Fabio Ferrarelli
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Deepak K Sarpal
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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14
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Sarpal DK, Tarcijonas G, Calabro FJ, Foran W, Haas GL, Luna B, Murty VP. Context-specific abnormalities of the central executive network in first-episode psychosis: relationship with cognition. Psychol Med 2022; 52:2299-2308. [PMID: 33222723 PMCID: PMC9805803 DOI: 10.1017/s0033291720004201] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/03/2023]
Abstract
BACKGROUND Cognitive impairments, which contribute to the profound functional deficits observed in psychotic disorders, have found to be associated with abnormalities in trial-level cognitive control. However, neural tasks operate within the context of sustained cognitive states, which can be assessed with 'background connectivity' following the removal of task effects. To date, little is known about the integrity of brain processes supporting the maintenance of a cognitive state in individuals with psychotic disorders. Thus, here we examine background connectivity during executive processing in a cohort of participants with first-episode psychosis (FEP). METHODS The following fMRI study examined background connectivity of the dorsolateral prefrontal cortex (DLPFC), during working memory engagement in a group of 43 patients with FEP, relative to 35 healthy controls (HC). Findings were also examined in relation to measures of executive function. RESULTS The FEP group relative to HC showed significantly lower background DLPFC connectivity with bilateral superior parietal lobule (SPL) and left inferior parietal lobule. Background connectivity between DLPFC and SPL was also positively associated with overall cognition across all subjects and in our FEP group. In comparison, resting-state frontoparietal connectivity did not differ between groups and was not significantly associated with overall cognition, suggesting that psychosis-related alterations in executive networks only emerged during states of goal-oriented behavior. CONCLUSIONS These results provide novel evidence indicating while frontoparietal connectivity at rest appears intact in psychosis, when engaged during a cognitive state, it is impaired possibly undermining cognitive control capacities in FEP.
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Affiliation(s)
- Deepak K. Sarpal
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Goda Tarcijonas
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Finnegan J. Calabro
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - William Foran
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gretchen L. Haas
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vishnu P. Murty
- Department of Psychology, Temple University, Philadelphia, PA, USA
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15
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Blazer A, Chengappa KNR, Foran W, Parr AC, Kahn CE, Luna B, Sarpal DK. Changes in corticostriatal connectivity and striatal tissue iron associated with efficacy of clozapine for treatment‑resistant schizophrenia. Psychopharmacology (Berl) 2022; 239:2503-2514. [PMID: 35435461 PMCID: PMC9013738 DOI: 10.1007/s00213-022-06138-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/31/2022] [Indexed: 12/02/2022]
Abstract
RATIONALE Though numerous studies demonstrate the superiority of clozapine (CLZ) for treatment of persistent psychotic symptoms that are characteristic of treatment-refractory schizophrenia (TRS), what remains unknown are the neural and molecular mechanisms underlying CLZ's efficacy. Recent work implicates increased corticostriatal functional connectivity as a marker of response to non-CLZ, dopamine (DA) D2-receptor blocking antipsychotic drugs. However, it is undetermined whether this connectivity finding also relates to CLZ's unique efficacy, or if response to CLZ is associated with changes in striatal DA functioning. OBJECTIVE In a cohort of 22 individuals with TRS, we examined response to CLZ in relation to the following: (1) change in corticostriatal functional connectivity; and (2) change in a magnetic resonance-based measure of striatal tissue iron (R2'), which demonstrates utility as a proxy measure for elements of DA functioning. METHODS Participants underwent scanning while starting CLZ and after 12 weeks of CLZ treatment. We used both cortical and striatal regions of interest to examine changes in corticostriatal interactions and striatal R2' in relation to CLZ response (% reduction of psychotic symptoms). RESULTS We first found that response to CLZ was associated with an increase in corticostriatal connectivity between the dorsal caudate and regions of the frontoparietal network (P < 0.05, corrected). Secondly, we observed no significant changes in striatal R2' across CLZ treatment. CONCLUSION Overall, these results indicate that changes in corticostriatal networks without gross shifts in striatal DA functioning underlies CLZ response. Our results provide novel mechanistic insight into response to CLZ treatment.
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Affiliation(s)
- Annie Blazer
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - K N Roy Chengappa
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - William Foran
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Ashley C Parr
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Charles E Kahn
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Deepak K Sarpal
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
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16
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Sonnenschein SF, Parr AC, Larsen B, Calabro FJ, Foran W, Eack SM, Luna B, Sarpal DK. Subcortical brain iron deposition in individuals with schizophrenia. J Psychiatr Res 2022; 151:272-278. [PMID: 35523067 DOI: 10.1016/j.jpsychires.2022.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 12/06/2021] [Revised: 04/01/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022]
Abstract
Subcortical structures play a critical role the pathophysiology and treatment of schizophrenia (SZ), yet underlying neurophysiological processes, in vivo, remain largely unexplored. Brain tissue iron, which can be measured with magnetic resonance-based methods, is a crucial component of a variety of neuronal functions including neurotransmitter synthesis. Here we used a proxy measure of tissue iron to examine basal ganglia and thalamic structures in an adult cohort of individuals with chronic SZ. A publicly available dataset of 72 individuals with SZ between ages 18 and 65, and a matched sample of 74 healthy control (HC) participants were included. A novel method that calculated the inverse-normalized T2*-weighted contrast (1/nT2*) was used to estimate brain iron within the basal ganglia and thalamus. Between group, age- and sex-related differences in 1/nT2* were examined, in addition to correlations with measures of psychopathology and cognition. Individuals with SZ showed greater 1/nT2* (iron index) compared to HCs in the thalamus (p < 0.01, FWE corrected). Age-related 1/nT2* accumulation was noted in regions of the basal ganglia, coinciding with prior work, and prominent sex-differences were noted in the caudate and thalamus (p < 0.01, FWE corrected). No significant relationship was observed between 1/nT2* and measures of neurocognition or psychopathology. Overall, our findings characterize a non-invasive proxy measure of tissue iron in SZ and highlight thalamic iron accumulation as a potential marker of illness.
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Affiliation(s)
| | | | - Bart Larsen
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Shaun M Eack
- Department of Psychiatry, USA; School of Social Work, USA
| | - Beatriz Luna
- Department of Psychiatry, USA; Department of Psychology, USA; Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
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17
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Sarpal DK, Blazer A, Wilson JD, Calabro FJ, Foran W, Kahn CE, Luna B, Chengappa KNR. Relationship between plasma clozapine/N-desmethylclozapine and changes in basal forebrain-dorsolateral prefrontal cortex coupling in treatment-resistant schizophrenia. Schizophr Res 2022; 243:170-177. [PMID: 35381515 PMCID: PMC9189030 DOI: 10.1016/j.schres.2022.03.014] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/07/2022] [Accepted: 03/27/2022] [Indexed: 10/18/2022]
Abstract
Clozapine (CLZ) demonstrates a unique clinical efficacy relative to other antipsychotic drugs. Previous work has linked the plasma ratio of CLZ and its major metabolite, N-desmethylclozapine (NDMC), to an inverse relationship with cognition via putative action on the cholinergic system. However, neuroimaging correlates of CLZ/NDMC remain unknown. Here, we examined changes in basal forebrain functional connectivity with the dorsolateral prefrontal cortex, and secondly, cognition in relation to the CLZ/NDMC ratio. A cohort of nineteen chronically ill participants with treatment-resistant schizophrenia (TRS) undergoing 12 weeks of CLZ treatment were included. Measures of cognition and plasma CLZ/NDMC ratios were obtained in addition to resting-state functional neuroimaging scans, captured at baseline and after 12 weeks of CLZ treatment. We observed a significant correlation between basal forebrain-DLPFC connectivity and CLZ/NDMC ratios across CLZ treatment (p = 0.02). Consistent with previous findings, we also demonstrate a positive relationship between CLZ/NDMC ratio and working memory (p = 0.03). These findings may reflect the action of CLZ and NDMC on the muscarinic cholinergic system, highlighting a possible neural correlate of cognition across treatment.
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Affiliation(s)
- Deepak K. Sarpal
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Annie Blazer
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - James D. Wilson
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Finnegan J. Calabro
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - William Foran
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Charles E. Kahn
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA,Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - KN Roy Chengappa
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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18
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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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19
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Wood HJ, Gannon JM, Chengappa KNR, Sarpal DK. Group teletherapy for first-episode psychosis: Piloting its integration with coordinated specialty care during the COVID-19 pandemic. Psychol Psychother 2021; 94:382-389. [PMID: 33078496 DOI: 10.1111/papt.12310] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 07/29/2020] [Revised: 08/26/2020] [Indexed: 12/15/2022]
Abstract
Digital health has emerged in recent years as a tool to optimize care delivery and promote treatment adherence among individuals with first-episode psychosis (FEP). Recent mandates for social distancing and sheltering in place due to the COVID-19 pandemic have catapulted efforts to provide ongoing coordinated specialty care (CSC) on virtual platforms. While prior evidence provides support for the general implementation of virtual individual therapy, there is limited guidance and evidence for the adoption of group teletherapy. Here we describe our efforts to implement group teletherapy for two small cohorts of individuals with FEP receiving care in a coordinated specialty care clinic using methods adopted from Acceptance and Commitment Therapy. We observed high adherence with group visits as well as client satisfaction across groups. Based on our results, we have taken efforts to implement virtual group therapy more permanently in our clinic. Our experience provides guidance and a model for integration of virtual group therapy within CSC. PRACTITIONER POINTS: In-person group therapy can be adapted as an online treatment modality for individuals with first-episode psychosis (FEP). Group teletherapy is both accessible and satisfactory to individuals with FEP. Group teletherapy has potential as a more standard and widespread treatment modality within coordinated specialty care for FEP.
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Affiliation(s)
- Helen J Wood
- Comprehensive Recovery Services, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Jessica M Gannon
- Comprehensive Recovery Services, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA.,Department of Psychiatry, University of Pittsburgh, Pennsylvania, USA
| | - K N Roy Chengappa
- Comprehensive Recovery Services, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA.,Department of Psychiatry, University of Pittsburgh, Pennsylvania, USA
| | - Deepak K Sarpal
- Comprehensive Recovery Services, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA.,Department of Psychiatry, University of Pittsburgh, Pennsylvania, USA
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Tarcijonas G, Foran W, Blazer A, Eack SM, Luna B, Sarpal DK. Independent support for corticopallidal contributions to schizophrenia-related functional impairment. Schizophr Res 2020; 216:168-174. [PMID: 31882276 PMCID: PMC7239703 DOI: 10.1016/j.schres.2019.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/09/2019] [Revised: 12/02/2019] [Accepted: 12/15/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Abnormalities between the prefrontal cortex and basal ganglia have been described by numerous studies of schizophrenia (SZ). We recently reported that individuals with first episode SZ who develop greater vocational and social impairments show lower baseline functional connectivity between the globus pallidus (GP) and regions of the intrinsic salience network. Here we extend these findings to probe the integrity of this system in individuals with chronic illness. METHODS All data were obtained from a publicly available Center of Biomedical Research Excellence dataset (http://fcon_1000. PROJECTS nitric.org/indi/retro/cobre.html) that included resting-state fMRI and structural scans, and an array of clinical and neuropsychological measures. Participants with SZ were divided into high- or low-functioning groups based on scores across measures of psychopathology and cognitive functioning. Corticopallidal functional connectivity was examined between low- and high-functioning individuals with SZ and matched healthy control participants. We focused on connectivity between GP structures and a priori regions of the salience network that were significant in our previous study. Exploratory voxel-wise analyses were also conducted. RESULTS Lower functioning individuals with SZ demonstrated less connectivity between bilateral GP externa and nodes within the salience network, relative to healthy controls. No connectivity differences were observed between low- and high-functioning individuals with SZ. Exploratory voxel-wise analyses highlighted additional large-scale corticopallidal abnormalities in lower-functioning participants with SZ. CONCLUSIONS These results confirm our previous work in a more chronic cohort of individuals with SZ. Our findings further advance corticopallidal connectivity as a biomarker of functional impairments in SZ and lay the groundwork for treatment-based studies.
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Affiliation(s)
- Goda Tarcijonas
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - William Foran
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Annie Blazer
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shaun M Eack
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Deepak K Sarpal
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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21
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Blair Thies M, DeRosse P, Sarpal DK, Argyelan M, Fales CL, Gallego JA, Robinson DG, Lencz T, Homan P, Malhotra AK. Interaction of Cannabis Use Disorder and Striatal Connectivity in Antipsychotic Treatment Response. Schizophr Bull Open 2020; 1:sgaa014. [PMID: 32803161 PMCID: PMC7418867 DOI: 10.1093/schizbullopen/sgaa014] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Antipsychotic (AP) medications are the mainstay for the treatment of schizophrenia spectrum disorders (SSD), but their efficacy is unpredictable and widely variable. Substantial efforts have been made to identify prognostic biomarkers that can be used to guide optimal prescription strategies for individual patients. Striatal regions involved in salience and reward processing are disrupted as a result of both SSD and cannabis use, and research demonstrates that striatal circuitry may be integral to response to AP drugs. In the present study, we used functional magnetic resonance imaging (fMRI) to investigate the relationship between a history of cannabis use disorder (CUD) and a striatal connectivity index (SCI), a previously developed neural biomarker for AP treatment response in SSD. Patients were part of a 12-week randomized, double-blind controlled treatment study of AP drugs. A sample of 48 first-episode SSD patients with no more than 2 weeks of lifetime exposure to AP medications, underwent a resting-state fMRI scan pretreatment. Treatment response was defined a priori as a binary (response/nonresponse) variable, and a SCI was calculated in each patient. We examined whether there was an interaction between lifetime CUD history and the SCI in relation to treatment response. We found that CUD history moderated the relationship between SCI and treatment response, such that it had little predictive value in SSD patients with a CUD history. In sum, our findings highlight that biomarker development can be critically impacted by patient behaviors that influence neurobiology, such as a history of CUD.
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Affiliation(s)
- Melanie Blair Thies
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
| | - Pamela DeRosse
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Deepak K Sarpal
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Miklos Argyelan
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Christina L Fales
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
| | - Juan A Gallego
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Graduate Center—City University of New York, New York, NY
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Delbert G Robinson
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Todd Lencz
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Philipp Homan
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
| | - Anil K Malhotra
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
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22
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Tarcijonas G, Foran W, Haas GL, Luna B, Sarpal DK. Intrinsic Connectivity of the Globus Pallidus: An Uncharted Marker of Functional Prognosis in People With First-Episode Schizophrenia. Schizophr Bull 2020; 46:184-192. [PMID: 31150557 PMCID: PMC6942165 DOI: 10.1093/schbul/sbz034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/12/2022]
Abstract
There is growing evidence suggesting that abnormalities in cortical-basal ganglia circuitry may play a significant role in determining outcomes in schizophrenia. The globus pallidus (GP), a critical structure within this circuitry, unique in its role as a mediator of competing inputs through the striatum, has not been well characterized in schizophrenia. The following study examined functional interactions of the GP in individuals with first-episode schizophrenia (FES). To probe the large-scale intrinsic connectivity of the GP, resting-state fMRI scans were obtained from patients with FES and sex and age-matched healthy controls. Participants with FES were also evaluated after 6 months via the Strauss-Carpenter Outcomes Scale to assess overall functional trajectory. The GP was parcellated to generate seeds within its substructures, and connectivity maps were generated. Our FES cohort showed significantly lower functional connectivity between the left GP interna and a network of regions including the dorsolateral prefrontal cortex, caudate, and cerebellum at baseline. In addition, FES participants with lower overall scores of functioning at 6 months showed significantly decreased connectivity between the GP interna and the dorsal anterior cingulate and bilateral insula, all regions important for motivational salience. These results provide novel evidence for unique abnormalities in functional interactions of the GP with key prefrontal cortical regions in FES. Our findings also suggest that reduced prefrontal-pallidal connectivity may serve as a predictor of early functional outcome.
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Affiliation(s)
- Goda Tarcijonas
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - William Foran
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Gretchen L Haas
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA,Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | - Deepak K Sarpal
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,To whom correspondence should be addressed; Department of Psychiatry, University of Pittsburgh, 3501 Forbes Avenue, Suite 530, Pittsburgh, PA 15213, US; tel: 412-246-5618, fax: 412-246-5007, e-mail:
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23
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Manivannan A, Foran W, Jalbrzikowski M, Murty VP, Haas GL, Tarcijonas G, Luna B, Sarpal DK. Association Between Duration of Untreated Psychosis and Frontostriatal Connectivity During Maintenance of Visuospatial Working Memory. Biol Psychiatry Cogn Neurosci Neuroimaging 2019; 4:454-461. [PMID: 30852127 DOI: 10.1016/j.bpsc.2019.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/09/2019] [Accepted: 01/16/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND A longer duration of untreated psychosis (DUP) has been linked with poor clinical outcomes and variation in resting-state striatal connectivity with central executive regions. However, the link between DUP and task-based activation of executive neurocognition has not previously been examined. This functional magnetic resonance imaging study examined the association between DUP and both activation and frontostriatal functional connectivity during a visual working memory (WM) paradigm in patients with first-episode psychosis. METHODS Patients with first-episode psychosis (n = 37) underwent functional magnetic resonance imaging scanning while performing a visual WM task. At the single-subject level, task conditions were modeled; at the group level, each condition was examined along with DUP. Activation was examined within the dorsolateral prefrontal cortex, a primary region supporting visual WM activation. Frontostriatal functional connectivity during the WM was examined via psychophysical interaction between the dorsal caudate and the dorsolateral prefrontal cortex. Results were compared with a reference range of connectivity values in a matched group of healthy volunteers (n = 25). Task performance was also examined in relation to neuroimaging findings. RESULTS No significant association was observed between DUP and WM activation. Longer DUP showed less functional frontostriatal connectivity with the maintenance of increasing WM load. Results were not related to task performance measures, consistent with previous work. CONCLUSIONS Our data suggest that DUP may affect frontostriatal circuitry that supports executive functioning. Future work is necessary to examine if these findings contribute to the mechanism underlying the relationship between DUP and worsened clinical outcomes.
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Affiliation(s)
- Ashwinee Manivannan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William Foran
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maria Jalbrzikowski
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Gretchen L Haas
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Goda Tarcijonas
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Deepak K Sarpal
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
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24
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Tarcijonas G, Sarpal DK. Neuroimaging markers of antipsychotic treatment response in schizophrenia: An overview of magnetic resonance imaging studies. Neurobiol Dis 2018; 131:104209. [PMID: 29953933 DOI: 10.1016/j.nbd.2018.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 12/22/2017] [Revised: 05/16/2018] [Accepted: 06/23/2018] [Indexed: 12/18/2022] Open
Abstract
Antipsychotic drugs are the primary treatment for psychosis, yet individual response to their administration remains variable. At present, no biological predictors of response exist to guide clinicians as they select treatments for patients, and our understanding of the neurobiology underlying the heterogeneity of outcomes remains limited. Magnetic Resonance Imaging (MRI) has been applied by numerous studies to examine the response to antipsychotic treatment, though a large gap remains between their results and our clinical practice. To advance patient care with precision medicine approaches, prior work must be accounted for and built upon with future studies. This review provides an overview of studies that relate treatment outcome to various MRI-related measures, including structural, spectroscopic, diffusion tensor, and functional imaging. Knowledge derived from these studies will be discussed along with future directions for the field.
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Affiliation(s)
- Goda Tarcijonas
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Deepak K Sarpal
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
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25
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Sarpal DK, Robinson DG, Fales C, Lencz T, Argyelan M, Karlsgodt KH, Gallego JA, John M, Kane JM, Szeszko PR, Malhotra AK. Relationship between Duration of Untreated Psychosis and Intrinsic Corticostriatal Connectivity in Patients with Early Phase Schizophrenia. Neuropsychopharmacology 2017; 42:2214-2221. [PMID: 28294137 PMCID: PMC5603815 DOI: 10.1038/npp.2017.55] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [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: 09/18/2016] [Revised: 01/31/2017] [Accepted: 02/11/2017] [Indexed: 11/09/2022]
Abstract
Patients with first-episode psychosis experience psychotic symptoms for a mean of up to 2 years prior to initiation of treatment, and long duration of untreated psychosis (DUP) is associated with poor clinical outcomes. Meanwhile, evidence compiled from numerous studies suggests that longer DUP is not associated with structural brain abnormalities. To date, few studies have examined the relationship between DUP and functional neuroimaging measures. In the present study, we used seed-based resting-state functional connectivity to examine the impact of DUP on corticostriatal circuitry. We included 83 patients with early phase schizophrenia and minimal exposure to antipsychotic drugs (<2 years), who underwent resting state scanning while entering 12 weeks of prospective treatment with second-generation antipsychotic drugs. Functional connectivity maps of the striatum were generated and examined in relation to DUP as a covariate. Mediation analyses were performed on a composite measure of corticostriatal connectivity derived from the significant results of our DUP analysis. We found that longer DUP correlated with worse response to treatment as well as overall decreased functional connectivity between striatal nodes and specific regions within frontal and parietal cortices. Moreover, the relationship between DUP and treatment response was significantly mediated by corticostriatal connectivity. Our results indicate that variation in corticostriatal circuitry may play a role in the relationship between longer DUP and worsened response to treatment. Future prospective studies are necessary to further characterize potential causal links between DUP, striatal circuitry and clinical outcomes.
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Affiliation(s)
- Deepak K Sarpal
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Delbert G Robinson
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Christina Fales
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Todd Lencz
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Miklos Argyelan
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | | | - Juan A Gallego
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Majnu John
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Philip R Szeszko
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,James J. Peters VA Medical Center, Bronx, NY, USA
| | - Anil K Malhotra
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA,Division of Psychiatry Research, Department of Psychiatry, The Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA, Tel: 718 470 8012, Fax: 718 343 1659, E-mail:
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27
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Argyelan M, Lencz T, Kaliora S, Sarpal DK, Weissman N, Kingsley PB, Malhotra AK, Petrides G. Subgenual cingulate cortical activity predicts the efficacy of electroconvulsive therapy. Transl Psychiatry 2016; 6:e789. [PMID: 27115120 PMCID: PMC4872412 DOI: 10.1038/tp.2016.54] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/25/2016] [Accepted: 02/28/2016] [Indexed: 12/12/2022] Open
Abstract
Electroconvulsive therapy (ECT) is the most effective treatment for depression, yet its mechanism of action is unknown. Our goal was to investigate the neurobiological underpinnings of ECT response using longitudinally collected resting-state functional magnetic resonance imaging (rs-fMRI) in 16 patients with treatment-resistant depression and 10 healthy controls. Patients received bifrontal ECT 3 times a week under general anesthesia. We acquired rs-fMRI at three time points: at baseline, after the 1st ECT administration and after the course of the ECT treatment; depression was assessed with the Hamilton Depression Rating Scale (HAM-D). The primary measure derived from rs-fMRI was fractional amplitude of low frequency fluctuation (fALFF), which provides an unbiased voxel-wise estimation of brain activity. We also conducted seed-based functional connectivity analysis based on our primary findings. We compared treatment-related changes in HAM-D scores with pre- and post-treatment fALFF and connectivity measures. Subcallosal cingulate cortex (SCC) demonstrated higher BOLD signal fluctuations (fALFF) at baseline in depressed patients, and SCC fALFF decreased over the course of treatment. The baseline level of fALFF of SCC predicted response to ECT. In addition, connectivity of SCC with bilateral hippocampus, bilateral temporal pole, and ventromedial prefrontal cortex was significantly reduced over the course of treatment. These results suggest that the antidepressant effect of ECT may be mediated by downregulation of SCC activity and connectivity. SCC function may serve as an important biomarker of target engagement in the development of novel therapies for depression that is resistant to treatment with standard medications.
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Affiliation(s)
- M Argyelan
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, Glen Oaks, NY 11004, USA. E-mail:
| | - T Lencz
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - S Kaliora
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - D K Sarpal
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - N Weissman
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - P B Kingsley
- Department of Radiology, North Shore University Hospital, Northwell Health, Manhasset, NY, USA
| | - A K Malhotra
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - G Petrides
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA
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28
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Sarpal DK, Argyelan M, Robinson DG, Szeszko PR, Karlsgodt KH, John M, Weissman N, Gallego JA, Kane JM, Lencz T, Malhotra AK. Baseline Striatal Functional Connectivity as a Predictor of Response to Antipsychotic Drug Treatment. Am J Psychiatry 2016; 173:69-77. [PMID: 26315980 PMCID: PMC4845897 DOI: 10.1176/appi.ajp.2015.14121571] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Clinical response to antipsychotic drug treatment is highly variable, yet prognostic biomarkers are lacking. The authors recently demonstrated that successful antipsychotic drug treatment alters resting-state functional connectivity of the striatum. The goal of the present study was to test whether intrinsic striatal connectivity patterns provide prognostic information and can serve as a potential biomarker of treatment response to antipsychotic drugs. METHOD The authors used resting-state functional MRI (fMRI) to develop a prognostic index in a discovery cohort of 41 first-episode schizophrenia patients, then tested this index in an independent cohort of 40 newly hospitalized chronic patients with acute psychosis. In the discovery cohort, patients underwent resting-state fMRI scanning at the initiation of randomized controlled treatment with a second-generation antipsychotic. Whole-brain functional connectivity maps were generated for each subject from striatal seed regions. A stringent measure of clinical response was calculated that required sustained improvement over two consecutive study visits. Clinical response was entered into a survival analysis, and Cox regression was applied to the functional connectivity data. A striatal connectivity index was created, comprising functional connections of the striatum that predicted treatment response. This striatal connectivity index was tested on a generalizability cohort of patients with psychotic disorders who were hospitalized for an acute psychotic episode. RESULTS A total of 91 regions functionally connected with the striatum provided significant prognostic information. Connectivity in these regions was used to create a baseline striatal connectivity index that predicted response to antipsychotic treatment with high sensitivity and specificity in both the discovery and generalizability cohorts. CONCLUSIONS These results provide evidence that individual differences in striatal functional connectivity predict response to antipsychotic drug treatment in acutely psychotic patients. With further development, this has the potential to serve as a prognostic biomarker with clinical utility and to reduce the overall burden associated with psychotic illnesses.
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29
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Sarpal DK, Robinson DG, Lencz T, Argyelan M, Ikuta T, Karlsgodt K, Gallego JA, Kane JM, Szeszko PR, Malhotra AK. Antipsychotic treatment and functional connectivity of the striatum in first-episode schizophrenia. JAMA Psychiatry 2015; 72:5-13. [PMID: 25372846 PMCID: PMC4286512 DOI: 10.1001/jamapsychiatry.2014.1734] [Citation(s) in RCA: 228] [Impact Index Per Article: 25.3] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Previous evidence has implicated corticostriatal abnormalities in the pathophysiology of psychosis. Although the striatum is the primary target of all efficacious antipsychotics, the relationship between its functional connectivity and symptomatic reduction remains unknown. OBJECTIVE To explore the longitudinal effect of treatment with second-generation antipsychotics on functional connectivity of the striatum during the resting state in patients experiencing a first episode of psychosis. DESIGN, SETTING, AND PARTICIPANTS This prospective controlled study took place at a clinical research center and included 24 patients with first-episode psychosis and 24 healthy participants matched for age, sex, education, and handedness. Medications were administered in a double-blind randomized manner. INTERVENTIONS Patients were scanned at baseline and after 12 weeks of treatment with either risperidone or aripiprazole. Their symptoms were evaluated with the Brief Psychiatric Rating Scale at baseline and follow-up. Healthy participants were scanned twice within a 12-week interval. MAIN OUTCOMES AND MEASURES Functional connectivity of striatal regions was examined via functional magnetic resonance imaging using a seed-based approach. Changes in functional connectivity of these seeds were compared with reductions in ratings of psychotic symptoms. RESULTS Patients had a median exposure of 1 day to antipsychotic medication prior to being scanned (mean [SD] = 4.5 [6.1]). Eleven patients were treated with aripiprazole and 13 patients were treated with risperidone. As psychosis improved, we observed an increase in functional connectivity between striatal seed regions and the anterior cingulate, dorsolateral prefrontal cortex, and limbic regions such as the hippocampus and anterior insula (P < .05, corrected for multiple comparisons). Conversely, a negative relationship was observed between reduction in psychosis and functional connectivity of striatal regions with structures within the parietal lobe (P < .05, corrected for multiple comparisons). CONCLUSIONS AND RELEVANCE Our results indicated that corticostriatal functional dysconnectivity in psychosis is a state-dependent phenomenon. Increased functional connectivity of the striatum with prefrontal and limbic regions may be a biomarker for improvement in symptoms associated with antipsychotic treatment.
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Affiliation(s)
- Deepak K. Sarpal
- Department of Psychiatry, The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY
| | - Delbert G. Robinson
- Department of Psychiatry, The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY,Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
| | - Todd Lencz
- Department of Psychiatry, The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY,Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
| | - Miklos Argyelan
- Department of Psychiatry, The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY
| | - Toshikazu Ikuta
- Department of Communication Sciences and Disorders, School of Applied Sciences, University of Mississippi, University, MS
| | - Katherine Karlsgodt
- Department of Psychiatry, The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY
| | - Juan A. Gallego
- Department of Psychiatry, The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY,Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
| | - John M. Kane
- Department of Psychiatry, The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY,Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
| | - Philip R. Szeszko
- Department of Psychiatry, The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY,Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
| | - Anil K. Malhotra
- Department of Psychiatry, The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY,Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
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