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Ambarchi Z, Boulton KA, Thapa R, Thomas EE, DeMayo MM, Sasson NJ, Hickie IB, Guastella AJ. Evidence of a reduced role for circumscribed interests in the social attention patterns of children with Autism Spectrum Disorder. J Autism Dev Disord 2023; 53:3999-4011. [PMID: 35927513 PMCID: PMC10499676 DOI: 10.1007/s10803-022-05638-4] [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] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/27/2022]
Abstract
Reduced social attention is characteristic of Autism Spectrum Disorder (ASD). It has been suggested to result from an early onset and excessive influence of circumscribed interests (CIs) on gaze behaviour, compared to typically developing (TYP) individuals. To date, these findings have been mixed. The current eye-tracking study utilised a visual preference paradigm to investigate the influence of CI versus non-CI objects on attention patterns in children with ASD (aged 3-12 years, n = 37) and their age-matched TYP peers (n = 30). Compared to TYP, social and object attention was reduced in the ASD group irrespective of the presence of CIs. Results suggest a reduced role for CIs and extend recent evidence of atypical attention patterns across social and non-social domains in ASD.
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Affiliation(s)
- Z Ambarchi
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 2050, Sydney, Australia
| | - K A Boulton
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 2050, Sydney, Australia
| | - R Thapa
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 2050, Sydney, Australia
| | - E E Thomas
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 2050, Sydney, Australia
| | - M M DeMayo
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 2050, Sydney, Australia
| | - N J Sasson
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, USA
| | - I B Hickie
- Brain and Mind Centre, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Adam J Guastella
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 2050, Sydney, Australia.
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2
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Cotton SM, Menssink J, Filia K, Rickwood D, Hickie IB, Hamilton M, Hetrick S, Parker A, Herrman H, McGorry PD, Gao C. The psychometric characteristics of the Kessler Psychological Distress Scale (K6) in help-seeking youth: What do you miss when using it as an outcome measure? Psychiatry Res 2021; 305:114182. [PMID: 34455216 DOI: 10.1016/j.psychres.2021.114182] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
This is the first study to describe psychometric properties of the Kessler Psychological Distress Scale (K6) in a large cohort of help-seeking young people presenting to primary mental health care services. The aim was to determine whether the K6 was appropriate for monitoring outcomes in such settings. 1067 young people were recruited from Australian headspace services. We examined dimensionality of the K6, measurement invariance, and how the K6 correlated with the the Patient Health Questionnaire-9 (PHQ-9)and the Generalised Anxiety Disorder-7 Scale (GAD-7). Standardised Response Mean (SRM) and Cohen's d effect size (ES) were used to examine 3-month stability of the K6. The best-fitting model was a two-factor model: (i) nervous and restlessness; and (ii) hopeless, worthless, depressed and effort. Measurement non-invariance was observed for sex and age groups. K6 strongly correlated with the PHQ-9 and GAD-7. The K6 was less sensitive to change compared to these other two measures. There was some support for the K6 being a screener for young people presenting to primary care; however, there issues arise with its use as an outcome measure. These issues include measurement non-invariance, concern about the dimensionality and focus of items, and its sensitivity to change.
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Affiliation(s)
- S M Cotton
- Orygen, Parkville, Melbourne VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne VIC, Australia.
| | - J Menssink
- Orygen, Parkville, Melbourne VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne VIC, Australia
| | - K Filia
- Orygen, Parkville, Melbourne VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne VIC, Australia
| | - D Rickwood
- headspace National Youth Mental Health Foundation Ltd, Melbourne VIC, Australia; Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - I B Hickie
- Brain and Mind, University of Sydney, Camperdown, NSW, Australia
| | - M Hamilton
- Orygen, Parkville, Melbourne VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne VIC, Australia
| | - S Hetrick
- Department of Psychological Medicine, The University of Auckland, Auckland, Australia
| | - A Parker
- Orygen, Parkville, Melbourne VIC, Australia; Victoria University, Institute of Health and Sport, Melbourne VIC, Australia
| | - H Herrman
- Orygen, Parkville, Melbourne VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne VIC, Australia
| | - P D McGorry
- Orygen, Parkville, Melbourne VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne VIC, Australia
| | - C Gao
- Orygen, Parkville, Melbourne VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne VIC, Australia
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Demetriou EA, Park SH, Pepper KL, Naismith SL, Song YJ, Thomas EE, Hickie IB, Guastella AJ. A transdiagnostic examination of anxiety and stress on executive function outcomes in disorders with social impairment. J Affect Disord 2021; 281:695-707. [PMID: 33358175 DOI: 10.1016/j.jad.2020.11.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 08/12/2020] [Accepted: 11/08/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Executive function (EF) difficulties characterise a number of psychiatric conditions and EF impairment may be a predisposing factor and/or consequence of anxiety and stress. The aim of the study was to examine EF factors in a mixed clinical cohort (Autism Spectrum Disorder and Social Anxiety Disorder) characterised by social impairment and investigate the influence of trait anxiety and state-based depression, anxiety and stress. METHODS In Study 1, a factor analysis identified EF and non-EF latent factor structures (N=205). In Study 2, (N=137) multiple regression analyses investigated the association between trait anxiety and state based depression, anxiety and stress, on EF and non-EF cognitive domains and on the two composite indices of the Behavioural Rating Inventory of Executive Function (BRIEF). RESULTS Trait anxiety was associated with better performance on neuropsychological measures of EF while state-based stress was associated with lower EF performance. A dissociation was observed between trait anxiety and state stress on the two behavioural indices of the BRIEF. Depression, anxiety and stress did not predict performance on non-EF cognitive domains. LIMITATIONS The cross-sectional design precludes cause-effect conclusions, further only self-report measures of affect were utilised and our performance measures of EF did not include a working memory test. CONCLUSIONS The results demonstrate that trait anxiety and state-based stress influence EF processes across disorders with social impairment. The transdiagnostic efficacy of this finding can facilitate remediation strategies, it may also contribute to individuals with Autism Spectrum Disorder gaining better access to mental health services.
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Affiliation(s)
- E A Demetriou
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, 2050
| | - S H Park
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, 2050
| | - K L Pepper
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, 2050
| | - S L Naismith
- School of Psychology, University of Sydney, Camperdown, 2050
| | - Y J Song
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, 2050
| | - E E Thomas
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, 2050
| | - I B Hickie
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, 2050; Youth Mental Health Unit, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, 2050
| | - A J Guastella
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, 2050.
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Hadar H, Zhang H, Phillips LJ, Amminger GP, Berger GE, Chen EYH, de Haan L, Hartmann JA, Hickie IB, Lavoie S, Markulev C, McGorry PD, Mossaheb N, Nieman DH, Nordentoft M, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Smesny S, Thompson A, Verma S, Yuen HP, Yung AR, Nelson B. Do schizotypal or borderline personality disorders predict onset of psychotic disorder or persistent attenuated psychotic symptoms in patients at high clinical risk? Schizophr Res 2020; 220:275-277. [PMID: 32305167 DOI: 10.1016/j.schres.2020.03.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/13/2020] [Accepted: 03/29/2020] [Indexed: 11/28/2022]
Affiliation(s)
- H Hadar
- Psychology Department, University of Otago, Dunedin, New Zealand
| | - H Zhang
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - L J Phillips
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - G P Amminger
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - G E Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - E Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong, Hong Kong
| | - L de Haan
- Department of Psychiatry, Amsterdam UMC, Academic Medical Center, Amsterdam, Netherlands
| | - J A Hartmann
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - I B Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia
| | - S Lavoie
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - C Markulev
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - P D McGorry
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - D H Nieman
- Department of Psychiatry, Amsterdam UMC, Academic Medical Center, Amsterdam, Netherlands
| | - M Nordentoft
- Psychiatric Centre Bispebjerg, Copenhagen, Denmark
| | | | - M R Schäfer
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - M Schlögelhofer
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University Vienna, Vienna, Austria
| | - S Smesny
- Department of Psychiatry, University Hospital Jena, Jena, Germany
| | - A Thompson
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - S Verma
- Institute of Mental Health, Singapore, Singapore
| | - H P Yuen
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - A R Yung
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Institute of Brain, Behaviour, and Mental Health, University of Manchester, Manchester, United Kingdom
| | - B Nelson
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.
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Nelson B, Yuen HP, Amminger GP, Berger G, Chen EYH, de Haan L, Hartmann JA, Hickie IB, Lavoie S, Markulev C, Mossaheb N, Nieman DH, Nordentoft M, Polari A, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Smesny S, Tedja A, Thompson A, Verma S, Yung AR, McGorry PD. Distress related to attenuated psychotic symptoms: Static and dynamic association with transition to psychosis, non-remission and transdiagnostic symptomatology in clinical high-risk patients in an international intervention trial. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/schizbullopen/sgaa006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
This study examined whether distress in relation to attenuated psychotic symptoms (DAPS) is associated with clinical outcomes in an ultra-high-risk (UHR) for psychosis sample. We also investigated whether DAPS is associated with cognitive style (attributional style and cognitive biases) and whether amount of psychosocial treatment provided is associated with reduction in DAPS. The study was a secondary analysis of the ‘Neurapro’ clinical trial of omega-3 fatty acids. 304 UHR patients were recruited across ten early intervention services. Data from baseline assessment, regular assessments over 12 months and medium term follow up (mean=3.4 years) were used for analysis. Findings indicated: a positive association between DAPS assessed over time and transition to psychosis; a significant positive association between baseline and longitudinal DAPS and transdiagnostic clinical and functional outcomes; a significant positive association between baseline and longitudinal DAPS and non-remission of UHR status. There was no relationship between severity of DAPS and cognitive style. A greater amount of psychosocial treatment (cognitive-behavioural case management) was associated with an increase in DAPS scores. The study indicates that UHR patients who are more distressed by their attenuated psychotic symptoms are more likely to have a poorer clinical trajectory transdiagnostically. Assessment of DAPS may therefore function as a useful marker of risk for a range of poor outcomes. The findings underline the value of repeated assessment of variables and incorporation of dynamic change into predictive modelling. More research is required into mechanisms driving distress associated with symptoms and the possible bidirectional relationship between symptom severity and associated distress.
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Affiliation(s)
- B Nelson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - H P Yuen
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - G P Amminger
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - G Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland
| | - E Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - L de Haan
- Academic Medical Center, Amsterdam, the Netherlands
| | - J A Hartmann
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - I B Hickie
- Brain and Mind Research Institute, University of Sydney, Australia
| | - S Lavoie
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - C Markulev
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Austria
| | - D H Nieman
- Academic Medical Center, Amsterdam, the Netherlands
| | - M Nordentoft
- CORE-Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - A Polari
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - M R Schäfer
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - M Schlögelhofer
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Austria
| | - S Smesny
- University Hospital Jena, Jena, Germany
| | - A Tedja
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - A Thompson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - S Verma
- Institute of Mental Health, Singapore, Singapore
| | - A R Yung
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - P D McGorry
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Psychology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne
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Youn S, Phillips LJ, Amminger GP, Berger G, Chen EYH, de Haan L, Hartmann JA, Hickie IB, Lavoie S, Markulev C, McGorry PD, Mossaheb N, Nieman DH, Nordentoft M, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Smesny S, Thompson A, Verma S, Yuen HP, Yung AR, Nelson B. Basic symptoms in young people at ultra-high risk of psychosis: Association with clinical characteristics and outcomes. Schizophr Res 2020; 216:255-261. [PMID: 31866077 DOI: 10.1016/j.schres.2019.11.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Received: 05/29/2019] [Revised: 09/06/2019] [Accepted: 11/25/2019] [Indexed: 12/30/2022]
Abstract
There has been limited research into the predictive value of basic symptoms and their relationship with other psychopathology in patients identified using the 'ultra high risk' (UHR) for psychosis approach. The current study investigated whether basic symptoms, specifically cognitive disturbances (COGDIS), were associated with a greater risk of transition to psychotic disorder and persistent attenuated psychotic symptoms (APS) at medium term follow-up (mean = 3.4 years) in UHR patients, as well as with general psychopathology at baseline. The sample included 304 UHR participants (mean age = 19.12 years) involved in an international multicenter trial of omega-3 fatty acids. UHR individuals who also met the COGDIS criteria (basic symptoms risk criteria) did not have a greater risk of transition than those who met the UHR criteria alone. However, meeting COGDIS risk criteria was associated with a greater likelihood of meeting the UHR attenuated psychotic symptoms risk group (i.e., having persistent attenuated psychotic symptoms) at 12-month follow-up (odds ratio = 1.85; 95% CI = 1.03, 3.32). Greater severity of cognitive basic symptoms was also independently associated with more severe general psychopathology at study entry. The findings do not support the notion that combined risk identification approaches (UHR and basic symptoms) aid in the identification of individuals at greatest risk of psychosis, although this interpretation is limited by the modest transition to psychosis rate (13%) and the time of follow up. However, the findings indicate that basic symptoms may be a clinically useful marker of more severe general psychopathology in UHR groups and risk for persistent attenuated psychotic symptoms.
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Affiliation(s)
- S Youn
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - L J Phillips
- Department of Psychology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - G P Amminger
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - G Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland
| | - E Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - L de Haan
- Academic Medical Center, Amsterdam, the Netherlands
| | - J A Hartmann
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - I B Hickie
- Brain and Mind Research Institute, University of Sydney, Australia
| | - S Lavoie
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - C Markulev
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - P D McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Austria
| | - D H Nieman
- Academic Medical Center, Amsterdam, the Netherlands
| | - M Nordentoft
- Psychiatric Centre Bispebjerg, Copenhagen, Denmark
| | | | - M R Schäfer
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - M Schlögelhofer
- Department of Psychiatry, Medical University of Vienna, Austria
| | - S Smesny
- University Hospital Jena, Jena, Germany
| | - A Thompson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - S Verma
- Institute of Mental Health, Singapore, Singapore
| | - H P Yuen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - A R Yung
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - B Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
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7
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Milton AC, La Monica H, Dowling M, Yee H, Davenport T, Braunstein K, Flego A, Burns JM, Hickie IB. Gambling and the Role of Resilience in an International Online Sample of Current and Ex-serving Military Personnel as Compared to the General Population. J Gambl Stud 2019; 36:477-498. [PMID: 31620927 DOI: 10.1007/s10899-019-09900-w] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Compared to the general population, military personnel are particularly vulnerable to developing gambling problems. The present study examined the presentation of gambling-including gambling frequency, personal thoughts on reducing gambling and recommendations from others to reduce gambling-across these populations. Additionally, the study measured the association between gambling and various psychosocial risk and protective factors-including psychological distress, suicidal ideation, external encouragement to reduce substance use, days out of role, personal wellbeing, resilience, social support and intimate bonds. Data was extracted from the Global Health & Wellbeing Survey, an online self-report survey conducted in Australia, Canada, New Zealand, the United Kingdom and the United States. Of the 10,765 eligible respondents, 394 were military veterans and 337 were active military personnel. Consistent with previous research, a higher proportion of gambling behaviours were observed in both current and ex-serving military samples, compared to the general population. To varying degrees, significant associations were found between the different gambling items and all psychosocial risk and protective factors in the general population sample. However, the military sample yielded only one significant association between gambling frequency and the protective factor 'resilience'. A post hoc stepwise linear regression analysis demonstrated the possible mediating role resilience plays between gambling frequency and other psychosocial risk (psychological distress, and suicidal thoughts and behaviour) and protective factors (personal wellbeing) for the military sample. Given the findings, it is recommended that routine screening tools identifying problem gambling are used within the military, and subsequent resilience focused interventions are offered to at risk personnel.
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Affiliation(s)
- A C Milton
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2006, Australia. .,Project Synergy, InnoWell Pty Ltd, Sydney, NSW, Australia.
| | - H La Monica
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2006, Australia.,Project Synergy, InnoWell Pty Ltd, Sydney, NSW, Australia
| | - M Dowling
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2006, Australia.,Project Synergy, InnoWell Pty Ltd, Sydney, NSW, Australia
| | - H Yee
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2006, Australia.,Project Synergy, InnoWell Pty Ltd, Sydney, NSW, Australia
| | - T Davenport
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2006, Australia.,Project Synergy, InnoWell Pty Ltd, Sydney, NSW, Australia
| | - K Braunstein
- Project Synergy, InnoWell Pty Ltd, Sydney, NSW, Australia
| | - A Flego
- The Movember Foundation, Melbourne, VIC, Australia
| | - J M Burns
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2006, Australia
| | - I B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2006, Australia
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8
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Perera S, Hetrick S, Cotton S, Parker A, Rickwood D, Davenport T, Hickie IB, Herrman H, McGorry P. Awareness of headspace youth mental health service centres across Australian communities between 2008 and 2015. J Ment Health 2019; 29:410-417. [DOI: 10.1080/09638237.2019.1630718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- S. Perera
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - S. Hetrick
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S. Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - A. Parker
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - D. Rickwood
- Faculty of Health, University of Canberra, Canberra, Australia
- Headspace, National Youth Mental Health Foundation, Melbourne, Australia
| | - T. Davenport
- Brain and Mind Centre, University of Sydney, Australia
| | - I. B. Hickie
- Brain and Mind Centre, University of Sydney, Australia
| | - H. Herrman
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - P. McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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9
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Yuen HP, Mackinnon A, Hartmann J, Amminger GP, Markulev C, Lavoie S, Schäfer MR, Polari A, Mossaheb N, Schlögelhofer M, Smesny S, Hickie IB, Berger G, Chen EYH, de Haan L, Nieman DH, Nordentoft M, Riecher-Rössler A, Verma S, Thompson A, Yung AR, McGorry PD, Nelson B. Dynamic prediction of transition to psychosis using joint modelling. Schizophr Res 2018; 202:333-340. [PMID: 30539771 DOI: 10.1016/j.schres.2018.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/01/2018] [Accepted: 07/01/2018] [Indexed: 10/28/2022]
Abstract
Considerable research has been conducted seeking risk factors and constructing prediction models for transition to psychosis in individuals at ultra-high risk (UHR). Nearly all such research has only employed baseline predictors, i.e. data collected at the baseline time point, even though longitudinal data on relevant measures such as psychopathology have often been collected at various time points. Dynamic prediction, which is the updating of prediction at a post-baseline assessment using baseline and longitudinal data accumulated up to that assessment, has not been utilized in the UHR context. This study explored the use of dynamic prediction and determined if it could enhance the prediction of frank psychosis onset in UHR individuals. An emerging statistical methodology called joint modelling was used to implement the dynamic prediction. Data from the NEURAPRO study (n = 304 UHR individuals), an intervention study with transition to psychosis study as the primary outcome, were used to investigate dynamic predictors. Compared with the conventional approach of using only baseline predictors, dynamic prediction using joint modelling showed significantly better sensitivity, specificity and likelihood ratios. As dynamic prediction can provide an up-to-date prediction for each individual at each new assessment post entry, it can be a useful tool to help clinicians adjust their prognostic judgements based on the unfolding clinical symptomatology of the patients. This study has shown that a dynamic approach to psychosis prediction using joint modelling has the potential to aid clinicians in making decisions about the provision of timely and personalized treatment to patients concerned.
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Affiliation(s)
- H P Yuen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia.
| | - A Mackinnon
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia; Black Dog Institute, New South Wales, Australia; University of New South Wales, New South Wales, Australia
| | - J Hartmann
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - G P Amminger
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - C Markulev
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - S Lavoie
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - M R Schäfer
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - A Polari
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia; Orygen Youth Health, Melbourne, Australia
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Austria
| | - M Schlögelhofer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Austria
| | - S Smesny
- University Hospital Jena, Germany
| | - I B Hickie
- Brain and Mind Centre, University of Sydney, Australia
| | - G Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland
| | - E Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - L de Haan
- Academic Medical Center, Amsterdam, the Netherlands
| | - D H Nieman
- Academic Medical Center, Amsterdam, the Netherlands
| | - M Nordentoft
- Mental Health Centre Copenhagen, Mental Health Services in the Capital Region, Copenhagen University Hospital, Denmark
| | | | - S Verma
- Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - A Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, England, UK; North Warwickshire Early Intervention in Psychosis Service, Coventry and Warwickshire NHS Partnership Trust, England, UK
| | - A R Yung
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK; Greater Manchester West NHS Mental Health Foundation Trust, Manchester, England, UK
| | - P D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - B Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
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10
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Nelson B, Amminger GP, Yuen HP, Markulev C, Lavoie S, Schäfer MR, Hartmann JA, Mossaheb N, Schlögelhofer M, Smesny S, Hickie IB, Berger G, Chen EYH, de Haan L, Nieman DH, Nordentoft M, Riecher-Rössler A, Verma S, Thompson A, Yung AR, McGorry PD. NEURAPRO: a multi-centre RCT of omega-3 polyunsaturated fatty acids versus placebo in young people at ultra-high risk of psychotic disorders-medium-term follow-up and clinical course. NPJ Schizophr 2018; 4:11. [PMID: 29941938 PMCID: PMC6018097 DOI: 10.1038/s41537-018-0052-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/04/2018] [Accepted: 05/11/2018] [Indexed: 11/09/2022]
Abstract
This study reports a medium-term follow-up of a randomised, double-blind, placebo-controlled trial of omega-3 polyunsaturated fatty acids (PUFA) in ultra-high risk for psychosis (UHR) patients. Primary outcomes of interest were transition to psychosis and symptomatic and functional outcome. A secondary aim was to investigate clinical predictors of medium-term outcome. Three hundred four UHR participants were recruited across 10 specialised early psychosis services in Australia, Asia, and Europe. The intervention consisted of 1.4 g/daily of omega-3 PUFA or placebo, plus up to 20 sessions of cognitive-behavioural case management (CBCM), over the 6-month study period, with participants receiving further CBCM sessions on basis of need between months 6-12. Mean time to follow-up was 3.4 (median = 3.3; SD = 0.9) years. There was a modest increase in transitions between 12-month and medium-term follow-up (11-13%) and substantial improvement in symptoms and functioning between baseline and follow-up, with no differences between the treatment groups. Most improvement had been achieved by end of the intervention. 55% of the sample received mental health treatment between end of intervention and follow-up. Omega-3 PUFA did not provide additional benefits to good quality psychosocial intervention over the medium term. Although most improvement had been achieved by end of intervention the substantial rates of post-intervention mental health service use indicate longer-term clinical need in UHR patients. The post-intervention phase treatment or the longer-term effect of CBCM, or a combination of the two, may have contributed to maintaining the gains achieved during the intervention phase and prevented significant deterioration after this time.
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Affiliation(s)
- B Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia. .,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
| | - G P Amminger
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Department of Psychiatry, Medical University of Vienna, Vienna, Austria
| | - H P Yuen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - C Markulev
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - S Lavoie
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - M R Schäfer
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Department of Psychiatry, Medical University of Vienna, Vienna, Austria
| | - J A Hartmann
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - M Schlögelhofer
- Department of Psychiatry, Medical University of Vienna, Vienna, Austria
| | - S Smesny
- University Hospital Jena, Jena, Germany
| | - I B Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - G Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland
| | - E Y H Chen
- Department of Psychiatry, University of Hong Kong, Pokfulam, Hong Kong
| | - L de Haan
- Academic Medical Center, Amsterdam, The Netherlands
| | - D H Nieman
- Academic Medical Center, Amsterdam, The Netherlands
| | - M Nordentoft
- Psychiatric Centre Bispebjerg, Copenhagen, Denmark
| | | | - S Verma
- Institute of Mental Health, Singapore, Singapore
| | - A Thompson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.,North Warwickshire Early Intervention in Psychosis Service, Coventry and Warwickshire NHS Partnership Trust, Coventry, UK
| | - A R Yung
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - P D McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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11
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Kelly S, Jahanshad N, Zalesky A, Kochunov P, Agartz I, Alloza C, Andreassen OA, Arango C, Banaj N, Bouix S, Bousman CA, Brouwer RM, Bruggemann J, Bustillo J, Cahn W, Calhoun V, Cannon D, Carr V, Catts S, Chen J, Chen JX, Chen X, Chiapponi C, Cho KK, Ciullo V, Corvin AS, Crespo-Facorro B, Cropley V, De Rossi P, Diaz-Caneja CM, Dickie EW, Ehrlich S, Fan FM, Faskowitz J, Fatouros-Bergman H, Flyckt L, Ford JM, Fouche JP, Fukunaga M, Gill M, Glahn DC, Gollub R, Goudzwaard ED, Guo H, Gur RE, Gur RC, Gurholt TP, Hashimoto R, Hatton SN, Henskens FA, Hibar DP, Hickie IB, Hong LE, Horacek J, Howells FM, Hulshoff Pol HE, Hyde CL, Isaev D, Jablensky A, Jansen PR, Janssen J, Jönsson EG, Jung LA, Kahn RS, Kikinis Z, Liu K, Klauser P, Knöchel C, Kubicki M, Lagopoulos J, Langen C, Lawrie S, Lenroot RK, Lim KO, Lopez-Jaramillo C, Lyall A, Magnotta V, Mandl RCW, Mathalon DH, McCarley RW, McCarthy-Jones S, McDonald C, McEwen S, McIntosh A, Melicher T, Mesholam-Gately RI, Michie PT, Mowry B, Mueller BA, Newell DT, O'Donnell P, Oertel-Knöchel V, Oestreich L, Paciga SA, Pantelis C, Pasternak O, Pearlson G, Pellicano GR, Pereira A, Pineda Zapata J, Piras F, Potkin SG, Preda A, Rasser PE, Roalf DR, Roiz R, Roos A, Rotenberg D, Satterthwaite TD, Savadjiev P, Schall U, Scott RJ, Seal ML, Seidman LJ, Shannon Weickert C, Whelan CD, Shenton ME, Kwon JS, Spalletta G, Spaniel F, Sprooten E, Stäblein M, Stein DJ, Sundram S, Tan Y, Tan S, Tang S, Temmingh HS, Westlye LT, Tønnesen S, Tordesillas-Gutierrez D, Doan NT, Vaidya J, van Haren NEM, Vargas CD, Vecchio D, Velakoulis D, Voineskos A, Voyvodic JQ, Wang Z, Wan P, Wei D, Weickert TW, Whalley H, White T, Whitford TJ, Wojcik JD, Xiang H, Xie Z, Yamamori H, Yang F, Yao N, Zhang G, Zhao J, van Erp TGM, Turner J, Thompson PM, Donohoe G. Widespread white matter microstructural differences in schizophrenia across 4322 individuals: results from the ENIGMA Schizophrenia DTI Working Group. Mol Psychiatry 2018; 23:1261-1269. [PMID: 29038599 PMCID: PMC5984078 DOI: 10.1038/mp.2017.170] [Citation(s) in RCA: 412] [Impact Index Per Article: 68.7] [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: 10/17/2016] [Revised: 05/02/2017] [Accepted: 06/07/2017] [Indexed: 12/15/2022]
Abstract
The regional distribution of white matter (WM) abnormalities in schizophrenia remains poorly understood, and reported disease effects on the brain vary widely between studies. In an effort to identify commonalities across studies, we perform what we believe is the first ever large-scale coordinated study of WM microstructural differences in schizophrenia. Our analysis consisted of 2359 healthy controls and 1963 schizophrenia patients from 29 independent international studies; we harmonized the processing and statistical analyses of diffusion tensor imaging (DTI) data across sites and meta-analyzed effects across studies. Significant reductions in fractional anisotropy (FA) in schizophrenia patients were widespread, and detected in 20 of 25 regions of interest within a WM skeleton representing all major WM fasciculi. Effect sizes varied by region, peaking at (d=0.42) for the entire WM skeleton, driven more by peripheral areas as opposed to the core WM where regions of interest were defined. The anterior corona radiata (d=0.40) and corpus callosum (d=0.39), specifically its body (d=0.39) and genu (d=0.37), showed greatest effects. Significant decreases, to lesser degrees, were observed in almost all regions analyzed. Larger effect sizes were observed for FA than diffusivity measures; significantly higher mean and radial diffusivity was observed for schizophrenia patients compared with controls. No significant effects of age at onset of schizophrenia or medication dosage were detected. As the largest coordinated analysis of WM differences in a psychiatric disorder to date, the present study provides a robust profile of widespread WM abnormalities in schizophrenia patients worldwide. Interactive three-dimensional visualization of the results is available at www.enigma-viewer.org.
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Affiliation(s)
- S Kelly
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA,Harvard Medical School, Boston, MA, USA,Imaging Genetics Center, Keck School of Medicine, University of Southern California, Marina del Rey, CA 90292, USA. E-mail:
| | - N Jahanshad
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - A Zalesky
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, VIC, Australia
| | - P Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - I Agartz
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - C Alloza
- University of Edinburgh, Edinburgh, UK
| | | | - C Arango
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - N Banaj
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - S Bouix
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - C A Bousman
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, VIC, Australia,Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia,Department of General Practice, The University of Melbourne, Parkville, VIC, Australia,Swinburne University of Technology, Melbourne, VIC, Australia
| | - R M Brouwer
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Bruggemann
- Neuroscience Research Australia and School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - J Bustillo
- University of New Mexico, Albuquerque, NM, USA
| | - W Cahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - V Calhoun
- The Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, USA,The Mind Research Network, Albuquerque, NM, USA
| | - D Cannon
- Centre for Neuroimaging and Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland
| | - V Carr
- Neuroscience Research Australia and School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - S Catts
- Discipline of Psychiatry, School of Medicine, University of Queensland, Herston, QLD, Australia
| | - J Chen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, USA
| | - J-x Chen
- Beijing Huilongguan Hospital, Beijing, China
| | - X Chen
- Worldwide Research and Development, Pfizer, Cambridge, MA, USA
| | | | - Kl K Cho
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - V Ciullo
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - A S Corvin
- Department of Psychiatry and Neuropsychiatric Genetics Research Group, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - B Crespo-Facorro
- University Hospital Marqués de Valdecilla, IDIVAL, Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain,CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Santander, Spain
| | - V Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, VIC, Australia
| | - P De Rossi
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy,Department NESMOS, Faculty of Medicine and Psychology, University ‘Sapienza’ of Rome, Rome, Italy,Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - C M Diaz-Caneja
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - E W Dickie
- Center for Addiction and Mental Health, Toronto, ON, Canada
| | - S Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Technische Universität Dresden, Faculty of Medicine, University Hospital C.G. Carus, Dresden, Germany
| | - F-m Fan
- Beijing Huilongguan Hospital, Beijing, China
| | - J Faskowitz
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - H Fatouros-Bergman
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - L Flyckt
- University of New South Wales, School of Psychiatry, Sydney, NSW, Australia,The University of Queensland, Queensland Brain Institute and Centre for Advanced Imaging, Brisbane, QLD, Australia
| | - J M Ford
- University of California, VAMC, San Francisco, CA, USA
| | - J-P Fouche
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - M Fukunaga
- Division of Cerebral Integration, National Institute for Physiological Sciences, Aichi, Japan
| | - M Gill
- Department of Psychiatry and Neuropsychiatric Genetics Research Group, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - D C Glahn
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital and Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - R Gollub
- Harvard Medical School, Boston, MA, USA,Departments of Psychiatry and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - E D Goudzwaard
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - H Guo
- Zhumadian Psychiatry Hospital, Henan Province, China
| | - R E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - R C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - T P Gurholt
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - R Hashimoto
- Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, Osaka, Japan,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - S N Hatton
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - F A Henskens
- School of Electrical Engineering and Computer Science, University of Newcastle, Callaghan, NSW, Australia,Health Behaviour Research Group, University of Newcastle, Callaghan, NSW, Australia,Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - D P Hibar
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - I B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - L E Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - J Horacek
- National Institute of Mental Health, Klecany, Czech Republic,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - F M Howells
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - H E Hulshoff Pol
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C L Hyde
- Worldwide Research and Development, Pfizer, Cambridge, MA, USA
| | - D Isaev
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - A Jablensky
- University of Western Australia, Perth, WA, Australia
| | - P R Jansen
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Janssen
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain,Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E G Jönsson
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - L A Jung
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt/Main, Germany
| | - R S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Z Kikinis
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - K Liu
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, VIC, Australia
| | - P Klauser
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, VIC, Australia,Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences and Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia,Department of Psychiatry, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - C Knöchel
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt/Main, Germany
| | - M Kubicki
- Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J Lagopoulos
- Sunshine Coast Mind and Neuroscience Institute, University of the Sunshine Coast QLD, Australia, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - C Langen
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S Lawrie
- University of Edinburgh, Edinburgh, UK
| | - R K Lenroot
- Neuroscience Research Australia and School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - K O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - C Lopez-Jaramillo
- Research Group in Psychiatry (GIPSI), Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Mood Disorder Program, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - A Lyall
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - R C W Mandl
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D H Mathalon
- University of California, VAMC, San Francisco, CA, USA
| | | | - S McCarthy-Jones
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - C McDonald
- Centre for Neuroimaging and Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland
| | - S McEwen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - T Melicher
- Third Faculty of Medicine, Charles University, Prague, Czech Republic,The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - R I Mesholam-Gately
- Harvard Medical School and Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess, Medical Center, Boston, MA, USA
| | - P T Michie
- Hunter Medical Research Institute, Newcastle, NSW, Australia,The University of Newcastle, Newcastle, NSW, Australia,Schizophrenia Research Institute, Sydney, NSW, Australia
| | - B Mowry
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia and Queensland Centre for Mental Health Research, Brisbane and Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - B A Mueller
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - D T Newell
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - P O'Donnell
- Worldwide Research and Development, Pfizer, Cambridge, MA, USA
| | - V Oertel-Knöchel
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt/Main, Germany
| | - L Oestreich
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia and Queensland Centre for Mental Health Research, Brisbane and Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - S A Paciga
- Worldwide Research and Development, Pfizer, Cambridge, MA, USA
| | - C Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, VIC, Australia,Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia,Schizophrenia Research Institute, Sydney, NSW, Australia,Centre for Neural Engineering (CfNE), Department of Electrical and Electronic Engineering, University of Melbourne, Parkville, VIC, Australia
| | - O Pasternak
- Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - G Pearlson
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital and Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - G R Pellicano
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - A Pereira
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - F Piras
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy,School of Biomedical Sciences, Faculty of Health, the University of Newcastle, Callaghan, NSW, Australia
| | - S G Potkin
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - A Preda
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - P E Rasser
- Hunter Medical Research Institute, Newcastle, NSW, Australia,Priority Centre for Brain and Mental Health Research, The University of Newcastle, Newcastle, NSW, Australia
| | - D R Roalf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - R Roiz
- University Hospital Marqués de Valdecilla, IDIVAL, Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain,CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Santander, Spain
| | - A Roos
- SU/UCT MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - D Rotenberg
- Center for Addiction and Mental Health, Toronto, ON, Canada
| | - T D Satterthwaite
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - P Savadjiev
- Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - U Schall
- Hunter Medical Research Institute, Newcastle, NSW, Australia,Priority Centre for Brain and Mental Health Research, The University of Newcastle, Newcastle, NSW, Australia
| | - R J Scott
- Hunter Medical Research Institute, Newcastle, NSW, Australia,School of Biomedical Sciences, Faculty of Health, the University of Newcastle, Callaghan, NSW, Australia
| | - M L Seal
- Murdoch Childrens Research Institute, The Royal Children’s Hospital, Parkville, VIC, Australia
| | - L J Seidman
- Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Harvard Medical School and Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess, Medical Center, Boston, MA, USA
| | - C Shannon Weickert
- Schizophrenia Research Institute, Sydney, NSW, Australia,Neuroscience Research Australia, Sydney, NSW, Australia,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - C D Whelan
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - M E Shenton
- Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA,VA Boston Healthcare System, Boston, MA, USA
| | - J S Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - G Spalletta
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy,Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - F Spaniel
- National Institute of Mental Health, Klecany, Czech Republic,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - E Sprooten
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital and Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - M Stäblein
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt/Main, Germany
| | - D J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa,Department of Psychiatry and MRC Unit on Anxiety and Stress Disorders, University of Cape Town, Cape Town, South Africa
| | - S Sundram
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia,Department of Psychiatry, School of Clinical Sciences, Monash University and Monash Health, Clayton, VIC, Australia
| | - Y Tan
- Beijing Huilongguan Hospital, Beijing, China
| | - S Tan
- Beijing Huilongguan Hospital, Beijing, China
| | - S Tang
- Chongqing Three Gorges Central Hospital, Chongqing, China
| | - H S Temmingh
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - L T Westlye
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Psychology, University of Oslo, Oslo, Norway
| | - S Tønnesen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - D Tordesillas-Gutierrez
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Santander, Spain,Neuroimaging Unit, Technological Facilities, Valdecilla Biomedical Research Institute IDIVAL, Santander, Spain
| | - N T Doan
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J Vaidya
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - N E M van Haren
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C D Vargas
- Research Group in Psychiatry (GIPSI), Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - D Vecchio
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - D Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - A Voineskos
- Kimel Family Translational Imaging-Genetics Research Laboratory, Campbell Family Mental Health Research Institute, CAMH Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - J Q Voyvodic
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Z Wang
- Beijing Huilongguan Hospital, Beijing, China
| | - P Wan
- Zhumadian Psychiatry Hospital, Henan Province, China
| | - D Wei
- Luoyang Fifth People's Hospital, Henan Province, China
| | - T W Weickert
- Schizophrenia Research Institute, Sydney, NSW, Australia,Neuroscience Research Australia, Sydney, NSW, Australia,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - H Whalley
- University of Edinburgh, Edinburgh, UK
| | - T White
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - T J Whitford
- University of New South Wales, School of Psychiatry, Sydney, NSW, Australia
| | - J D Wojcik
- Harvard Medical School and Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess, Medical Center, Boston, MA, USA
| | - H Xiang
- Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Z Xie
- Worldwide Research and Development, Pfizer, Cambridge, MA, USA
| | - H Yamamori
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - F Yang
- Beijing Huilongguan Hospital, Beijing, China
| | - N Yao
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - G Zhang
- Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore, MD, USA
| | - J Zhao
- Centre for Neuroimaging and Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland,School of Psychology, Shaanxi Normal University and Key Laboratory for Behavior and Cognitive Neuroscience of Shaanxi Province, Xi’an, Shaanxi, China
| | - T G M van Erp
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - J Turner
- Psychology Department & Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - P M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - G Donohoe
- Centre for Neuroimaging and Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland
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12
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McHugh MJ, McGorry PD, Yuen HP, Hickie IB, Thompson A, de Haan L, Mossaheb N, Smesny S, Lin A, Markulev C, Schloegelhofer M, Wood SJ, Nieman D, Hartmann JA, Nordentoft M, Schäfer M, Amminger GP, Yung A, Nelson B. The Ultra-High-Risk for psychosis groups: Evidence to maintain the status quo. Schizophr Res 2018; 195:543-548. [PMID: 29055567 DOI: 10.1016/j.schres.2017.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/31/2017] [Accepted: 09/03/2017] [Indexed: 01/12/2023]
Abstract
Individuals are considered Ultra-High-Risk (UHR) for psychosis if they meet a set of standardised criteria including presumed genetic vulnerability (Trait), or a recent history of Attenuated Psychotic Symptoms (APS) or Brief Limited Intermittent Psychotic Symptoms (BLIPS). Recent calls to revise these criteria have arisen from evidence that Trait, APS and BLIPS groups may transition to psychosis at different rates. Concurrently, it has become clear that the UHR status confers clinical risk beyond transition to psychosis. Specifically, most UHR individuals will not develop psychosis, but will experience high rates of non-psychotic disorders, persistent APS and poor long-term functional outcomes. Rather than focus on transition, the present study investigated whether UHR groups differ in their broader clinical risk profile by examining baseline clinical characteristics and long-term outcomes other than transition to psychosis. Four UHR groups were defined: Trait-only, APS-only, Trait+APS, and any BLIPS. Participants (N=702) were recruited upon entry to early intervention services and followed-up over a period of up to 13years (mean=4.53, SD=3.84). The groups evidenced similar symptom severity (SANS for negative symptoms, BPRS for positive and depression/anxiety symptoms) and psychosocial functioning (SOFAS, GAF, QLS) at baseline and follow-up as well as similar prevalence of non-psychotic disorders at follow-up. Our findings demonstrate that UHR groups evidence a similar clinical risk profile when we expand this beyond transition to psychosis, and consequently support maintaining the existing UHR criteria.
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Affiliation(s)
- M J McHugh
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia.
| | - P D McGorry
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia
| | - H P Yuen
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia
| | - I B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - A Thompson
- Division of Mental Health and Wellbeing, The University of Warwick, Coventry, UK
| | - L de Haan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University Vienna, Austria
| | - S Smesny
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - A Lin
- Telethon Kids Institute, The University of Western Australia, Australia
| | - C Markulev
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia
| | - M Schloegelhofer
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University Vienna, Austria; Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - S J Wood
- School of Psychology, University of Birmingham, Birmingham, UK; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Melbourne, Australia
| | - D Nieman
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J A Hartmann
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia
| | - M Nordentoft
- Mental Health Centre Copenhagen, Mental health Services Capital Region of Denmark, Denmark; Psychiatric Centre Copenhagen, University of Copenhagen, Denmark
| | - M Schäfer
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia
| | - G P Amminger
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia
| | - A Yung
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - B Nelson
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia
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13
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Lee RSC, Hermens DF, Scott J, O'Dea B, Glozier N, Scott EM, Hickie IB. A transdiagnostic study of education, employment, and training outcomes in young people with mental illness. Psychol Med 2017; 47:2061-2070. [PMID: 28393749 DOI: 10.1017/s0033291717000484] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 01/01/2023]
Abstract
BACKGROUND Optimizing functional recovery in young individuals with severe mental illness constitutes a major healthcare priority. The current study sought to quantify the cognitive and clinical factors underpinning academic and vocational engagement in a transdiagnostic and prospective youth mental health cohort. The primary outcome measure was 'not in education, employment or training' ('NEET') status. METHOD A clinical sample of psychiatric out-patients aged 15-25 years (n = 163) was assessed at two time points, on average, 24 months apart. Functional status, and clinical and neuropsychological data were collected. Bayesian structural equation modelling was used to confirm the factor structure of predictors and cross-lagged effects at follow-up. RESULTS Individually, NEET status, cognitive dysfunction and negative symptoms at baseline were predictive of NEET status at follow-up (p < 0.05). Baseline cognitive functioning was the only predictor of follow-up NEET status in the multivariate Bayesian model, while controlling for baseline NEET status. For every 1 s.d. deficit in cognition, the probability of being disengaged at follow-up increased by 40% (95% credible interval 19-58%). Baseline NEET status predicted poorer negative symptoms at follow-up (β = 0.24, 95% credible interval 0.04-0.43). CONCLUSIONS Disengagement with education, employment or training (i.e. being NEET) was reported in about one in four members of this cohort. The initial level of cognitive functioning was the strongest determinant of future NEET status, whereas being academically or vocationally engaged had an impact on future negative symptomatology. If replicated, these findings support the need to develop early interventions that target cognitive phenotypes transdiagnostically.
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Affiliation(s)
- R S C Lee
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - D F Hermens
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - J Scott
- Academic Psychiatry,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne,UK
| | - B O'Dea
- Faculty of Medicine,Black Dog Institute, UNSW,Sydney, NSW,Australia
| | - N Glozier
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - E M Scott
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - I B Hickie
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
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14
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Schmaal L, Hibar DP, Sämann PG, Hall GB, Baune BT, Jahanshad N, Cheung JW, van Erp TGM, Bos D, Ikram MA, Vernooij MW, Niessen WJ, Tiemeier H, Hofman A, Wittfeld K, Grabe HJ, Janowitz D, Bülow R, Selonke M, Völzke H, Grotegerd D, Dannlowski U, Arolt V, Opel N, Heindel W, Kugel H, Hoehn D, Czisch M, Couvy-Duchesne B, Rentería ME, Strike LT, Wright MJ, Mills NT, de Zubicaray GI, McMahon KL, Medland SE, Martin NG, Gillespie NA, Goya-Maldonado R, Gruber O, Krämer B, Hatton SN, Lagopoulos J, Hickie IB, Frodl T, Carballedo A, Frey EM, van Velzen LS, Penninx BWJH, van Tol MJ, van der Wee NJ, Davey CG, Harrison BJ, Mwangi B, Cao B, Soares JC, Veer IM, Walter H, Schoepf D, Zurowski B, Konrad C, Schramm E, Normann C, Schnell K, Sacchet MD, Gotlib IH, MacQueen GM, Godlewska BR, Nickson T, McIntosh AM, Papmeyer M, Whalley HC, Hall J, Sussmann JE, Li M, Walter M, Aftanas L, Brack I, Bokhan NA, Thompson PM, Veltman DJ. Cortical abnormalities in adults and adolescents with major depression based on brain scans from 20 cohorts worldwide in the ENIGMA Major Depressive Disorder Working Group. Mol Psychiatry 2017; 22:900-909. [PMID: 27137745 PMCID: PMC5444023 DOI: 10.1038/mp.2016.60] [Citation(s) in RCA: 687] [Impact Index Per Article: 98.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/25/2016] [Accepted: 03/17/2016] [Indexed: 12/20/2022]
Abstract
The neuro-anatomical substrates of major depressive disorder (MDD) are still not well understood, despite many neuroimaging studies over the past few decades. Here we present the largest ever worldwide study by the ENIGMA (Enhancing Neuro Imaging Genetics through Meta-Analysis) Major Depressive Disorder Working Group on cortical structural alterations in MDD. Structural T1-weighted brain magnetic resonance imaging (MRI) scans from 2148 MDD patients and 7957 healthy controls were analysed with harmonized protocols at 20 sites around the world. To detect consistent effects of MDD and its modulators on cortical thickness and surface area estimates derived from MRI, statistical effects from sites were meta-analysed separately for adults and adolescents. Adults with MDD had thinner cortical gray matter than controls in the orbitofrontal cortex (OFC), anterior and posterior cingulate, insula and temporal lobes (Cohen's d effect sizes: -0.10 to -0.14). These effects were most pronounced in first episode and adult-onset patients (>21 years). Compared to matched controls, adolescents with MDD had lower total surface area (but no differences in cortical thickness) and regional reductions in frontal regions (medial OFC and superior frontal gyrus) and primary and higher-order visual, somatosensory and motor areas (d: -0.26 to -0.57). The strongest effects were found in recurrent adolescent patients. This highly powered global effort to identify consistent brain abnormalities showed widespread cortical alterations in MDD patients as compared to controls and suggests that MDD may impact brain structure in a highly dynamic way, with different patterns of alterations at different stages of life.
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Affiliation(s)
- L Schmaal
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - D P Hibar
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | - P G Sämann
- Neuroimaging Core Unit, Max Planck Institute of Psychiatry, Munich, Germany
| | - G B Hall
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - B T Baune
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - N Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | - J W Cheung
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | - T G M van Erp
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - D Bos
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M A Ikram
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M W Vernooij
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - W J Niessen
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Medical Informatics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - H Tiemeier
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - A Hofman
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - K Wittfeld
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - H J Grabe
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - D Janowitz
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - R Bülow
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - M Selonke
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - H Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- German Center for Cardiovascular Research (DZHK), partner site Griefswald, Greifswald, Germany
- German Center for Diabetes Research (DZD), partner site Griefswald, Greifswald, Germany
| | - D Grotegerd
- Department of Psychiatry, University of Muenster, Muenster, Germany
| | - U Dannlowski
- Department of Psychiatry, University of Muenster, Muenster, Germany
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - V Arolt
- Department of Psychiatry, University of Muenster, Muenster, Germany
| | - N Opel
- Department of Psychiatry, University of Muenster, Muenster, Germany
| | - W Heindel
- Department of Clinical Radiology, University of Muenster, Muenster, Germany
| | - H Kugel
- Department of Clinical Radiology, University of Muenster, Muenster, Germany
| | - D Hoehn
- Neuroimaging Core Unit, Max Planck Institute of Psychiatry, Munich, Germany
| | - M Czisch
- Neuroimaging Core Unit, Max Planck Institute of Psychiatry, Munich, Germany
| | - B Couvy-Duchesne
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- Center for Advanced Imaging, The University of Queensland, Brisbane, QLD, Australia
- Queensland Institute of Medical Research Berghofer, Brisbane, QLD, Australia
| | - M E Rentería
- Queensland Institute of Medical Research Berghofer, Brisbane, QLD, Australia
| | - L T Strike
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - M J Wright
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- Center for Advanced Imaging, The University of Queensland, Brisbane, QLD, Australia
| | - N T Mills
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- Queensland Institute of Medical Research Berghofer, Brisbane, QLD, Australia
| | - G I de Zubicaray
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - K L McMahon
- Center for Advanced Imaging, The University of Queensland, Brisbane, QLD, Australia
| | - S E Medland
- Queensland Institute of Medical Research Berghofer, Brisbane, QLD, Australia
| | - N G Martin
- Queensland Institute of Medical Research Berghofer, Brisbane, QLD, Australia
| | - N A Gillespie
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA, USA
| | - R Goya-Maldonado
- Centre for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, University Medical Center (UMG), Georg-August-University, Göttingen, Germany
| | - O Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - B Krämer
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - S N Hatton
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - J Lagopoulos
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - I B Hickie
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - T Frodl
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
- Department of Psychiatry and Institute of Neuroscience, Trinity College, Dublin, Ireland
| | - A Carballedo
- Department of Psychiatry and Institute of Neuroscience, Trinity College, Dublin, Ireland
| | - E M Frey
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - L S van Velzen
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - B W J H Penninx
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - M-J van Tol
- Neuroimaging Center, Section of Cognitive Neuropsychiatry, Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - N J van der Wee
- Department of Psychiatry and Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands
| | - C G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - B J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - B Mwangi
- UT Center of Excellence on Mood Disoders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - B Cao
- UT Center of Excellence on Mood Disoders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - J C Soares
- UT Center of Excellence on Mood Disoders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - I M Veer
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - H Walter
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - D Schoepf
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - B Zurowski
- Center for Integrative Psychiatry, University of Lübeck, Lübeck, Germany
| | - C Konrad
- Department of Psychiatry, University of Marburg, Marburg, Germany
- Department of Psychiatry and Psychotherapy, Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
| | - E Schramm
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - C Normann
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - K Schnell
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - M D Sacchet
- Neurosciences Program and Department of Psychology, Stanford University, Stanford, CA, USA
| | - I H Gotlib
- Neurosciences Program and Department of Psychology, Stanford University, Stanford, CA, USA
| | - G M MacQueen
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - B R Godlewska
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - T Nickson
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - A M McIntosh
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
- Centre for Cogntive Ageing and Cogntive Epidemiology, University of Edinburgh, Edinburg, UK
| | - M Papmeyer
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
- Division of Systems Neuroscience of Psychopathology, Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - H C Whalley
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - J Hall
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - J E Sussmann
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
- Department of Psychiatry, NHS Borders, Melrose, UK
| | - M Li
- Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - M Walter
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Department of Psychiatry, University Tübingen, Tübingen, Germany
| | - L Aftanas
- Department of Experimental and Clinical Neuroscience, Scientific Research Institute of Physiology and Basic Medicine, Novosibirsk, Russia
| | - I Brack
- Department of Experimental and Clinical Neuroscience, Scientific Research Institute of Physiology and Basic Medicine, Novosibirsk, Russia
| | - N A Bokhan
- Mental Health Research Institute, Tomsk, Russia
- Faculty of Psychology, National Research Tomsk State University, Tomsk, Russia
- Department of General Medicine, Siberian State Medical University, Tomsk, Russia
| | - P M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | - D J Veltman
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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15
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Masi A, Lampit A, DeMayo MM, Glozier N, Hickie IB, Guastella AJ. A comprehensive systematic review and meta-analysis of pharmacological and dietary supplement interventions in paediatric autism: moderators of treatment response and recommendations for future research. Psychol Med 2017; 47:1323-1334. [PMID: 28091344 DOI: 10.1017/s0033291716003457] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/05/2022]
Abstract
BACKGROUND Autism spectrum disorders (ASDs) are pervasive and multifactorial neurodevelopmental conditions, characterized by impairments in social communication and interaction, and restricted, repetitive patterns of behaviour, interests or activities. Treatment options to ameliorate symptoms of ASDs are limited. Heterogeneity complicates the quest for personalized medicine in this population. Our aim was to investigate if there are baseline characteristics of patients that moderate response or trial design features that impede the identification of efficacious interventions for ASDs. METHOD Literature searches of EMBASE, MEDLINE and PsycINFO identified 43 studies for qualitative assessment of baseline characterization of participants and 37 studies for quantitative analysis of moderators of treatment response. Criteria included blinded randomized controlled trials (RCTs) in paediatric ASD, with at least 10 participants per arm or 20 overall, of oral treatments, including pharmacological interventions and dietary supplements. RESULTS Random-effects meta-analysis of 1997 participants (81% male) identified three moderators associated with an increase in treatment response: trials located in Europe and the Middle-East; outcome measures designated primary status; and the type of outcome measure. Inconsistent reporting of baseline symptom severity and intellectual functioning prevented analysis of these variables. Qualitative synthesis of baseline characteristics identified at least 31 variables, with only age and gender reported in all trials. Biological markers were included in six RCTs. CONCLUSIONS Few trials reported adequate baseline characteristics to permit detailed analysis of response to treatment. Consideration of geographical location, baseline severity and intellectual function is required to ensure generalizability of results. The use of biological markers and correlates in ASD trials remains in its infancy. There is great need to improve the application of baseline characterization and incorporation of biological markers and correlates to permit selection of participants into homogeneous subgroups and to inform response to treatment in ASD.
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Affiliation(s)
- A Masi
- Autism Clinic for Translational Research,Brain and Mind Centre,Central Clinical School,Sydney Medical School,University of Sydney,Camperdown,NSW,Australia
| | - A Lampit
- Regenerative Neuroscience Group,Brain and Mind Centre,University of Sydney,Camperdown,NSW,Australia
| | - M M DeMayo
- Autism Clinic for Translational Research,Brain and Mind Centre,Central Clinical School,Sydney Medical School,University of Sydney,Camperdown,NSW,Australia
| | - N Glozier
- Autism Clinic for Translational Research,Brain and Mind Centre,Central Clinical School,Sydney Medical School,University of Sydney,Camperdown,NSW,Australia
| | - I B Hickie
- Autism Clinic for Translational Research,Brain and Mind Centre,Central Clinical School,Sydney Medical School,University of Sydney,Camperdown,NSW,Australia
| | - A J Guastella
- Autism Clinic for Translational Research,Brain and Mind Centre,Central Clinical School,Sydney Medical School,University of Sydney,Camperdown,NSW,Australia
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16
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Carney R, Yung AR, Amminger GP, Bradshaw T, Glozier N, Hermens DF, Hickie IB, Killackey E, McGorry P, Pantelis C, Wood SJ, Purcell R. Substance use in youth at risk for psychosis. Schizophr Res 2017; 181:23-29. [PMID: 27590573 DOI: 10.1016/j.schres.2016.08.026] [Citation(s) in RCA: 33] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND People with schizophrenia have high rates of substance use which contributes to co-morbidity and premature mortality. Some evidence suggests people at-risk for psychosis have high rates of substance use. We aimed to assess substance use in a help-seeking cohort, comparing those at-risk and not at-risk for psychosis, and to establish any relationship with clinical symptoms. METHOD Participants were help-seeking youth presenting to mental health services in Sydney and Melbourne. 279 (34.8%) were at-risk for psychosis, and 452 (56.4%) did not meet criteria for a psychotic disorder or risk for psychosis. The excluded individuals were made up of 59 (7.4%) young people who met criteria for a psychotic disorder and 11 (1.4%) who were unable to be evaluated. We assessed the association of substance use involvement with risk status and clinical symptoms using multivariate regression. RESULTS Individuals at-risk for psychosis had significantly higher tobacco, alcohol and cannabis use than those not at-risk. Multivariate analysis revealed at-risk status was significantly associated with higher alcohol involvement scores when adjusting for age and gender, but no association was found for cannabis or tobacco. At-risk status was no longer associated with alcohol involvement when cannabis or tobacco use was added into the analysis. CONCLUSION Tobacco smoking, alcohol consumption and cannabis use are common in help-seeking youth, particularly those at-risk for psychosis. It is important to consider co-occurring use of different substances in adolescents. Early substance misuse in this phase of illness could be targeted to improve physical and mental health in young people.
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Affiliation(s)
- R Carney
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
| | - A R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Greater Manchester West Mental Health NHS Foundation Trust, UK
| | - G P Amminger
- Orygen - The National Centre of Excellence in Youth Mental Health, University of Melbourne, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Australia
| | - T Bradshaw
- School of Nursing, Midwifery and Social Work, University of Manchester, UK
| | - N Glozier
- Brain & Mind Centre, University of Sydney, New South Wales, Australia
| | - D F Hermens
- Brain & Mind Centre, University of Sydney, New South Wales, Australia
| | - I B Hickie
- Brain & Mind Centre, University of Sydney, New South Wales, Australia
| | - E Killackey
- Orygen - The National Centre of Excellence in Youth Mental Health, University of Melbourne, Victoria, Australia
| | - P McGorry
- Orygen - The National Centre of Excellence in Youth Mental Health, University of Melbourne, Victoria, Australia
| | - C Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Victoria, Australia
| | - S J Wood
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Victoria, Australia; School of Psychology, University of Birmingham, UK
| | - R Purcell
- Orygen - The National Centre of Excellence in Youth Mental Health, University of Melbourne, Victoria, Australia
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17
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Grierson AB, Hickie IB, Naismith SL, Scott J. The role of rumination in illness trajectories in youth: linking trans-diagnostic processes with clinical staging models. Psychol Med 2016; 46:2467-2484. [PMID: 27352637 PMCID: PMC4988274 DOI: 10.1017/s0033291716001392] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 12/28/2015] [Revised: 05/04/2016] [Accepted: 05/12/2016] [Indexed: 01/04/2023]
Abstract
Research in developmental psychopathology and clinical staging models has increasingly sought to identify trans-diagnostic biomarkers or neurocognitive deficits that may play a role in the onset and trajectory of mental disorders and could represent modifiable treatment targets. Less attention has been directed at the potential role of cognitive-emotional regulation processes such as ruminative response style. Maladaptive rumination (toxic brooding) is a known mediator of the association between gender and internalizing disorders in adolescents and is increased in individuals with a history of early adversity. Furthermore, rumination shows moderate levels of genetic heritability and is linked to abnormalities in neural networks associated with emotional regulation and executive functioning. This review explores the potential role of rumination in exacerbating the symptoms of alcohol and substance misuse, and bipolar and psychotic disorders during the peak age range for illness onset. Evidence shows that rumination not only amplifies levels of distress and suicidal ideation, but also extends physiological responses to stress, which may partly explain the high prevalence of physical and mental co-morbidity in youth presenting to mental health services. In summary, the normative developmental trajectory of rumination and its role in the evolution of mental disorders and physical illness demonstrates that rumination presents a detectable, modifiable trans-diagnostic risk factor in youth.
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Affiliation(s)
- A. B. Grierson
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - I. B. Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - S. L. Naismith
- Charles Perkins Centre & Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - J. Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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18
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Jayaweera HK, Hickie IB, Duffy SL, Mowszowski L, Norrie L, Lagopoulos J, Naismith SL. Episodic memory in depression: the unique contribution of the anterior caudate and hippocampus. Psychol Med 2016; 46:2189-2199. [PMID: 27150660 DOI: 10.1017/s0033291716000787] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 02/03/2023]
Abstract
BACKGROUND Learning and memory impairments in older adults with depression are linked to hippocampal atrophy. However, other subcortical regions may also be contributing to these deficits. We aimed to examine whether anterior caudate nucleus volume is significantly reduced in older adults with depression compared to controls; whether anterior caudate volume is associated with performance on tasks of episodic learning and memory, and if so, whether this association is independent of the effects of the hippocampus. METHOD Eighty-four health-seeking participants meeting criteria for lifetime major depressive disorder (mean age = 64.2, s.d. = 9.1 years) and 27 never-depressed control participants (mean age = 63.9, s.d. = 8.0 years) underwent neuropsychological assessment including verbal episodic memory tests [Rey Auditory Verbal Learning Test and Logical Memory (WMS-III)]. Magnetic resonance imaging was conducted, from which subregions of the caudate nucleus were manually demarcated bilaterally and hippocampal volume was calculated using semi-automated methods. RESULTS Depressed subjects had smaller right anterior caudate (RAC) (t = 2.3, p = 0.026) and poorer memory compared to controls (t = 2.5, p < 0.001). For depressed subjects only, smaller RAC was associated with poorer verbal memory (r = 0.3, p = 0.003) and older age (r = -0.46, p < 0.001). Multivariable regression showed that the RAC and hippocampus volume uniquely accounted for 5% and 3% of the variance in memory, respectively (β = 0.25, t = 2.16, p = 0.033; β = 0.19, t = 1.71, p = 0.091). CONCLUSIONS In older people with depression, the anterior caudate nucleus and the hippocampus play independent roles in mediating memory. While future studies examining this structure should include larger sample sizes and adjust for multiple comparisons, these findings support the critical role of the striatum in depression.
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Affiliation(s)
- H K Jayaweera
- Healthy Brain Ageing Program,University of Sydney,NSW,Australia
| | - I B Hickie
- Healthy Brain Ageing Program,University of Sydney,NSW,Australia
| | - S L Duffy
- Healthy Brain Ageing Program,University of Sydney,NSW,Australia
| | - L Mowszowski
- Healthy Brain Ageing Program,University of Sydney,NSW,Australia
| | - L Norrie
- Healthy Brain Ageing Program,University of Sydney,NSW,Australia
| | - J Lagopoulos
- Brain and Mind Centre,University of Sydney,NSW,Australia
| | - S L Naismith
- Healthy Brain Ageing Program,University of Sydney,NSW,Australia
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19
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Schmaal L, Veltman DJ, van Erp TGM, Sämann PG, Frodl T, Jahanshad N, Loehrer E, Tiemeier H, Hofman A, Niessen WJ, Vernooij MW, Ikram MA, Wittfeld K, Grabe HJ, Block A, Hegenscheid K, Völzke H, Hoehn D, Czisch M, Lagopoulos J, Hatton SN, Hickie IB, Goya-Maldonado R, Krämer B, Gruber O, Couvy-Duchesne B, Rentería ME, Strike LT, Mills NT, de Zubicaray GI, McMahon KL, Medland SE, Martin NG, Gillespie NA, Wright MJ, Hall GB, MacQueen GM, Frey EM, Carballedo A, van Velzen LS, van Tol MJ, van der Wee NJ, Veer IM, Walter H, Schnell K, Schramm E, Normann C, Schoepf D, Konrad C, Zurowski B, Nickson T, McIntosh AM, Papmeyer M, Whalley HC, Sussmann JE, Godlewska BR, Cowen PJ, Fischer FH, Rose M, Penninx BWJH, Thompson PM, Hibar DP. Subcortical brain alterations in major depressive disorder: findings from the ENIGMA Major Depressive Disorder working group. Mol Psychiatry 2016; 21:806-12. [PMID: 26122586 PMCID: PMC4879183 DOI: 10.1038/mp.2015.69] [Citation(s) in RCA: 672] [Impact Index Per Article: 84.0] [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: 10/27/2014] [Revised: 03/13/2015] [Accepted: 04/01/2015] [Indexed: 11/09/2022]
Abstract
The pattern of structural brain alterations associated with major depressive disorder (MDD) remains unresolved. This is in part due to small sample sizes of neuroimaging studies resulting in limited statistical power, disease heterogeneity and the complex interactions between clinical characteristics and brain morphology. To address this, we meta-analyzed three-dimensional brain magnetic resonance imaging data from 1728 MDD patients and 7199 controls from 15 research samples worldwide, to identify subcortical brain volumes that robustly discriminate MDD patients from healthy controls. Relative to controls, patients had significantly lower hippocampal volumes (Cohen's d=-0.14, % difference=-1.24). This effect was driven by patients with recurrent MDD (Cohen's d=-0.17, % difference=-1.44), and we detected no differences between first episode patients and controls. Age of onset ⩽21 was associated with a smaller hippocampus (Cohen's d=-0.20, % difference=-1.85) and a trend toward smaller amygdala (Cohen's d=-0.11, % difference=-1.23) and larger lateral ventricles (Cohen's d=0.12, % difference=5.11). Symptom severity at study inclusion was not associated with any regional brain volumes. Sample characteristics such as mean age, proportion of antidepressant users and proportion of remitted patients, and methodological characteristics did not significantly moderate alterations in brain volumes in MDD. Samples with a higher proportion of antipsychotic medication users showed larger caudate volumes in MDD patients compared with controls. This currently largest worldwide effort to identify subcortical brain alterations showed robust smaller hippocampal volumes in MDD patients, moderated by age of onset and first episode versus recurrent episode status.
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Affiliation(s)
- L Schmaal
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands,Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center, P.O. Box 74077, Amsterdam 1070 BB, The Netherlands. E-mail:
| | - D J Veltman
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - T G M van Erp
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - P G Sämann
- Max Planck Institute of Psychiatry, Munich, Germany
| | - T Frodl
- Department of Psychiatry, University of Regensburg, Regensburg, Germany,Department of Psychiatry, University of Dublin, Trinity College, Dublin, Ireland
| | - N Jahanshad
- Imaging Genetics Center, Department of Neurology, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - E Loehrer
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - H Tiemeier
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A Hofman
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - W J Niessen
- Departments of Radiology and Medical Informatics, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - M W Vernooij
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Departments of Radiology and Medical Informatics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M A Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Departments of Radiology and Medical Informatics, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - K Wittfeld
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - H J Grabe
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany,Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany,Helios Hospital Stralsund, Stralsund, Germany
| | - A Block
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - K Hegenscheid
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - H Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - D Hoehn
- Max Planck Institute of Psychiatry, Munich, Germany
| | - M Czisch
- Max Planck Institute of Psychiatry, Munich, Germany
| | - J Lagopoulos
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Camperdown, Australia
| | - S N Hatton
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Camperdown, Australia
| | - I B Hickie
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Camperdown, Australia
| | - R Goya-Maldonado
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany
| | - B Krämer
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany
| | - O Gruber
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany
| | - B Couvy-Duchesne
- NeuroImaging Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia,School of Psychology, University of Queensland, Brisbane, QLD, Australia,Center for Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
| | - M E Rentería
- Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - L T Strike
- NeuroImaging Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia,School of Psychology, University of Queensland, Brisbane, QLD, Australia,Center for Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
| | - N T Mills
- Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia,Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
| | - G I de Zubicaray
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - K L McMahon
- Center for Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
| | - S E Medland
- Quantitative Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - N G Martin
- Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - N A Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - M J Wright
- NeuroImaging Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - G B Hall
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - G M MacQueen
- Department of Psychiatry, Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - E M Frey
- Department of Psychiatry, University of Regensburg, Regensburg, Germany
| | - A Carballedo
- Department of Psychiatry and Institute of Neuroscience, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - L S van Velzen
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - M J van Tol
- University of Groningen, University Medical Center Groningen, NeuroImaging Center, Groningen, The Netherlands
| | - N J van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden University, Leiden, The Netherlands,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - I M Veer
- Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - H Walter
- Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - K Schnell
- Department of General Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - E Schramm
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - C Normann
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - D Schoepf
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - C Konrad
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - B Zurowski
- Center for Integrative Psychiatry, University of Lübeck, Lübeck, Germany
| | - T Nickson
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - A M McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - M Papmeyer
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - H C Whalley
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - J E Sussmann
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - B R Godlewska
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - P J Cowen
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - F H Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité Universitätsmedizin, Berlin, Germany,Institute for Social Medicine, Epidemology and Health Economics, Charité Universitätsmedizin, Berlin, Germany
| | - M Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité Universitätsmedizin, Berlin, Germany,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - B W J H Penninx
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - P M Thompson
- Imaging Genetics Center, Department of Neurology, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - D P Hibar
- Imaging Genetics Center, Department of Neurology, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
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20
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Schmaal L, Veltman DJ, van Erp TGM, Sämann PG, Frodl T, Jahanshad N, Loehrer E, Vernooij MW, Niessen WJ, Ikram MA, Wittfeld K, Grabe HJ, Block A, Hegenscheid K, Hoehn D, Czisch M, Lagopoulos J, Hatton SN, Hickie IB, Goya-Maldonado R, Krämer B, Gruber O, Couvy-Duchesne B, Rentería ME, Strike LT, Wright MJ, de Zubicaray GI, McMahon KL, Medland SE, Gillespie NA, Hall GB, van Velzen LS, van Tol MJ, van der Wee NJ, Veer IM, Walter H, Schramm E, Normann C, Schoepf D, Konrad C, Zurowski B, McIntosh AM, Whalley HC, Sussmann JE, Godlewska BR, Fischer FH, Penninx BWJH, Thompson PM, Hibar DP. Response to Dr Fried & Dr Kievit, and Dr Malhi et al. Mol Psychiatry 2016; 21:726-8. [PMID: 26903270 PMCID: PMC4876636 DOI: 10.1038/mp.2016.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- L Schmaal
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - D J Veltman
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - T G M van Erp
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - P G Sämann
- Max Planck Institute of Psychiatry, Neuroimaging Research Group, Munich, Germany
| | - T Frodl
- Department of Psychiatry and Psychotherapy, Otto von Guericke University of Magdeburg, Magdeburg, Germany
- Department of Psychiatry, Trinity College, University of Dublin, Dublin, Ireland
| | - N Jahanshad
- Imaging Genetics Center, Department of Neurology, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - E Loehrer
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MS, USA
| | - M W Vernooij
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - W J Niessen
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Medical Informatics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - M A Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - K Wittfeld
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - H J Grabe
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- Helios Hospital Stralsund, Stralsund, Germany
| | - A Block
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - K Hegenscheid
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - D Hoehn
- Max Planck Institute of Psychiatry, Neuroimaging Research Group, Munich, Germany
| | - M Czisch
- Max Planck Institute of Psychiatry, Neuroimaging Research Group, Munich, Germany
| | - J Lagopoulos
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - S N Hatton
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - I B Hickie
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - R Goya-Maldonado
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, University Medical Center (UMG), Gerog-August-University, Goettingen, Germany
| | - B Krämer
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, University Medical Center (UMG), Gerog-August-University, Goettingen, Germany
| | - O Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - B Couvy-Duchesne
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- Center for Advanced Imaging, The University of Queensland, Brisbane, QLD, Australia
- Queensland Institute of Medical Research Berghofer, Brisbane, QLD, Australia
| | - M E Rentería
- Department of Genetic Epidemiology, Queensland Institute of Medical Research Berghofer, Brisbane, QLD, Australia
| | - L T Strike
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - M J Wright
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- Center for Advanced Imaging, The University of Queensland, Brisbane, QLD, Australia
| | - G I de Zubicaray
- Faculty of Health, The Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - K L McMahon
- Center for Advanced Imaging, The University of Queensland, Brisbane, QLD, Australia
| | - S E Medland
- Department of Quantitative Genetics, Queensland Institute of Medical Research Berghofer, Brisbane, QLD, Australia
| | - N A Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - G B Hall
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - L S van Velzen
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - M-J van Tol
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Groningen, The Netherlands
| | - N J van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - I M Veer
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - H Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - E Schramm
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
- Psychiatric University Clinic, Basel, Switzerland
| | - C Normann
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - D Schoepf
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - C Konrad
- Department of Psychiatry and Psychotherapy, Agaplesion Diakoniklinikum, Rotenburg, Germany
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - B Zurowski
- Center for Integrative Psychiatry, University of Lübeck, Lübeck, Germany
| | - A M McIntosh
- Division of Psychiatry, University of Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK
| | - H C Whalley
- Division of Psychiatry, University of Edinburgh, UK
| | - J E Sussmann
- Division of Psychiatry, University of Edinburgh, UK
| | - B R Godlewska
- Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - F H Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité Universitätsmedizin, Berlin, Germany
- Institute for Social Medicine, Epidemology and Health Economics, Charité Universitätsmedizin, Berlin, Germany
| | - B W J H Penninx
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - P M Thompson
- Imaging Genetics Center, Department of Neurology, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - D P Hibar
- Imaging Genetics Center, Department of Neurology, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
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21
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Stringer S, Minică CC, Verweij KJH, Mbarek H, Bernard M, Derringer J, van Eijk KR, Isen JD, Loukola A, Maciejewski DF, Mihailov E, van der Most PJ, Sánchez-Mora C, Roos L, Sherva R, Walters R, Ware JJ, Abdellaoui A, Bigdeli TB, Branje SJT, Brown SA, Bruinenberg M, Casas M, Esko T, Garcia-Martinez I, Gordon SD, Harris JM, Hartman CA, Henders AK, Heath AC, Hickie IB, Hickman M, Hopfer CJ, Hottenga JJ, Huizink AC, Irons DE, Kahn RS, Korhonen T, Kranzler HR, Krauter K, van Lier PAC, Lubke GH, Madden PAF, Mägi R, McGue MK, Medland SE, Meeus WHJ, Miller MB, Montgomery GW, Nivard MG, Nolte IM, Oldehinkel AJ, Pausova Z, Qaiser B, Quaye L, Ramos-Quiroga JA, Richarte V, Rose RJ, Shin J, Stallings MC, Stiby AI, Wall TL, Wright MJ, Koot HM, Paus T, Hewitt JK, Ribasés M, Kaprio J, Boks MP, Snieder H, Spector T, Munafò MR, Metspalu A, Gelernter J, Boomsma DI, Iacono WG, Martin NG, Gillespie NA, Derks EM, Vink JM. Genome-wide association study of lifetime cannabis use based on a large meta-analytic sample of 32 330 subjects from the International Cannabis Consortium. Transl Psychiatry 2016; 6:e769. [PMID: 27023175 PMCID: PMC4872459 DOI: 10.1038/tp.2016.36] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/21/2015] [Indexed: 01/15/2023] Open
Abstract
Cannabis is the most widely produced and consumed illicit psychoactive substance worldwide. Occasional cannabis use can progress to frequent use, abuse and dependence with all known adverse physical, psychological and social consequences. Individual differences in cannabis initiation are heritable (40-48%). The International Cannabis Consortium was established with the aim to identify genetic risk variants of cannabis use. We conducted a meta-analysis of genome-wide association data of 13 cohorts (N=32 330) and four replication samples (N=5627). In addition, we performed a gene-based test of association, estimated single-nucleotide polymorphism (SNP)-based heritability and explored the genetic correlation between lifetime cannabis use and cigarette use using LD score regression. No individual SNPs reached genome-wide significance. Nonetheless, gene-based tests identified four genes significantly associated with lifetime cannabis use: NCAM1, CADM2, SCOC and KCNT2. Previous studies reported associations of NCAM1 with cigarette smoking and other substance use, and those of CADM2 with body mass index, processing speed and autism disorders, which are phenotypes previously reported to be associated with cannabis use. Furthermore, we showed that, combined across the genome, all common SNPs explained 13-20% (P<0.001) of the liability of lifetime cannabis use. Finally, there was a strong genetic correlation (rg=0.83; P=1.85 × 10(-8)) between lifetime cannabis use and lifetime cigarette smoking implying that the SNP effect sizes of the two traits are highly correlated. This is the largest meta-analysis of cannabis GWA studies to date, revealing important new insights into the genetic pathways of lifetime cannabis use. Future functional studies should explore the impact of the identified genes on the biological mechanisms of cannabis use.
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Affiliation(s)
- S Stringer
- Department of Complex Trait Genetics, VU Amsterdam, Center for Neurogenomics and Cognitive Research, Amsterdam, The Netherlands
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
| | - C C Minică
- Department of Biological Psychology/Netherlands Twin Register, VU University, Amsterdam, The Netherlands
| | - K J H Verweij
- Department of Biological Psychology/Netherlands Twin Register, VU University, Amsterdam, The Netherlands
- Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
- Department of Developmental Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - H Mbarek
- Department of Biological Psychology/Netherlands Twin Register, VU University, Amsterdam, The Netherlands
| | - M Bernard
- The Hospital for Sick Children Research Institute, Toronto, Canada
| | - J Derringer
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - K R van Eijk
- Department of Human Neurogenetics, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J D Isen
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - A Loukola
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
| | - D F Maciejewski
- Department of Developmental Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - E Mihailov
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - P J van der Most
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C Sánchez-Mora
- Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - L Roos
- Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - R Sherva
- Biomedical Genetics Department, Boston University School of Medicine, Boston, MA, USA
| | - R Walters
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - J J Ware
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - A Abdellaoui
- Department of Biological Psychology/Netherlands Twin Register, VU University, Amsterdam, The Netherlands
| | - T B Bigdeli
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavior Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - S J T Branje
- Research Centre Adolescent Development, Utrecht University, Utrecht, The Netherlands
| | - S A Brown
- Department of Psychology and Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - M Bruinenberg
- The LifeLines Cohort Study, University of Groningen, Groningen, The Netherlands
| | - M Casas
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - T Esko
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - I Garcia-Martinez
- Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - S D Gordon
- Genetic Epidemiology, Molecular Epidemiology and Neurogenetics Laboratories, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - J M Harris
- Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - C A Hartman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A K Henders
- Genetic Epidemiology, Molecular Epidemiology and Neurogenetics Laboratories, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - A C Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - I B Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia
| | - M Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - C J Hopfer
- Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
| | - J J Hottenga
- Department of Biological Psychology/Netherlands Twin Register, VU University, Amsterdam, The Netherlands
| | - A C Huizink
- Department of Developmental Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - D E Irons
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - R S Kahn
- Department of Human Neurogenetics, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T Korhonen
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - H R Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - K Krauter
- Department of Molecular, Cellular and Developmental Biology, University of Colorado Boulder, Boulder, CO, USA
| | - P A C van Lier
- Department of Developmental Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - G H Lubke
- Department of Biological Psychology/Netherlands Twin Register, VU University, Amsterdam, The Netherlands
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - P A F Madden
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - R Mägi
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - M K McGue
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - S E Medland
- Genetic Epidemiology, Molecular Epidemiology and Neurogenetics Laboratories, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - W H J Meeus
- Research Centre Adolescent Development, Utrecht University, Utrecht, The Netherlands
- Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | - M B Miller
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - G W Montgomery
- Genetic Epidemiology, Molecular Epidemiology and Neurogenetics Laboratories, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - M G Nivard
- Department of Biological Psychology/Netherlands Twin Register, VU University, Amsterdam, The Netherlands
| | - I M Nolte
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A J Oldehinkel
- Interdisciplinary Center for Pathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Z Pausova
- The Hospital for Sick Children Research Institute, Toronto, Canada
- Department of Physiology and Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - B Qaiser
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
| | - L Quaye
- Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - J A Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V Richarte
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - R J Rose
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, USA
| | - J Shin
- The Hospital for Sick Children Research Institute, Toronto, Canada
| | - M C Stallings
- Department of Psychology and Neuroscience, Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - A I Stiby
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - T L Wall
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - M J Wright
- Genetic Epidemiology, Molecular Epidemiology and Neurogenetics Laboratories, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - H M Koot
- Department of Developmental Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - T Paus
- Rotman Research Institute, Baycrest, Toronto, ON, Canada
- Department of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
- Center for the Developing Brain, Child Mind Institute, New York, NY, USA
| | - J K Hewitt
- Department of Psychology and Neuroscience, Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - M Ribasés
- Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - J Kaprio
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - M P Boks
- Department of Human Neurogenetics, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Snieder
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T Spector
- Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - M R Munafò
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies and School of Experimental Psychology, University of Bristol, Bristol, UK
| | - A Metspalu
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - J Gelernter
- Department of Psychiatry, Genetics, and Neurobiology, Yale University School of Medicine and VA CT, West Haven, CT, USA
| | - D I Boomsma
- Department of Biological Psychology/Netherlands Twin Register, VU University, Amsterdam, The Netherlands
- Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - W G Iacono
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - N G Martin
- Genetic Epidemiology, Molecular Epidemiology and Neurogenetics Laboratories, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - N A Gillespie
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavior Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Genetic Epidemiology, Molecular Epidemiology and Neurogenetics Laboratories, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - E M Derks
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
| | - J M Vink
- Department of Biological Psychology/Netherlands Twin Register, VU University, Amsterdam, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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22
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Masi A, Lampit A, Glozier N, Hickie IB, Guastella AJ. Predictors of placebo response in pharmacological and dietary supplement treatment trials in pediatric autism spectrum disorder: a meta-analysis. Transl Psychiatry 2015; 5:e640. [PMID: 26393486 PMCID: PMC5068810 DOI: 10.1038/tp.2015.143] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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: 06/12/2015] [Revised: 08/04/2015] [Accepted: 08/09/2015] [Indexed: 12/21/2022] Open
Abstract
Large placebo responses in many clinical trials limit our capacity to identify effective therapeutics. Although it is often assumed that core behaviors in children with autism spectrum disorders (ASDs) rarely remit spontaneously, there has been limited investigation of the size of the placebo response in relevant clinical trials. These trials also rely on caregiver and clinical observer reports as outcome measures. The objectives of this meta-analysis are to identify the pooled placebo response and the predictors of placebo response in pharmacological and dietary supplement treatment trials for participants with a diagnosis of ASD. Randomized controlled trials (RCTs) in pediatric ASD, conducted between 1980 and August 2014, were identified through a search of Medline, EMBASE, Web of Science, Cochrane Database of Systematic Reviews and clinicaltrials.gov. RCTs of at least 14 days duration, comparing the treatment response for an oral active agent and placebo using at least one of the common outcome measures, were included. Analysis of 25 data sets (1315 participants) revealed a moderate effect size for overall placebo response (Hedges' g=0.45, 95% confidence interval (0.34-0.56), P<0.001). Five factors were associated with an increase in response to placebo, namely: an increased response to the active intervention; outcome ratings by clinicians (as compared with caregivers); trials of pharmacological and adjunctive interventions; and trials located in Iran. There is a clear need for the identification of objective measures of change in clinical trials for ASD, such as evaluation of biological activity or markers, and for consideration of how best to deal with placebo response effects in trial design and analyses.
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Affiliation(s)
- A Masi
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
| | - A Lampit
- Regenerative Neuroscience Group, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
| | - N Glozier
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
| | - I B Hickie
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
| | - A J Guastella
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia,Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia. E-mail: adam.guastella.sydney.edu.au
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23
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Masi A, Quintana DS, Glozier N, Lloyd AR, Hickie IB, Guastella AJ. Cytokine aberrations in autism spectrum disorder: a systematic review and meta-analysis. Mol Psychiatry 2015; 20:440-6. [PMID: 24934179 DOI: 10.1038/mp.2014.59] [Citation(s) in RCA: 296] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/01/2014] [Accepted: 04/22/2014] [Indexed: 12/28/2022]
Abstract
The role of non-diagnostic features in the pathophysiology of autism spectrum disorders (ASDs) is unclear. Increasing evidence suggests immune system alterations in ASD may be implicated in the severity of behavioral impairment and other developmental outcomes. The primary objective of this meta-analysis was to investigate if there is a characteristic abnormal cytokine profile in ASD compared with healthy controls (HCs). We identified relevant studies following a search of MEDLINE, EMBASE, PsycINFO, Web of Knowledge and Scopus. A meta-analysis was performed on studies comparing plasma and serum concentrations of cytokines in unmedicated participants with ASD and HCs. Results were reported according to PRISMA statement. Seventeen studies with a total sample size of 743 participants with ASD and 592 HC were included in the analysis. Nineteen cytokines were assessed. Concentrations of interleukin (IL)-1beta (P<0.001), IL-6 (P=0.03), IL-8 (P=0.04), interferon-gamma (P=0.02), eotaxin (P=0.01) and monocyte chemotactic protein-1 (P<0.05) were significantly higher in the participants with ASD compared with the HC group, while concentrations of transforming growth factor-β1 were significantly lower (P<0.001). There were no significant differences between ASD participants and controls for the other 12 cytokines analyzed. The findings of our meta-analysis identified significantly altered concentrations of cytokines in ASD compared to HCs, strengthening evidence of an abnormal cytokine profile in ASD where inflammatory signals dominate.
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Affiliation(s)
- A Masi
- Autism Clinic for Translational Research, Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
| | - D S Quintana
- Autism Clinic for Translational Research, Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
| | - N Glozier
- Autism Clinic for Translational Research, Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
| | - A R Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, University of New South Wales, Kensington, NSW, Australia
| | - I B Hickie
- Autism Clinic for Translational Research, Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
| | - A J Guastella
- Autism Clinic for Translational Research, Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
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Purcell R, Jorm AF, Hickie IB, Yung AR, Pantelis C, Amminger GP, Glozier N, Killackey E, Phillips L, Wood SJ, Mackinnon A, Scott E, Kenyon A, Mundy L, Nichles A, Scaffidi A, Spiliotacopoulos D, Taylor L, Tong JPY, Wiltink S, Zmicerevska N, Hermens D, Guastella A, McGorry PD. Transitions Study of predictors of illness progression in young people with mental ill health: study methodology. Early Interv Psychiatry 2015; 9:38-47. [PMID: 23889887 DOI: 10.1111/eip.12079] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 11/27/2012] [Accepted: 06/09/2013] [Indexed: 11/28/2022]
Abstract
AIM An estimated 75% of mental disorders begin before the age of 24 and approximately 25% of 13-24-year-olds are affected by mental disorders at any one time. To better understand and ideally prevent the onset of post-pubertal mental disorders, a clinical staging model has been proposed that provides a longitudinal perspective of illness development. This heuristic model takes account of the differential effects of both genetic and environmental risk factors, as well as markers relevant to the stage of illness, course or prognosis. The aim of the Transitions Study is to test empirically the assumptions that underpin the clinical staging model. Additionally, it will permit investigation of a range of psychological, social and genetic markers in terms of their capacity to define current clinical stage or predict transition from less severe or enduring to more severe and persistent stages of mental disorder. METHOD This paper describes the study methodology, which involves a longitudinal cohort design implemented within four headspace youth mental health services in Australia. Participants are young people aged 12-25 years who have sought help at headspace and consented to complete a comprehensive assessment of clinical state and psychosocial risk factors. A total of 802 young people (66% female) completed baseline assessments. Annual follow-up assessments have commenced. CONCLUSIONS The results of this study may have implications for the way mental disorders are diagnosed and treated, and progress our understanding of the pathophysiologies of complex mental disorders by identifying genetic or psychosocial markers of illness stage or progression.
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Affiliation(s)
- R Purcell
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria
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Rentería ME, Hansell NK, Strike LT, McMahon KL, de Zubicaray GI, Hickie IB, Thompson PM, Martin NG, Medland SE, Wright MJ. Genetic architecture of subcortical brain regions: common and region-specific genetic contributions. Genes Brain Behav 2014; 13:821-30. [PMID: 25199620 DOI: 10.1111/gbb.12177] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/01/2014] [Accepted: 09/07/2014] [Indexed: 11/27/2022]
Abstract
Understanding the aetiology of patterns of variation within and covariation across brain regions is key to advancing our understanding of the functional, anatomical and developmental networks of the brain. Here we applied multivariate twin modelling and principal component analysis (PCA) to investigate the genetic architecture of the size of seven subcortical regions (caudate nucleus, thalamus, putamen, pallidum, hippocampus, amygdala and nucleus accumbens) in a genetically informative sample of adolescents and young adults (N = 1038; mean age = 21.6 ± 3.2 years; including 148 monozygotic and 202 dizygotic twin pairs) from the Queensland Twin IMaging (QTIM) study. Our multivariate twin modelling identified a common genetic factor that accounts for all the heritability of intracranial volume (0.88) and a substantial proportion of the heritability of all subcortical structures, particularly those of the thalamus (0.71 out of 0.88), pallidum (0.52 out of 0.75) and putamen (0.43 out of 0.89). In addition, we also found substantial region-specific genetic contributions to the heritability of the hippocampus (0.39 out of 0.79), caudate nucleus (0.46 out of 0.78), amygdala (0.25 out of 0.45) and nucleus accumbens (0.28 out of 0.52). This provides further insight into the extent and organization of subcortical genetic architecture, which includes developmental and general growth pathways, as well as the functional specialization and maturation trajectories that influence each subcortical region.
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Affiliation(s)
- M E Rentería
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia; School of Psychology, University of Queensland, St Lucia, QLD, Australia
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Affiliation(s)
- R S C Lee
- Clinical Research Unit, Brain and Mind Research Institute,University of Sydney,Sydney,Australia
| | - I B Hickie
- Clinical Research Unit, Brain and Mind Research Institute,University of Sydney,Sydney,Australia
| | - D F Hermens
- Clinical Research Unit, Brain and Mind Research Institute,University of Sydney,Sydney,Australia
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Affiliation(s)
- I B Hickie
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
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Lee RSC, Redoblado-Hodge MA, Naismith SL, Hermens DF, Porter MA, Hickie IB. Cognitive remediation improves memory and psychosocial functioning in first-episode psychiatric out-patients. Psychol Med 2013; 43:1161-1173. [PMID: 23237010 PMCID: PMC3642720 DOI: 10.1017/s0033291712002127] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/27/2012] [Accepted: 08/13/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cognitive remediation (CR) is an effective treatment for several psychiatric disorders. To date, there have been no published studies examining solely first-episode psychiatric cohorts, despite the merits demonstrated by early intervention CR studies. The current study aimed to assess the effectiveness of CR in patients with a first-episode of either major depression or psychosis. Method Fifty-five patients (mean age = 22.8 years, s.d. = 4.3) were randomly assigned to either CR (n = 28) or treatment as usual (TAU; n = 27). CR involved once-weekly 2-h sessions for a total of 10 weeks. Patients were comprehensively assessed before and after treatment. Thirty-six patients completed the study, and analyses were conducted using an intent-to-treat (ITT) approach with all available data. RESULTS In comparison to TAU, CR was associated with improved immediate learning and memory controlling for diagnosis and baseline differences. Similarly, CR patients demonstrated greater improvements than TAU patients in psychosocial functioning irrespective of diagnosis. Delayed learning and memory improvements mediated the effect of treatment on psychosocial functioning at a marginal level. CONCLUSIONS CR improves memory and psychosocial outcome in first-episode psychiatric out-patients for both depression and psychosis. Memory potentially mediated the functional gains observed. Future studies need to build on the current findings in larger samples using blinded allocation and should incorporate longitudinal follow-up and assessment of potential moderators (e.g. social cognition, self-efficacy) to examine sustainability and the precise mechanisms of CR effects respectively.
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Affiliation(s)
- R S C Lee
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
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Lagopoulos J, Hermens DF, Tobias-Webb J, Duffy S, Naismith SL, White D, Scott E, Hickie IB. In vivo glutathione levels in young persons with bipolar disorder: a magnetic resonance spectroscopy study. J Psychiatr Res 2013; 47:412-7. [PMID: 23312884 DOI: 10.1016/j.jpsychires.2012.12.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/12/2012] [Accepted: 12/14/2012] [Indexed: 01/23/2023]
Abstract
Oxidative stress has recently been reported to assume a significant role in the pathophysiology of bipolar disorder. Several studies have demonstrated the replenishment of glutathione (GSH) diminishes oxidative cellular damage and ameliorates depressive symptoms in this disorder. Whilst the mechanism by which GSH exerts any clinical effect is unknown it has been proposed that it involves the bolstering of antioxidant defences by increasing the bioavailability of GSH, which in turn reverses clinical symptoms of depression. Such a proposal is predicated on the implicit assumption that GSH is diminished in these patients prior to GSH supplementation. However hitherto no study has reported in vivo measures of GSH in patients with bipolar disorder. Using magnetic resonance spectroscopy we obtained in vivo measures of GSH in young people with bipolar disorder and contrasted these with matched healthy controls. Young people with bipolar disorder were found to have no diminution in baseline GSH concentration and, furthermore, no significant correlations were found between GSH and clinical scores of depression or mania. The results do not support the hypothesis that oxidative stress is involved in the primary pathophysiology of bipolar disorder.
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Affiliation(s)
- J Lagopoulos
- Clinical Research Unit, Brain and Mind Research Institute, The University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia.
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Wang L, Hermens DF, Hickie IB, Lagopoulos J. A systematic review of resting-state functional-MRI studies in major depression. J Affect Disord 2012; 142:6-12. [PMID: 22858266 DOI: 10.1016/j.jad.2012.04.013] [Citation(s) in RCA: 241] [Impact Index Per Article: 20.1] [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: 11/07/2011] [Revised: 04/19/2012] [Accepted: 04/20/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND To evaluate the literature pertaining to the use of resting-state functional magnetic resonance imaging (fMRI) in Major Depression (MD). METHODS A search for papers published in English was conducted using MedLine, Embase, PsycINFO, OvidSP, and ScienceDirect with the following words: resting state, depression, MRI, affective, and default-mode. RESULTS The findings from 16 resting-state fMRI studies on MD are tabulated. Some common findings are discussed in further detail. CONCLUSION The use of resting-state fMRI in MD research has yielded a number of significant findings that provide the basis for understanding the pathophysiology of depressive symptoms. Of particular note and deserving of further research are the roles of the cortico-limbic mood regulating circuit (MRC) and the interaction between task-positive and task-negative networks in MD. There is increasing interest in the use of resting-state fMRI in the study of psychiatric conditions, and continued improvement in technique and methodology will prove valuable in future research.
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Affiliation(s)
- L Wang
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, 94 Mallet Street, Camperdown, NSW 2050, Australia
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Hansell NK, Wright MJ, Medland SE, Davenport TA, Wray NR, Martin NG, Hickie IB. Genetic co-morbidity between neuroticism, anxiety/depression and somatic distress in a population sample of adolescent and young adult twins. Psychol Med 2012; 42:1249-1260. [PMID: 22051348 DOI: 10.1017/s0033291711002431] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Genetic studies in adults indicate that genes influencing the personality trait of neuroticism account for substantial genetic variance in anxiety and depression and in somatic health. Here, we examine for the first time the factors underlying the relationship between neuroticism and anxiety/depressive and somatic symptoms during adolescence. METHOD The Somatic and Psychological Health Report (SPHERE) assessed symptoms of anxiety/depression (PSYCH-14) and somatic distress (SOMA-10) in 2459 adolescent and young adult twins [1168 complete pairs (35.4% monozygotic, 53% female)] aged 12-25 years (mean=15.5 ± 2.9). Differences between boys and girls across adolescence were explored for neuroticism, SPHERE-34, and the subscales PSYCH-14 and SOMA-10. Trivariate analyses partitioned sources of covariance in neuroticism, PSYCH-14 and SOMA-10. RESULTS Girls scored higher than boys on both neuroticism and SPHERE, with SPHERE scores for girls increasing slightly over time, whereas scores for boys decreased or were unchanged. Neuroticism and SPHERE scores were strongly influenced by genetic factors [heritability (h(2)) = 40-52%]. A common genetic source influenced neuroticism, PSYCH-14 and SOMA-10 (impacting PSYCH-14 more than SOMA-10). A further genetic source, independent of neuroticism, accounted for covariation specific to PSYCH-14 and SOMA-10. Environmental influences were largely specific to each measure. CONCLUSIONS In adolescence, genetic risk factors indexed by neuroticism contribute substantially to anxiety/depression and, to a lesser extent, perceived somatic health. Additional genetic covariation between anxiety/depressive and somatic symptoms, independent of neuroticism, had greatest influence on somatic distress, where it was equal in influence to the factor shared with neuroticism.
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Affiliation(s)
- N K Hansell
- Genetic Epidemiology, Queensland Institute of Medical Research, Brisbane, Australia
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Naismith SL, Hermens DF, Ip TKC, Bolitho S, Scott E, Rogers NL, Hickie IB. Circadian profiles in young people during the early stages of affective disorder. Transl Psychiatry 2012; 2:e123. [PMID: 22832967 PMCID: PMC3365266 DOI: 10.1038/tp.2012.47] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 04/05/2012] [Accepted: 04/10/2012] [Indexed: 11/20/2022] Open
Abstract
Although disturbances of the circadian system are strongly linked to affective disorders, no known studies have examined melatonin profiles in young people in early stages of illness. In this study, 44 patients with an affective disorder underwent clinical and neuropsychological assessments. They were then rated by a psychiatrist according to a clinical staging model and were categorized as having an 'attenuated syndrome' or an 'established disorder'. During the evening, salivary melatonin was sampled under dim light conditions over an 8-h interval and for each patient, the time of melatonin onset, total area under the curve and phase angle (difference between time of melatonin onset and time of habitual sleep onset) were computed. Results showed that there was no difference in the timing of melatonin onset across illness stages. However, area under the curve analyses showed that those patients with 'established disorders' had markedly reduced levels of melatonin secretion, and shorter phase angles, relative to those with 'attenuated syndromes'. These lower levels, in turn, were related to lower subjective sleepiness, and poorer performance on neuropsychological tests of verbal memory. Overall, these results suggest that for patients with established illness, dysfunction of the circadian system relates clearly to functional features and markers of underlying neurobiological change. Although the interpretation of these results would be greatly enhanced by control data, this work has important implications for the early delivery of chronobiological interventions in young people with affective disorders.
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Affiliation(s)
- S L Naismith
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Camperdown, NSW, Australia.
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Hermens DF, Lagopoulos J, Naismith SL, Tobias-Webb J, Hickie IB. Distinct neurometabolic profiles are evident in the anterior cingulate of young people with major psychiatric disorders. Transl Psychiatry 2012; 2:e110. [PMID: 22832954 PMCID: PMC3365254 DOI: 10.1038/tp.2012.35] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 03/15/2012] [Accepted: 04/05/2012] [Indexed: 12/30/2022] Open
Abstract
Currently, there are no validated neurobiological methods for distinguishing different pathophysiological pathways in young patients presenting in the early phases of major psychiatric disorders. Hence, treatments are delivered simply on the basis of their possible effects on nonspecific symptom constructs such as depression, cognitive change or psychotic symptoms. In this study, the ratios (relative to creatine) of key metabolites (N-acetyl aspartate, myoinositol, glutamate and glutathione) were measured with proton magnetic resonance spectroscopy ((1)H-MRS) within the anterior cingulate cortex of 88 young persons presenting with major mood or psychotic symptoms. We derived empirically (using a cluster analytical technique) three subgroups of subjects on the basis of their patterns of in vivo brain biochemistry. The three subgroups were distinguished (from each other) by all the four metabolites, in particular, glutathione and glutamate. By contrast, the groups could not be distinguished by differences in terms of other demographic, functional or clinical measures. We propose that this (1)H-MRS-based subclassification system could be used as the basis for much more specific tests of novel intervention strategies (notably, antioxidant and glutamatergic therapies) early in the course of major psychiatric disorders.
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Affiliation(s)
- D F Hermens
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Camperdown, New South Wales, Australia.
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Wray NR, Pergadia ML, Blackwood DHR, Penninx BWJH, Gordon SD, Nyholt DR, Ripke S, MacIntyre DJ, McGhee KA, Maclean AW, Smit JH, Hottenga JJ, Willemsen G, Middeldorp CM, de Geus EJC, Lewis CM, McGuffin P, Hickie IB, van den Oord EJCG, Liu JZ, Macgregor S, McEvoy BP, Byrne EM, Medland SE, Statham DJ, Henders AK, Heath AC, Montgomery GW, Martin NG, Boomsma DI, Madden PAF, Sullivan PF. Genome-wide association study of major depressive disorder: new results, meta-analysis, and lessons learned. Mol Psychiatry 2012; 17:36-48. [PMID: 21042317 PMCID: PMC3252611 DOI: 10.1038/mp.2010.109] [Citation(s) in RCA: 324] [Impact Index Per Article: 27.0] [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: 05/16/2010] [Revised: 09/12/2010] [Accepted: 09/27/2010] [Indexed: 12/14/2022]
Abstract
Major depressive disorder (MDD) is a common complex disorder with a partly genetic etiology. We conducted a genome-wide association study of the MDD2000+ sample (2431 cases, 3673 screened controls and >1 M imputed single-nucleotide polymorphisms (SNPs)). No SNPs achieved genome-wide significance either in the MDD2000+ study, or in meta-analysis with two other studies totaling 5763 cases and 6901 controls. These results imply that common variants of intermediate or large effect do not have main effects in the genetic architecture of MDD. Suggestive but notable results were (a) gene-based tests suggesting roles for adenylate cyclase 3 (ADCY3, 2p23.3) and galanin (GAL, 11q13.3); published functional evidence relates both of these to MDD and serotonergic signaling; (b) support for the bipolar disorder risk variant SNP rs1006737 in CACNA1C (P=0.020, odds ratio=1.10); and (c) lack of support for rs2251219, a SNP identified in a meta-analysis of affective disorder studies (P=0.51). We estimate that sample sizes 1.8- to 2.4-fold greater are needed for association studies of MDD compared with those for schizophrenia to detect variants that explain the same proportion of total variance in liability. Larger study cohorts characterized for genetic and environmental risk factors accumulated prospectively are likely to be needed to dissect more fully the etiology of MDD.
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Affiliation(s)
- N R Wray
- Genetic Epidemiology, Molecular Epidemiology, Psychiatric Genetics and Queensland Statistical Genetics Laboratories, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - M L Pergadia
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - D H R Blackwood
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - B W J H Penninx
- Department of Biological Psychology and Medical Center, VU University, Amsterdam, The Netherlands
| | - S D Gordon
- Genetic Epidemiology, Molecular Epidemiology, Psychiatric Genetics and Queensland Statistical Genetics Laboratories, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - D R Nyholt
- Genetic Epidemiology, Molecular Epidemiology, Psychiatric Genetics and Queensland Statistical Genetics Laboratories, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - S Ripke
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - D J MacIntyre
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - K A McGhee
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - A W Maclean
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - J H Smit
- Department of Biological Psychology and Medical Center, VU University, Amsterdam, The Netherlands
| | - J J Hottenga
- Department of Biological Psychology and Medical Center, VU University, Amsterdam, The Netherlands
| | - G Willemsen
- Department of Biological Psychology and Medical Center, VU University, Amsterdam, The Netherlands
| | - C M Middeldorp
- Department of Biological Psychology and Medical Center, VU University, Amsterdam, The Netherlands
| | - E J C de Geus
- Department of Biological Psychology and Medical Center, VU University, Amsterdam, The Netherlands
| | - C M Lewis
- Department of Medical and Molecular Genetics, King's College London, MRC SGDP Centre, Institute of Psychiatry, London, UK
| | - P McGuffin
- Department of Medical and Molecular Genetics, King's College London, MRC SGDP Centre, Institute of Psychiatry, London, UK
| | - I B Hickie
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, NSW, Australia
| | - E J C G van den Oord
- Center for Biomarker Research and Personalized Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - J Z Liu
- Genetic Epidemiology, Molecular Epidemiology, Psychiatric Genetics and Queensland Statistical Genetics Laboratories, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - S Macgregor
- Genetic Epidemiology, Molecular Epidemiology, Psychiatric Genetics and Queensland Statistical Genetics Laboratories, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - B P McEvoy
- Genetic Epidemiology, Molecular Epidemiology, Psychiatric Genetics and Queensland Statistical Genetics Laboratories, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - E M Byrne
- Genetic Epidemiology, Molecular Epidemiology, Psychiatric Genetics and Queensland Statistical Genetics Laboratories, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - S E Medland
- Genetic Epidemiology, Molecular Epidemiology, Psychiatric Genetics and Queensland Statistical Genetics Laboratories, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - D J Statham
- Genetic Epidemiology, Molecular Epidemiology, Psychiatric Genetics and Queensland Statistical Genetics Laboratories, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - A K Henders
- Genetic Epidemiology, Molecular Epidemiology, Psychiatric Genetics and Queensland Statistical Genetics Laboratories, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - A C Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - G W Montgomery
- Genetic Epidemiology, Molecular Epidemiology, Psychiatric Genetics and Queensland Statistical Genetics Laboratories, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - N G Martin
- Genetic Epidemiology, Molecular Epidemiology, Psychiatric Genetics and Queensland Statistical Genetics Laboratories, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - D I Boomsma
- Department of Biological Psychology and Medical Center, VU University, Amsterdam, The Netherlands
| | - P A F Madden
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - P F Sullivan
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
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Hickie IB, Naismith SL, Norrie LM, Scott EM. Managing depression across the life cycle: new strategies for clinicians and their patients. Intern Med J 2009; 39:720-7. [DOI: 10.1111/j.1445-5994.2009.02016.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hetrick SE, Parker AG, Hickie IB, Purcell R, Yung AR, McGorry PD. Early identification and intervention in depressive disorders: towards a clinical staging model. Psychother Psychosom 2008; 77:263-70. [PMID: 18560251 DOI: 10.1159/000140085] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Depressive disorders are common and associated risks include the onset of secondary disorders, substance use disorders, impairment in social and occupational functioning, and an increase in suicidality. As the onset often occurs in youth, there is a clear imperative for early identification and intervention to ameliorate, if not prevent, associated distress. METHODS An extensive search of relevant databases and an ancestry search was undertaken. RESULTS There is a limited but growing body of literature on this topic that is discussed in relation to a clinical staging model, which may prove to be a useful framework for identifying where an individual lies along the continuum of the course of a depressive illness thus allowing interventions to be matched for that stage. The identification of a subsyndromal and prodromal stage of depressive disorders provides early intervention opportunities. CONCLUSIONS It is argued that a clinical staging heuristic may increase the number of those treated early, which may in turn delay or prevent onset, reduce severity, or prevent progression in the course of depressive disorders.
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Affiliation(s)
- S E Hetrick
- ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia.
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Pirkis JE, Blashki GA, Murphy AW, Hickie IB, Ciechomski L. The contribution of general practice based research to the development of national policy: case studies from Ireland and Australia. Aust New Zealand Health Policy 2006; 3:4. [PMID: 16686961 PMCID: PMC1475588 DOI: 10.1186/1743-8462-3-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Accepted: 05/11/2006] [Indexed: 11/15/2022]
Abstract
Background This paper aims to describe the influence of general practice based research on the development of two specific policy initiatives, namely the Heartwatch Programme in Ireland and the Better Outcomes in Mental Health Care (BOiMHC) program in Australia. A case study approach was used to explore the extent to which relevant general practice based research shaped these initiatives. Results In both case studies, a range of factors beyond general practice based research shaped the initiative in question, including political will, the involvement of stakeholders (including key opinion leaders), and the historical context. Nonetheless, the research played an important role, and was not merely put to 'symbolic use' to support a position that had already been reached independently. Rather, both case studies provide examples of 'instrumental use': in the case of Heartwatch, the research was considered early in the piece; in the case of the BOiMHC program, it had a specific impact on the detail of the components of the initiative. Conclusion General practice based research can influence policy-making and planning processes by strengthening the foundation of evidence upon which they draw. This influence will not occur in a vacuum, however, and general practice researchers can maximise the likelihood of their work being 'picked up' in policy if they consider the principles underpinning knowledge transfer.
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Affiliation(s)
- JE Pirkis
- Program Evaluation Unit, School of Population Health, The University of Melbourne, Melbourne, Australia
| | - GA Blashki
- Program Evaluation Unit, School of Population Health, The University of Melbourne, Melbourne, Australia
- Health Services Research Department, Institute of Psychiatry, King's College London, London, UK
| | - AW Murphy
- Department of General Practice, National University of Ireland, Galway, Ireland
| | - IB Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - L Ciechomski
- Department of General Practice, School of Primary Health Care, Monash University, Melbourne, Australia
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Thewes B, Meiser B, Hickie IB. Psychometric properties of the Impact of Event Scale amongst women at increased risk for hereditary breast cancer. Psychooncology 2001; 10:459-68. [PMID: 11747058 DOI: 10.1002/pon.533] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The Impact of Event Scale (IES; Horowitz MJ, Wilner N, Alvarez W. 1979. Psychosom Med 41: 209-218) has been widely used in the psycho-oncology literature as a measure of cancer-related anxiety. More recently, the IES has been applied to the assessment of breast cancer-related anxiety amongst women who are at increased risk of developing hereditary breast cancer. Despite its widespread use, no studies to date have described the validity of the IES amongst these women. The present study is a replication of reliability analyses and exploration of the factor structure and validity of the IES amongst a sample of 480 female hereditary breast cancer clinic patients. Results suggest good internal consistency (Cronbach's alpha=0.84-0.91), and satisfactory test-retest reliability (IES-Total r=0.80). The IES was found to have good face validity and be an acceptable instrument to women at increased risk of breast cancer. The two-factor (intrusion and avoidance) structure originally reported (Horowitz et al. 1979; Zilberg NJ, Weiss DS, Horowitz MJ. 1982. J Consult Clin Psychol 50: 407-414) was replicated by factor analysis in the present study. Analysis of correlation coefficients between the IES, breast cancer-related events and attitudes and other standardized measures of distress and general somatic concern, provide some preliminary support for the concurrent and discriminative validity of the IES amongst women at increased risk of developing hereditary breast cancer.
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Affiliation(s)
- B Thewes
- Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, Australia.
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Davenport TA, Hickie IB, Naismith SL, Hadzi-Pavloviv D, Scott EM. Variability and predictors of mental disorder rates and medical practitioner responses across Australian general practices. Med J Aust 2001; 175:S37-41. [PMID: 11556434 DOI: 10.5694/j.1326-5377.2001.tb143788.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine the variation in prevalence of common mental disorders and general practitioner (GP) responses across Australian general practices, and to identify practice characteristics that predict these rates. DESIGN Cross-sectional national audit of general practices throughout Australia in 1998-1999. PARTICIPANTS 46515 ambulatory care patients attending 386 GPs. MAIN OUTCOME MEASURES Practice-based prevalence of mental disorders (based on patient-reported symptoms) and GP-reported rates of psychological diagnoses and treatment (median and range, excluding the upper and lower 10% of practices); practice characteristics (patient, doctor and organisational) that predict prevalences and rates, determined by multiple regression analysis. RESULTS Even after omitting the upper and lower 10% of practices, there were large variations between practices in prevalence of common mental disorders (range, 39% to 59% of patients; median, 48%), and substance misuse (range, 3%-13%; median, 7%). There were also large variations between practices in rates at which GPs made psychological diagnoses in each practice (range, 12%-51%; median, 27%), judged patients to be at risk to self or others (range, 6%-54%; median, 23%), provided psychological treatments (range, 8%-41%; median, 22%) and referred patients to specialist services (range, 1%-10%; median, 4%). Practice-based rates of disorders and GP responses were predicted not only by sociodemographic characteristics of patients in each practice (eg, mean age or proportion of unemployed people), but also by doctor characteristics (eg, age and sex) and practice organisation characteristics (eg, urban versus regional or rural location). CONCLUSION We identified patient, GP and practice characteristics that predict rates of mental disorder and treatments provided. These could be used to guide mental health service reform in general practice and assist with targeting relevant education and practice support programs.
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Affiliation(s)
- T A Davenport
- School of Psychiatry, University of New South Wales, Sydney
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Hickie IB, Davenport TA, Hadzi-Pavlovic D, Koschera A, Naismith SL, Scott EM, Wilhelm KA. Development of a simple screening tool for common mental disorders in general practice. Med J Aust 2001; 175:S10-7. [PMID: 11556430 DOI: 10.5694/j.1326-5377.2001.tb143784.x] [Citation(s) in RCA: 64] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To develop and validate a self-report screening tool for common mental disorders. DESIGN AND SETTING Sequential development and validation studies in three cohorts of patients in general practice and one cohort of patients in a specialist psychiatry clinic. PARTICIPANTS 1585 patients in general practice examined cross-sectionally and longitudinally; 46515 patients attending 386 general practitioners nationwide; 364 patients participating in a longitudinal study of psychiatric disorders in general practice; and 522 patients attending a specialist psychiatry clinic. MAIN OUTCOME MEASURES Performance of the 12 items from the 34-item SPHERE questionnaire against DSM-III-R and DSM-IV diagnoses of psychiatric disorder, self-reported Brief Disability Questionnaire findings, GPs' ratings of patients' needs for psychological care and degree of risk resulting from mental disorder, and patients' and GPs' reports of reasons for presentation. RESULTS Six somatic and six psychological questions identify two levels (and three types) of mental disorder: patients reporting both characteristic psychological and somatic symptoms (Level 1, Type 1), and patients reporting either psychological symptoms (Level 2, Type 2) or somatic symptoms (Level 2, Type 3). This classification system predicts disability ratings (Level 1, 8.2 "days out of role in the last month" and Level 2, 4.1 and 5.4 "days out of role in the last month" for Types 2 and 3, respectively), rates of lifetime psychiatric diagnoses (Level 1, 63% and Level 2, 59% and 48%, respectively), both patients' and GPs' report of reasons for presentation, and doctors' ratings of risk as a result of mental disorder. There are important and differing sociodemographic correlates for the three types of mental disorders. CONCLUSION A classification system based on the 12 items from the 34-item SPHERE questionnaire can be used to identify common mental disorders. This system has acceptable validity and reliability, and is suited specifically for general practice settings.
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Affiliation(s)
- I B Hickie
- School of Psychiatry, University of New South Wales, Sydney.
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Hickie IB, Davenport TA, Scott EM, Hadzi-Pavlovic D, Naismith SL, Koschera A. Unmet need for recognition of common mental disorders in Australian general practice. Med J Aust 2001; 175:S18-24. [PMID: 11556431 DOI: 10.5694/j.1326-5377.2001.tb143785.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the rate and predictors of unmet need for recognition of common mental disorders in Australian general practice. DESIGN AND SETTING Cross-sectional national audit of general practices throughout Australia in 1998-1999. PARTICIPANTS 46 515 ambulatory care patients attending 386 GPs. SCREENING TOOLS Prevalence of common mental disorders--12 items from the 34-item SPHERE self-report questionnaire and associated classification system; prevalence of recognition of mental disorders by GPs--GPs reporting whether patients had depression, anxiety, mixed depression/anxiety, somatoform, or other psychological disorder; predictors of unmet need for recognition of mental disorders--self-report questions about demography for patients and GPs, and about practice organisation for GPs. MAIN OUTCOME MEASURES Reported recognition of psychological disorders by GPs; actual prevalence of disorders; and patient, GP and practice characteristics predicting the failure to recognise disorders. RESULTS GPs did not recognise mental disorder in 56% (11922/21210) of patients. These comprised 46% (5134/11060) of patients in the higher level of mental disorders, and (in the second level of disorders) 58% (2906/5036) of patients with predominantly psychological symptoms, and 76% (3882/5114) of those with predominantly somatic symptoms. Patients more likely to have their need for psychological assessment met had the following characteristics: middle-aged (odds ratio [OR], 1.76; 95% CI, 1.59-1.96), female (OR, 1.19; 95% CI, 1.12-1.27), Australian-born (OR, 1.16; 95% CI, 1.08-1.24), unemployed (OR, 1.75; 95% CI, 1.64-1.89), single (OR, 1.52; 95% CI, 1.41-1.61), presenting with mainly psychological symptoms (OR, 3.54; 95% CI, 3.28-3.81), and presenting for psychological reasons (OR, 4.20; 95% CI, 3.02-5.82). Characteristics of doctors associated with meeting patients' need for assessment were being aged over 35 years (OR, 1.51; 95% CI, 1.09-2.08), having an interest in mental health (OR, 1.27; 95% CI, 1.15-1.41), having had previous mental health training (OR, 1.29; 95% CI, 1.15-1.45), being in part-time practice (OR, 1.23; 95% CI, 1.09-1.39), seeing fewer than 100 patients per week (OR, 1.29; 95% CI, 1.13-1.47), working in practices with fewer than 2000 patients (OR, 1.28; 95% CI, 1.13-1.45) and working in regional centres (OR, 1.16; 95% CI, 1.05-1.28). CONCLUSION Unmet need for recognition of common mental disorders remains high. Predictors of unmet need include a somatic symptom profile and practitioner and organisational characteristics which impede the provision of high quality mental health services.
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Affiliation(s)
- I B Hickie
- School of Psychiatry, University of New South Wales, Sydney.
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Affiliation(s)
- I B Hickie
- School of Psychiatry, University of New South Wales, Sydney
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Abstract
OBJECTIVE To determine the rates and predictors of treatments for patients with common mental disorders in Australian general practice. DESIGN AND SETTING Cross-sectional national audit of general practices throughout Australia in 1998-1999. PARTICIPANTS 46 515 ambulatory care patients attending 386 GPs. SCREENING TOOLS Prevalence of common mental disorders--12 items from the 34-item SPHERE self-report questionnaire and associated classification system; pharmacological and non-pharmacological treatment provided, as reported by the GPs--questions relating to treatments provided; predictors of treatments--self-report questions about demography for patients and GPs, and about practice organisation for GPs. MAIN OUTCOME MEASURES GPs' reported provision of pharmacological and nonpharmacological treatments; and patient, GP and practice characteristics predicting treatment provision. RESULTS There were complete data on treatment for 39 983 patients. 27% (10752) of all patients received some form of intervention; 21% (8304) received non-pharmacological and 12% (4765) received pharmacological treatments. Non-pharmacological treatments were mostly non-specific counselling and support (83%; 6892/8304). Among the 10303 patients with the most severe level of psychological disorders, only 50% (5152) received any intervention (38% [3872] received non-pharmacological and 27% [2766] pharmacological treatments). Evidence-based treatments were provided to only 12% (4961) of all patients (and only 27% [2802] of the 10303 with the most severe disorders). Although the newer antidepressant agents were commonly prescribed, older medications (mainly tricyclic antidepressants) were prescribed to older (OR, 1.29; 95% CI, 1.07-1.56), less educated (OR, 1.41; 95% CI, 1.12-1.79) and female (OR, 1.44; 95% CI, 1.23-1.70) patients. Among the 8304 patients receiving non-pharmacological treatments, specific (evidence-based) treatments were provided to only 17% (1412); these patients were typically middle-aged (OR, 2.94; 95% CI, 2.32-3.73) and the providing GPs were typically not in full-time practice (OR, 3.34; 95% CI, 2.56-4.17). CONCLUSION Practitioners largely provide non-specific, non-pharmacological interventions for patients with common mental disorders. Even among those with the most severe disorders, only a minority receive pharmacological or specific evidence-based non-pharmacological treatments.
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Affiliation(s)
- I B Hickie
- School of Psychiatry, University of New South Wales, Sydney.
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Hickie IB, Koschera A, Davenport TA, Naismith SL, Scott EM. Comorbidity of common mental disorders and alcohol or other substance misuse in Australian general practice. Med J Aust 2001; 175:S31-6. [PMID: 11556433 DOI: 10.5694/j.1326-5377.2001.tb143787.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine in patients attending general practice 1) the extent of comorbidity of mental disorders and alcohol or other substance misuse, and consequent disability; and 2) GPs' diagnosis and management of patients with comorbidity. DESIGN AND SETTING Cross-sectional national audit of general practices throughout Australia in 1998-1999. PARTICIPANTS 46 515 ambulatory care patients attending 386 GPs. SCREENING TOOLS Prevalence of common mental disorders--12 items from the 34-item SPHERE self-report questionnaire and associated classification system; prevalence of alcohol or other substance misuse--two self-report screening questions, defining "probable" misuse (a positive response to both questions) and "possible" misuse (a positive response to one of the questions); disability--four items from the Brief Disability Questionnaire, and self-reported "days out of role" and "days in bed" in the past month; and rates of psychological diagnosis, treatment and referral by GPs, and GPs' rating of patients' psychological risk. MAIN OUTCOME MEASURES Comorbidity of mental disorders and alcohol or other substance misuse; disability; and correlation with GPs' diagnosis and management. RESULTS The screening questions revealed possible alcohol or other substance misuse in 11% of patients (5171/46515), and probable misuse in an additional 8% of patients (3593/46515). Comorbidity of mental disorders and substance misuse occurred in 12% (5672/46515) of patients. Patients with comorbidity (compared with those with alcohol or other substance misuse alone) were: more disabled--mean "days out of role in the last month", 8.4 (95% CI, 7.7-9.1) v 3.6 (95% CI, 2.9-4.3); at greater psychological risk (as rated by GPs)--22% v 7%, respectively; more frequently given psychological diagnoses by GPs--51% v 21%; more frequently treated for a psychological condition by GPs--47% v 17%; and more frequently referred to mental health specialists by GPs--9% v 2%. CONCLUSION Comorbidity of mental disorders and alcohol or other substance misuse is common in patients attending general practice, and results in considerable disability. Such patients receive inadequate attention (diagnosis and management) from GPs. GPs identifying one of these two types of behaviour disorder in a patient should ascertain whether the other type is also present.
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Affiliation(s)
- I B Hickie
- School of Psychiatry, University of New South Wales, Sydney.
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Hickie IB, Davenport TA, Naismith SL, Scott EM. Conclusions about the assessment and management of common mental disorders in Australian general practice. SPHERE National Secretariat. Med J Aust 2001; 175:S52-5. [PMID: 11556438 DOI: 10.5694/j.1326-5377.2001.tb143791.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- I B Hickie
- School of Psychiatry, University of New South Wales, Sydney.
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Naismith SL, Hickie IB, Scott EM, Davenport TA. Effects of mental health training and clinical audit on general practitioners' management of common mental disorders. Med J Aust 2001; 175:S42-7. [PMID: 11556436 DOI: 10.5694/j.1326-5377.2001.tb143789.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effects of a seminar-based training program and clinical practice audit on general practitioners' (GPs') knowledge and management of common mental disorders. DESIGN Survey of GPs' knowledge before and after training, and clinical practice audit and re-audit after feedback. PARTICIPANTS AND SETTING GP volunteers from around Australia in 1998-1999: 1008 completed the pre-training test, 190 the post-training test, 386 the first audit (33235 patients), and 157 of these the re-audit (13280 patients), with 57 undertaking both audit and training. INTERVENTIONS Four-seminar, 12-hour training program focused on improving GPs' capacity to identify and manage patients with depression and anxiety; practice audit with patient- and practice-based feedback on diagnosis and treatment of common mental disorders. MAIN OUTCOME MEASURES Scores on pre- and post-training knowledge tests; self-rated improvements in confidence in managing patients with mental disorders after training; rates of psychological diagnoses and treatment by GPs on first audit and re-audit. RESULTS GPs' knowledge of pharmacological treatments and clinical management improved after the training program (P<0.001), and 97% of GPs reported increased confidence in their management skills. GPs who undertook training had higher diagnosis rates for common mental disorders in the first audit than those who did not undertake training (36% versus 29%; P<0.001), and their diagnosis rates increased over time (36% to 39%; P<0.01), while those of GPs who did not undertake training were unchanged. Similarly, GPs who undertook training provided more mental health treatments than those who did not (30% versus 27% in the first audit [P<0.001], and 31% versus 24% at reaudit [P<0.001]). They also place greater emphasis on use of nonpharmacological treatments (24% versus 21% at first audit [P<0.001], and 25% versus 19% at re-audit [P<0.001]). CONCLUSION Clinical audits may heighten awareness of mental disorders, but, on their own, they do not improve mental health practice. A relatively brief but skills-based training program may contribute to better management of patients with common mental disorders by increasing GPs' confidence and competence.
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Affiliation(s)
- S L Naismith
- School of Psychiatry, University of New South Wales, Sydney
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Hickie IB. Choosing antidepressant drugs in general practice. Aust Fam Physician 2001; 30:663-7. [PMID: 11558200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND General practitioners provide most of the mental health care to patients with common forms of anxiety or depression. There is a range of mental health therapies available, both pharmacological and nonpharmacological. In order to individualize treatment, practitioners need to consider the range of choices now available. OBJECTIVE To outline reasons for choosing between different antidepressant compounds in different clinical settings. DISCUSSION Newer antidepressant drugs, especially the selective serotonin reuptake inhibitors, now account for most of the antidepressant prescriptions written. Practitioners may find it useful to differentiate the severity and types of depressive disorders that patients commonly present with. Such differentiation may assist in the selection of appropriate second line choices or alternative first line choices in some situations.
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Affiliation(s)
- I B Hickie
- School of Psychiatry, University of New South Wales.
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Abstract
Risk factors to prolonged fatigue syndromes (PFS) are controversial. Pre-morbid and/or current psychiatric disturbance, and/or disturbed cell-mediated immunity (CMI), have been proposed as etiologic factors. Self-report measures of fatigue and psychologic distress and three in vitro measures of CMI were collected from 124 twin pairs. Crosstwin-crosstrait correlations were estimated for the complete monozygotic (MZ; 79 pairs) and dizygotic (DZ; 45 pairs) twin groups. Multivariate genetic and environmental models were fitted to explore the patterns of covariation between etiologic factors. For fatigue, the MZ correlation was more than double the DZ correlation (0.49 versus 0.16) indicating strong genetic control of familial aggregation. By contrast, for in vitro immune activation measures MZ and DZ correlations were similar (0.49-0.69 versus 0.42-0.53) indicating the etiologic role of shared environments. As small univariate associations were noted between prolonged fatigue and the in vitro immune measures (r = -0.07 to -0.12), multivariate models were fitted. Relevant etiologic factors included: a common genetic factor accounting for 48% of the variance in fatigue which also accounted for 4%, 6% and 8% reductions in immune activation; specific genetic factors for each of the in vitro immune measures; a shared environment factor influencing the three immune activation measures; and, most interestingly, unique environmental influences which increased fatigue but also increased markers of immune activation. PFS that are associated with in vitro measures of immune activation are most likely to be the consequence of current environmental rather than genetic factors. Such environmental factors could include physical agents such as infection and/or psychologic stress.
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Affiliation(s)
- I B Hickie
- School of Psychiatry, University of New South Wales, Sydney, Australia.
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Abstract
The past 50 years of medicine have been dominated by revolutions in biological sciences and clinical therapeutics. No less dramatic have been changes in our healthcare systems, with medical specialisation playing a leading role. The middle of the century saw the rapid development of the teaching hospital as the centre of professional education, collegiate identity, medical specialisation and clinical research. By contrast, the past 20 years have seen dramatic shifts in response to the demands of a more diverse community.
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Affiliation(s)
- J B Hickie
- University of New South Wales, Sydney, NSW.
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Hadzi-Pavlovic D, Hickie IB, Wilson AJ, Davenport TA, Lloyd AR, Wakefield D. Screening for prolonged fatigue syndromes: validation of the SOFA scale. Soc Psychiatry Psychiatr Epidemiol 2000; 35:471-9. [PMID: 11127722 DOI: 10.1007/s001270050266] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The identification of syndromes characterised by persistent and disabling mental and/or physical fatigue is of renewed interest in psychiatric epidemiology. This report details the development of two specific instruments: the SOFA/CFS for identification of patients with chronic fatigue syndrome (CFS) in specialist clinics and the SOFA/GP for identification of prolonged fatigue syndromes (PFS) in community and primary care settings. METHODS Patients with clinical diagnoses of CFS (n = 770) and consecutive attenders at primary care (n = 1593) completed various self-report questionnaires to assess severity of current fatigue-related symptoms and other common somatic and psychological symptoms. Quality receiver operating characteristic curves were used to derive appropriate cut-off scores for each of the instruments. Comparisons with other self-report measures of anxiety, depression and somatic distress are noted. Various multivariate statistical modelling techniques [latent class analysis (LCA), longitudinal LCA] were utilised to define the key features of PFS and describe its longitudinal characteristics. RESULTS The SOFA/CFS instrument performs well in specialist samples likely to contain a high proportion of patients with CFS disorders. Cut-off scores of either 1/2 or 2/3 can be used, depending on whether the investigators wish to preferentially emphasise false-negatives or false-positives. Patients from these settings can be thought of as consisting not only of those with a large number of unexplained medical symptoms, but also those with rather specific musculoskeletal and pain syndromes. The SOFA/GP instrument has potential cut-off scores of 1/2 or 2/3, with the latter preferred as it actively excludes all non-PFS cases (sensitivity = 81%, specificity = 100%). Patients with these syndromes in the community represent broader sets of underlying classes, with the emergence of not only musculoskeletal and multisymptomatic disorders, but also persons characterised by significant cognitive subjective impairment. Twelve-month longitudinal analyses of the primary care sample indicated that the underlying class structure was preserved over time. Comparisons with other measures of psychopathology indicated the relative independence of these constructs from conventional notions of anxiety and depression. CONCLUSIONS The SOFA/GP instrument (which is considerably modified from the SOFA/CFS in terms of anchor points for severity and chronicity) is preferred for screening in primary care and community settings. Patients with PFS and CFS present a range of psychopathology that differs in its underlying structure, cross-sectionally and longitudinally, from coventional notions of anxiety and depression.
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Affiliation(s)
- D Hadzi-Pavlovic
- Mood Disorders Unit, Prince of Wales Hospital, Randwick, NSW, Australia.
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