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Saleh Y, Jarratt-Barnham I, Petitet P, Fernandez-Egea E, Manohar SG, Husain M. Negative symptoms and cognitive impairment are associated with distinct motivational deficits in treatment resistant schizophrenia. Mol Psychiatry 2023; 28:4831-4841. [PMID: 37626135 PMCID: PMC10914595 DOI: 10.1038/s41380-023-02232-7] [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: 01/10/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Motivational deficits are a central feature of the negative syndrome in schizophrenia. They have consistently been associated with reduced willingness to expend physical effort in return for monetary rewards on effort based decision making (EBDM) paradigms. Nevertheless, the mechanisms underlying such altered performance are not well characterised, and it remains unclear if they are driven purely by negative symptoms, or also in part by cognitive impairment, antipsychotic treatment or even positive symptoms. Here we investigated the impact of all these factors using a paradigm that has not previously been used to measure EBDM in schizophrenia. METHODS Forty treatment resistant schizophrenia (TRS) patients on clozapine and matched controls (N = 80) completed a well validated EBDM task which offers monetary rewards in return for physical effort. Choice and reaction time data was analysed using logistic regressions, as well as Bayesian hierarchical drift diffusion modelling (HDDM). Behavioural parameters were compared between groups and their association with negative symptoms, cognitive function and serum clozapine levels were assessed. RESULTS Overall, TRS patients accepted significantly less offers than controls during effort-based decision making, suggesting they were less motivated. They demonstrated reduced sensitivity to increasing rewards, but surprisingly were also less averse to increasing effort. Despite a positive correlation between negative symptoms and cognitive function in TRS, reward sensitivity was associated only with cognitive performance. In contrast, reduced effort aversion correlated with negative symptom severity. Clozapine levels and positive symptoms were not associated with either behavioural parameter. CONCLUSION Motivational deficits in TRS are characterised by both diminished reward sensitivity and reduced effort aversion during EBDM. Cognitive dysfunction and negative symptom severity account for distinct aspects of these behavioural changes, despite positive associations between themselves. Overall, these findings demonstrate that negative symptoms and cognitive impairment have significant independent contributions to EBDM in TRS, thereby opening the possibility of individualised treatment targeting these mechanisms to improve motivation.
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Affiliation(s)
- Y Saleh
- Nuffield Department Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - I Jarratt-Barnham
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
- Cambridge Psychosis Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - P Petitet
- Nuffield Department Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK
- Centre de Recherche en Neurosciences de Lyon, Equipe Trajectories, Inserm UMR-S 1028, CNRS UMR 5292, Universite Lyon 1, Bron, France
| | - E Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
- Cambridge Psychosis Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - S G Manohar
- Nuffield Department Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - M Husain
- Nuffield Department Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Fernandez-Egea E. Is apathy a true trans-diagnostic construct? preliminary findings of the european study on apathy in schizophrenia. Eur Psychiatry 2021. [PMCID: PMC9471876 DOI: 10.1192/j.eurpsy.2021.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Apathy is a quantitive reduction of goal-directed activity either in behavioural, cognitive, emotional or social dimension in comparison to the person’s previous level of functioning in these areas. Apathy is prevalent across many neurodegenerative, neurological, and psychiatric disorders. It represents the most common behavioural and psychological symptom in people with Alzheimer’s Disease and is often observed in Parkinson’s disease, vascular dementia, stroke, traumatic brain injury, amyotrophic lateral sclerosis/motor neuron disease, frontotemporal dementia, progressive supranuclear palsy, major depression, and schizophrenia. However, the definition and terminology employed to refer to apathy can vary in the context of different conditions and specialities and the diagnostic criteria have evolved. Additionally, the term apathy is employed to describe both a symptom and a syndrome. Indeed, little progress has been achieved in assessing the validity of the same construct across different disorders (eg. neurodegenerative disorders, schizophrenia or affective disorders). In 2018, a new version of the diagnostic criteria for apathy (DCA) in neuropsychiatric disorders was published. The validity of this new consensus has yet to be assessed among all relevant populations, including schizophrenia. Six European centres (Naples, Geneve, Nice, Rennes, Barcelona, Cambridge) aimed to test the prevalence of apathy, measured with the 2018 DCA, in patients diagnosed with schizophrenia. As a second aim, we focused on the relationship between DCA and other measures of apathy and negative symptoms in schizophrenia (BNSS and PANSS). In this talk, we will compare the preliminary findings of this pan-European study in schizophrenia patients with previous studies on neurodegenerative disorders.
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Toll A, Bergé D, Burling K, Scoriels L, Treen D, Monserrat C, Marmol F, Duran X, Jones PB, Pérez-Solà V, Fernandez-Egea E, Mané A. Cannabis use influence on peripheral brain-derived neurotrophic factor levels in antipsychotic-naïve first-episode psychosis. Eur Arch Psychiatry Clin Neurosci 2020; 270:851-858. [PMID: 32185490 DOI: 10.1007/s00406-020-01117-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 09/16/2019] [Accepted: 03/03/2020] [Indexed: 12/14/2022]
Abstract
The objective of this study is to determine whether cannabis influences BDNF levels in patients with psychosis (FEP) and healthy volunteers (HV) to help understand the role of BDNF in psychosis. We assessed the association between BDNF and cannabis in a cohort of FEP antipsychotic-naïve patients and HV, whilst controlling for other potential confounding factors. 70 FEP drug-naive patients and 57 HV were recruited. A sociodemographic variable collection, structured clinical interview, weight and height measurement, substance use determination, and blood collection to determine BDNF levels by ELISA analysis were done. In FEP patients, cannabis use was associated with BDNF levels (high cannabis use was associated with lower BDNF levels). Moreover, cannabis use was statistically significantly associated with age (high use of cannabis was associated with younger age). In HV, no relationship between cannabis use and BDNF levels was observed. Otherwise, cannabis use was significantly associated with tobacco use, so that high cannabis users were also high tobacco users. This study showed a different association between cannabis use and BDNF levels in FEP patients compared with HV, particularly, with high doses of cannabis. These findings may help understand the deleterious effects of cannabis in some vulnerable individuals, as well as discrepancies in the literature.
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Affiliation(s)
- A Toll
- Institut de Neuropsiquiatria I Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain.,Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Madrid, Spain
| | - D Bergé
- Institut de Neuropsiquiatria I Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain.,Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Madrid, Spain
| | - K Burling
- Lab Cambridge Core Biochemical Assay Laboratory, Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - L Scoriels
- Department of Psychiatry and Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - D Treen
- Department of Psychiatry, Hospital Germanes Hospitalaries Sagrat Cor, Martorell, Spain
| | - C Monserrat
- Institut de Neuropsiquiatria I Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain.,Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - F Marmol
- Pharmacology Unit, Department of Medicine, Barcelona University, Barcelona, Spain
| | - X Duran
- Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - P B Jones
- Department of Psychiatry and Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - V Pérez-Solà
- Institut de Neuropsiquiatria I Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain.,Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Madrid, Spain
| | - E Fernandez-Egea
- Department of Psychiatry and Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - A Mané
- Institut de Neuropsiquiatria I Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain. .,Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain. .,Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Madrid, Spain.
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Mezquida G, Penadés R, Cabrera B, Savulich G, Lobo A, González-Pinto A, Penzol M, Corripio I, Fernandez-Egea E, Gassó P, Cuesta M, Bernardo M. Association of the brain-derived neurotrophic factor Val66Met polymorphism with negative symptoms severity, but not cognitive function, in first-episode schizophrenia spectrum disorders. Eur Psychiatry 2020; 38:61-69. [DOI: 10.1016/j.eurpsy.2016.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/18/2016] [Accepted: 04/24/2016] [Indexed: 12/12/2022] Open
Abstract
AbstractObjectiveA functional polymorphism of the brain-derived neurotrophic factor gene (BDNF) Val66Met has been associated with cognitive function and symptom severity in patients with schizophrenia. It has been suggested that the Val66Met polymorphism has a role as a modulator in a range of clinical features of the illness, including symptoms severity, therapeutic responsiveness, age of onset, brain morphology and cognitive function. However, little work has been done in first-episode schizophrenia (FES) spectrum disorders. The objective of this study is to investigate the association of the BDNF Val66Met polymorphism on cognitive function and clinical symptomatology in FES patients.MethodsUsing a cross-sectional design in a cohort of 204 patients with FES or a schizophrenia spectrum disorder and 204 healthy matched controls, we performed BDNF Val66Met genotyping and tested its relationship with cognitive testing (attention, working memory, learning/verbal memory and reasoning/problem-solving) and assessment of clinical symptom severity.ResultsThere was no significant influence of the BDNF allele frequency on cognitive factor scores in either patients or controls. An augmented severity of negative symptoms was found in FES patients that carried the Met allele.ConclusionsThe results of this study suggest that in patients with a first-episode of schizophrenia or a schizophrenia spectrum disorder, the BDNF Val66Met polymorphism does not exert an influence on cognitive functioning, but is associated with negative symptoms severity. BDNF may serve as suitable marker of negative symptomatology severity in FES patients within the schizophrenia spectrum.
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Mezquida G, Savulich G, Garcia-Rizo C, Garcia-Portilla MP, Toll A, Garcia-Alvarez L, Bobes J, Mané A, Bernardo M, Fernandez-Egea E. Inverse association between negative symptoms and body mass index in chronic schizophrenia. Schizophr Res 2018; 192:69-74. [PMID: 28412089 DOI: 10.1016/j.schres.2017.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 03/15/2017] [Accepted: 04/01/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND We investigated whether negative symptoms, such as poor motivation or anhedonia, were associated with higher body mass index (BMI) in stable patients with schizophrenia chronically treated with antipsychotic medication. METHODS 62 olanzapine- or clozapine-treated patients with illness duration of at least four years were selected from an international multicenter study on the characterization of negative symptoms. All participants completed the Brief Negative Symptom Scale (BNSS) and the Positive and Negative Syndrome Scale (PANSS). Bivariate correlations between BMI and negative symptoms (BNSS) were explored, as well as multiple regression analyses. We further explored the association of two principal component factors of the BNSS and BMI. Subsidiary analyses re-modeled the above using the negative symptoms subscale of the PANSS and the EMSLEY factor for negative symptoms for convergent validity. RESULTS Lower negative symptoms (BNSS score) were associated with higher BMI (r=-0.31; p=0.015). A multiple regression analysis showed that negative symptoms (BNSS score) and age were significant predictors of BMI (p=0.037). This was mostly driven by the motivation/pleasure factor of the BNSS. Within this second factor, BMI was negatively associated with anhedonia (r=-0.254; p=0.046) and asociality (r=-0.253; p=0.048), but not avolition (r=-0.169; p=0.188). EMSLEY score was positively associated with BNSS (r=0.873, p<0.001), but negatively associated with BMI (r=-0.308; p=0.015). The association between PANSS and BMI did not reach significance (r=-224, p=0.080). CONCLUSIONS We conclude that lower negative symptoms were associated with higher BMI (assessed using both the BNSS and EMSLEY) in chronic stable schizophrenia patients, mostly due to lower anhedonia and asociality levels.
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Affiliation(s)
- G Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain
| | - G Savulich
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, United Kingdom
| | - C Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M P Garcia-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, University of Oviedo, Spain
| | - A Toll
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain; Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - L Garcia-Alvarez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - J Bobes
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, University of Oviedo, Spain
| | - A Mané
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain; Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - M Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Medicine, University of Barcelona, Spain
| | - E Fernandez-Egea
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, United Kingdom; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Cambridgeshire and Peterborough NHS Foundation Trust, United Kingdom.
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Garcia-Rizo C, Fernandez-Egea E, Oliveira C, Meseguer A, Cabrera B, Mezquida G, Bioque M, Penades R, Parellada E, Bernardo M, Kirkpatrick B. Metabolic syndrome or glucose challenge in first episode of psychosis? Eur Psychiatry 2017; 41:42-46. [DOI: 10.1016/j.eurpsy.2016.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/30/2016] [Accepted: 10/05/2016] [Indexed: 12/22/2022] Open
Abstract
AbstractPatients with schizophrenia exhibit a reduced life expectancy. Although unhealthy lifestyle or suicide risk plays a role, the main causes are diverse medical conditions such as cardiovascular diseases, type 2 diabetes mellitus and metabolic syndrome. Albeit pharmacological secondary side effects might also trigger previous conditions, studies in naïve patients reflect diverse anomalies at the onset. Patients with a first episode of psychosis, display a wide scope of metabolic abnormalities, ranging from normality till pathological values depending on the parameters studied. We attempted to evaluate the metabolic syndrome and glycemic homeostasis in a subset of antipsychotic-naïve patients with a first episode of non-affective psychosis. Patients (n = 84) showed a similar prevalence of metabolic syndrome compared with a matched control sample (n = 98) (6% vs 4%, P = 0.562), while glucose homeostasis values differed significantly (14% vs. 5%, P = 0.034). Our results suggest that metabolic syndrome is not a useful clinical condition to be evaluated in patients before pharmacological treatment. Abnormal glycemic homeostasis at the onset of the disease requires specific diagnostic tools and preventive measures in order to avoid future cardiovascular events. New strategies must be implemented in order to evaluate the cardiovascular risk and subsequent morbidity in patients at the onset of the disease.
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Mané A, García-Rizo C, Garcia-Portilla MP, Bergé D, Sugranyes G, Garcia-Alvarez L, Bernardo M, Bobes J, Fernandez-Egea E. Spanish adaptation and validation of the Brief Negative Symptoms Scale. Compr Psychiatry 2014; 55:1726-9. [PMID: 24997648 DOI: 10.1016/j.comppsych.2014.05.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 11/26/2022] Open
Abstract
Negative symptoms prevalent in schizophrenia are associated with poor outcome. Developing new instruments to identify new treatments was highlighted at the NIMH-MATRICS Consensus Development Conference on Negative Symptoms. The new Brief Negative Symptoms scale (BNSS) demonstrated strong psychometric properties, but there is a need for validating it in non-English languages. A multi-center study was conducted to validate the Spanish version of the BNSS (BNSS-Sp) in 20 schizophrenia patients, following the original BNSS validation methodology. We found strong inter-rater, test-retest and internal consistency properties (for the total BNSS-Sp, intraclass correlation coefficient=0.97, Pearson's correlation coefficient r=0.95 (p<0.001), Cronbach's alpha=0.98).
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Affiliation(s)
- A Mané
- Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain; Fundació IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM).
| | - C García-Rizo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain
| | - M P Garcia-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Department of Psychiatry, University of Oviedo, Spain
| | - D Bergé
- Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain; Fundació IMIM, Barcelona, Spain
| | - G Sugranyes
- Child and Adolescent Psyquiatric Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - L Garcia-Alvarez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)
| | - M Bernardo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J Bobes
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Department of Psychiatry, University of Oviedo, Spain
| | - E Fernandez-Egea
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS foundation Trust, United Kingdom
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Garcia-Rizo C, Kirkpatrick B, Fernandez-Egea E, Oliveira C, Meseguer A, Grande I, Undurraga J, Vieta E, Bernardo M. "Is bipolar disorder an endocrine condition?" Glucose abnormalities in bipolar disorder. Acta Psychiatr Scand 2014; 129:73-4. [PMID: 24024599 PMCID: PMC4390128 DOI: 10.1111/acps.12194] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C. Garcia-Rizo
- Schizophrenia Program, Neuroscience Institute, Hospital Clinic, University of Barcelona, Barcelona,CIBERSAM, Madrid, Spain
| | - B. Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada School of Medicine, Reno, Nevada, USA
| | - E. Fernandez-Egea
- CIBERSAM, Madrid, Spain,Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Cambridge,Cambridgeshire and Peterborough NHS Foundation Trust, Huntingdon, UK
| | - C. Oliveira
- Schizophrenia Program, Neuroscience Institute, Hospital Clinic, University of Barcelona, Barcelona,CIBERSAM, Madrid, Spain
| | - A. Meseguer
- Schizophrenia Program, Neuroscience Institute, Hospital Clinic, University of Barcelona, Barcelona,CIBERSAM, Madrid, Spain
| | - I. Grande
- CIBERSAM, Madrid, Spain,Bipolar Disorders Program, Neuroscience Institute, Hospital Clinic, University of Barcelona, Barcelona
| | - J. Undurraga
- CIBERSAM, Madrid, Spain,Bipolar Disorders Program, Neuroscience Institute, Hospital Clinic, University of Barcelona, Barcelona
| | - E. Vieta
- CIBERSAM, Madrid, Spain,Bipolar Disorders Program, Neuroscience Institute, Hospital Clinic, University of Barcelona, Barcelona,Institute of Biomedical Research Agusti Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M. Bernardo
- Schizophrenia Program, Neuroscience Institute, Hospital Clinic, University of Barcelona, Barcelona,CIBERSAM, Madrid, Spain,Institute of Biomedical Research Agusti Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Scoriels L, Theegala S, Giro M, Ozanne S, Burling K, Jones P, Fernandez-Egea E. EPA-1690 – Cannabis use is associated with biological markers of ageing in healthy volunteers. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78833-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Batalla A, Garcia-Rizo C, Castellví P, Fernandez-Egea E, Yücel M, Parellada E, Kirkpatrick B, Martin-Santos R, Bernardo M. Screening for substance use disorders in first-episode psychosis: implications for readmission. Schizophr Res 2013; 146:125-31. [PMID: 23517662 PMCID: PMC4390132 DOI: 10.1016/j.schres.2013.02.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/05/2013] [Accepted: 02/24/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Screening of substance use may prove useful to prevent readmission after the first episode of psychosis. The aim of the present study was to evaluate the influence of drug use on readmission risk in a first-episode psychosis sample, and to determine whether the cannabis/cocaine subscale of the Dartmouth Assessment of Lifestyle Inventory (DALI) is a better predictive instrument than urinary analysis. METHODS After admission, first-episode psychotic patients were interviewed for substance use and assessed with the DALI scale. They also underwent blood and urine sampling. Time to readmission was studied as a dependent outcome. The Kaplan-Meier estimator was applied to estimate the survival curves for bivariate analysis. The Cox proportional hazards model for multivariate analysis was assessed in order to control for potential confounders. ROC curve and validity parameters were used to assess validity to detect readmission. RESULTS Fifty-eight patients were included. The DALI cannabis/cocaine subscale and urinalysis were associated with increased readmission risk in survival curves, mainly the first five years of follow-up. After controlling for potential confounding variables for readmission, only the DALI cannabis/cocaine subscale remained as a significant risk factor. In terms of validity, the DALI cannabis/cocaine subscale was more sensitive than urinalysis. Alcohol assessments were not related to readmission. CONCLUSIONS The findings demonstrated that a quick screening self-report scale for cannabis/cocaine use disorders is superior to urinary analysis for predicting readmission. Future research should consider longitudinal assessments of brief validated screening tests in order to evaluate their benefits in preventing early readmission in first-episode psychosis.
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Affiliation(s)
- Albert Batalla
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, Centro de Investigación Biomédica en Red en Salud Mental, 08036 Barcelona, Spain.
| | - Clemente Garcia-Rizo
- Schizophrenia Program, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, IDIBAPS, CIBERSAM, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Pere Castellví
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain, Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), and CIBER Epidemiología y Salud Pública (CIBERESP), Doctor Aiguader 88, 08033, Barcelona, Spain, CIBER Epidemiología y Salud Pública (CIBERESP), Doctor Aiguader 88, 08033, Barcelona, Spain
| | - Emili Fernandez-Egea
- Good Outcome Schizophrenia Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, UK, Department of Psychiatry and Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, Forvie Site, Cambridge CB2 0SZ, UK
| | - Murat Yücel
- School of Psychology and Psychiatry, Monash University, Clayton Campus, Melbourne, Victoria 3800, Australia
| | - Eduard Parellada
- Schizophrenia Program, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, IDIBAPS, CIBERSAM, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Brian Kirkpatrick
- Department of Psychiatry, Texas A&M University College of Medicine, Scott & White Healthcare, 1901 South Veterans Memorial Drive, 76504, Temple, TX, United States
| | - Rocío Martin-Santos
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain, Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Miguel Bernardo
- Schizophrenia Program, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, IDIBAPS, CIBERSAM, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Fernandez-Egea E, Bruna A, Garcia-Rizo C, Bernardo M, Kirkpatrick B. Stem cell signaling in newly diagnosed, antipsychotic-naive subjects with nonaffective psychosis. Mol Psychiatry 2009; 14:989-91. [PMID: 19851279 PMCID: PMC4390135 DOI: 10.1038/mp.2009.45] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- E Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Huntingdon, Cambridgeshire, UK,Programa Esquizofrènia Clínic, Servei de Psiquiatria, Department de Psiquiatria, Institut de Neurociències, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - A Bruna
- Cancer Research UK, Li Ka Shing Centre, Cambridge Research Institute (CRI), Cambridge, UK
| | - C Garcia-Rizo
- Programa Esquizofrènia Clínic, Servei de Psiquiatria, Department de Psiquiatria, Institut de Neurociències, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain,Centro de Investigación Biomèdica en Red de Salud Mental (CIBER-SAM), Spain
| | - M Bernardo
- Programa Esquizofrènia Clínic, Servei de Psiquiatria, Department de Psiquiatria, Institut de Neurociències, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain,Institut d’Investigacions Biomèdiques Agusti Pi i Sunyer (IDIBAPS), Barcelona, Spain,Centro de Investigación Biomèdica en Red de Salud Mental (CIBER-SAM), Spain
| | - B Kirkpatrick
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, Georgia
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Mateos JJ, Lomeña F, Parellada E, Mireia F, Fernandez-Egea E, Pavia J, Prats A, Pons F, Bernardo M. Lower striatal dopamine transporter binding in neuroleptic-naive schizophrenic patients is not related to antipsychotic treatment but it suggests an illness trait. Psychopharmacology (Berl) 2007; 191:805-11. [PMID: 17019564 DOI: 10.1007/s00213-006-0570-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Accepted: 08/08/2006] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Drug induced parkinsonism (DIP) is directly related to dopamine D2 receptor blockade. However, there are many references describing parkinsonian signs (PS) in naive-patients. In our previous study, we observed lower DAT binding in a group of first-episode schizophrenic patients after short-term treatment with risperidone, compared with age-matched healthy controls. AIM To clarify if DAT decrease could be an illness trait, excluding the effect of antipsychotics on DAT availability, and to determine whether DAT availability before treatment with antipsychotics may predict subsequent development of PS. MATERIALS AND METHODS A new series of 20 neuroleptic-naive schizophrenic patients and 15 healthy subjects was recruited. SPECT with [(123)I] FP-CIT (DaTSCAN(R)) was performed before starting antipsychotics and after 4 weeks of treatment. PS and psychopathological status were assessed by the Simpson-Angus (SAS), CGI and PANSS scales. Quantitative analyses of SPECTs were performed using ROIs placed in the caudate, putamen and occipital cortex. RESULTS Schizophrenic patients showed lower DAT binding compared with the healthy subjects at baseline (p<0.001) and after a 4-week-treatment period (p=0.001). Six out of eight schizophrenic patients of the DIP group were symptomatic for PS at baseline, in comparison to two out of 12 in the NoDIP group. Nonetheless, no differences were observed on DAT between DIP and NoDIP, neither at baseline (p=0.360) nor at endpoint (p=0.984). Finally, no differences between baseline-endpoint DAT binding were observed, neither in the DIP group (p=0.767) nor in the NoDIP group (p=0.093). CONCLUSION Our new series of first-episode naive-schizophrenic patients (1) points out DAT dysfunction as an illness trait due to the significantly lower DAT binding in schizophrenic patients in comparison to healthy subjects; (2) supports the results of other authors who describe PS in never-treated patients; (3) confirms that [(123)I] FP-CIT does not allow us to predict which patients will develop parkinsonism due to the lack of differences between DIP and NoDIP patients; and (4) confirms a null effect of antipsychotics on DAT due to the lack of differences in [(123)I] FP-CIT before and after a 4-week-treatment period.
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Affiliation(s)
- Jose J Mateos
- Nuclear Medicine Department, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
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Baillés E, Pintor L, Fernandez-Egea E, Torres X, Matrai S, De Pablo J, Arroyo S. Psychiatric disorders, trauma, and MMPI profile in a Spanish sample of nonepileptic seizure patients. Gen Hosp Psychiatry 2004; 26:310-5. [PMID: 15234827 DOI: 10.1016/j.genhosppsych.2004.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2003] [Accepted: 04/06/2004] [Indexed: 11/23/2022]
Abstract
The aim of this study was to examine clinical characteristics in patients with psychogenic nonepileptic seizures and to analyze the Minnesota Multiphasic Personality Inventory (MMPI) profiles and their relation to psychopathology. Thirty patients with nonepileptic seizures confirmed through video-electroencephalography were included. A structured clinical interview (Structured Clinical Interview for DSM-III-R), a measure of personality variables (MMPI), and several structured interviews designed for collecting data on clinical and personal history were administered. Descriptive and comparative statistical methods were used. Of the sample, 67.7% met criteria for two or more simultaneous Axis I diagnoses, and 60% for an Axis II personality disorder. The most frequently elevated scales of the MMPI were Schizophrenia and Depression. There were multiple scale elevations in 12 profiles, the 91.7% of which had elevated "neurotic" and "psychotic" scales. The subgroup with personality disorders showed higher scores on the MMPI Paranoia and Hypomania scales, and the subgroup with traumatic experiences showed higher scores on the MMPI Hypomania scale. Our sample comprising patients with nonepileptic seizures showed a significant degree of psychopathology and absence of a unique character substrate. According to grades of clinical severity of pseudoseizures, several subgroups and different therapeutic implications may be defined.
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Affiliation(s)
- Eva Baillés
- Instituto Clínico de Psiquiatría y Psicología, Hospital Clínico, C/ Villarroel-170, 08036 Barcelona, Spain
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