1
|
Millgate E, Kravariti E, Egerton A, Howes OD, Murray RM, Kassoumeri L, Donocik J, Lewis S, Drake R, Lawrie S, Murphy A, Collier T, Lees J, Stockton-Powdrell C, Walters J, Deakin B, MacCabe J. Cross-sectional study comparing cognitive function in treatment responsive versus treatment non-responsive schizophrenia: evidence from the STRATA study. BMJ Open 2021; 11:e054160. [PMID: 34824121 PMCID: PMC8627394 DOI: 10.1136/bmjopen-2021-054160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/04/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND 70%-84% of individuals with antipsychotic treatment resistance show non-response from the first episode. Emerging cross-sectional evidence comparing cognitive profiles in treatment resistant schizophrenia to treatment-responsive schizophrenia has indicated that verbal memory and language functions may be more impaired in treatment resistance. We sought to confirm this finding by comparing cognitive performance between antipsychotic non-responders (NR) and responders (R) using a brief cognitive battery for schizophrenia, with a primary focus on verbal tasks compared against other measures of cognition. DESIGN Cross-sectional. SETTING This cross-sectional study recruited antipsychotic treatment R and antipsychotic NR across four UK sites. Cognitive performance was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS). PARTICIPANTS One hundred and six participants aged 18-65 years with a diagnosis of schizophrenia or schizophreniform disorder were recruited according to their treatment response, with 52 NR and 54 R cases. OUTCOMES Composite and subscale scores of cognitive performance on the BACS. Group (R vs NR) differences in cognitive scores were investigated using univariable and multivariable linear regressions adjusted for age, gender and illness duration. RESULTS Univariable regression models observed no significant differences between R and NR groups on any measure of the BACS, including verbal memory (ß=-1.99, 95% CI -6.63 to 2.66, p=0.398) and verbal fluency (ß=1.23, 95% CI -2.46 to 4.91, p=0.510). This pattern of findings was consistent in multivariable models. CONCLUSIONS The lack of group difference in cognition in our sample is likely due to a lack of clinical distinction between our groups. Future investigations should aim to use machine learning methods using longitudinal first episode samples to identify responder subtypes within schizophrenia, and how cognitive factors may interact within this. TRAIL REGISTRATION NUMBER REC: 15/LO/0038.
Collapse
Affiliation(s)
- Edward Millgate
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Eugenia Kravariti
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Alice Egerton
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Oliver D Howes
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Laura Kassoumeri
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Jacek Donocik
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Shôn Lewis
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard Drake
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Stephen Lawrie
- Psychiatry, The University of Edinburgh Division of Psychiatry, Edinburgh, UK
| | - Anna Murphy
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Tracy Collier
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Jane Lees
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - James Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Bill Deakin
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - James MacCabe
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| |
Collapse
|
2
|
Jauhar S, Lai S, Bonoldi I, Salazar de Pablo G, di Forti M, Alameda L, Donocik J, Iacoponi E, Spencer T, Haege B, McLaughlan D, Taylor D, Young AH, Thornicroft G, Gaughran F, MacCabe JH, Murray RM, McGuire P, Fusar-Poli P. Early intervention in psychosis during the COVID-19 pandemic: Maudsley recommendations. Eur Neuropsychopharmacol 2021; 47:130-135. [PMID: 33642195 PMCID: PMC8640608 DOI: 10.1016/j.euroneuro.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 12/12/2022]
Affiliation(s)
- S Jauhar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; COAST service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - S Lai
- COAST service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - I Bonoldi
- TREAT service, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom
| | - G Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - M di Forti
- LEO service, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - L Alameda
- LEO service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - J Donocik
- LEIS service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - E Iacoponi
- LEO service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - T Spencer
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; OASIS service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - B Haege
- STEP service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - D McLaughlan
- LEO Ward, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - D Taylor
- Pharmacy and Pathology, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - A H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - G Thornicroft
- LEO service, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - F Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; National Psychosis Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - J H MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; National Psychosis Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - R M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom
| | - P McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom
| | - P Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; OASIS service, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| |
Collapse
|
3
|
Egerton A, Murphy A, Donocik J, Anton A, Barker GJ, Collier T, Deakin B, Drake R, Eliasson E, Emsley R, Gregory CJ, Griffiths K, Kapur S, Kassoumeri L, Knight L, Lambe EJB, Lawrie SM, Lees J, Lewis S, Lythgoe DJ, Matthews J, McGuire P, McNamee L, Semple S, Shaw AD, Singh KD, Stockton-Powdrell C, Talbot PS, Veronese M, Wagner E, Walters JTR, Williams SR, MacCabe JH, Howes OD. Dopamine and Glutamate in Antipsychotic-Responsive Compared With Antipsychotic-Nonresponsive Psychosis: A Multicenter Positron Emission Tomography and Magnetic Resonance Spectroscopy Study (STRATA). Schizophr Bull 2021; 47:505-516. [PMID: 32910150 PMCID: PMC7965076 DOI: 10.1093/schbul/sbaa128] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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] [Indexed: 02/06/2023]
Abstract
The variability in the response to antipsychotic medication in schizophrenia may reflect between-patient differences in neurobiology. Recent cross-sectional neuroimaging studies suggest that a poorer therapeutic response is associated with relatively normal striatal dopamine synthesis capacity but elevated anterior cingulate cortex (ACC) glutamate levels. We sought to test whether these measures can differentiate patients with psychosis who are antipsychotic responsive from those who are antipsychotic nonresponsive in a multicenter cross-sectional study. 1H-magnetic resonance spectroscopy (1H-MRS) was used to measure glutamate levels (Glucorr) in the ACC and in the right striatum in 92 patients across 4 sites (48 responders [R] and 44 nonresponders [NR]). In 54 patients at 2 sites (25 R and 29 NR), we additionally acquired 3,4-dihydroxy-6-[18F]fluoro-l-phenylalanine (18F-DOPA) positron emission tomography (PET) to index striatal dopamine function (Kicer, min-1). The mean ACC Glucorr was higher in the NR than the R group after adjustment for age and sex (F1,80 = 4.27; P = .04). This was associated with an area under the curve for the group discrimination of 0.59. There were no group differences in striatal dopamine function or striatal Glucorr. The results provide partial further support for a role of ACC glutamate, but not striatal dopamine synthesis, in determining the nature of the response to antipsychotic medication. The low discriminative accuracy might be improved in groups with greater clinical separation or increased in future studies that focus on the antipsychotic response at an earlier stage of the disorder and integrate other candidate predictive biomarkers. Greater harmonization of multicenter PET and 1H-MRS may also improve sensitivity.
Collapse
Affiliation(s)
- Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Anna Murphy
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jacek Donocik
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Adriana Anton
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Academic Unit of Radiology, Medical School, Faculty of Medicine, Dentistry & Health, University of Sheffield, Sheffield, UK
| | - Gareth J Barker
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Tracy Collier
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Bill Deakin
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard Drake
- Division of Psychology and Mental Health, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Emma Eliasson
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Richard Emsley
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Catherine J Gregory
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Kira Griffiths
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Shitij Kapur
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Laura Kassoumeri
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Laura Knight
- CUBRIC, School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Emily J B Lambe
- CUBRIC, School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Jane Lees
- Division of Psychology and Mental Health, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David J Lythgoe
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Julian Matthews
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Lily McNamee
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Scott Semple
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Alexander D Shaw
- CUBRIC, School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Krish D Singh
- CUBRIC, School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Charlotte Stockton-Powdrell
- Division of Psychology and Mental Health, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Peter S Talbot
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mattia Veronese
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ernest Wagner
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Stephen R Williams
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - James H MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London, UK
| |
Collapse
|
4
|
McCutcheon R, Beck K, D'Ambrosio E, Donocik J, Gobjila C, Jauhar S, Kaar S, Pillinger T, Reis Marques T, Rogdaki M, Howes OD. Antipsychotic plasma levels in the assessment of poor treatment response in schizophrenia. Acta Psychiatr Scand 2018; 137:39-46. [PMID: 29072776 PMCID: PMC5734612 DOI: 10.1111/acps.12825] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [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] [Accepted: 09/28/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Treatment resistance is a challenge for the management of schizophrenia. It is not always clear whether inadequate response is secondary to medication ineffectiveness, as opposed to medication underexposure due to non-adherence or pharmacokinetic factors. We investigated the prevalence of subtherapeutic antipsychotic plasma levels in patients identified as treatment-resistant by their treating clinician. METHOD Between January 2012 and April 2017, antipsychotic plasma levels were measured in 99 individuals provisionally diagnosed with treatment-resistant schizophrenia by their treating clinicians, but not prescribed clozapine. Patients were followed up to determine whether they were subsequently admitted to hospital. RESULTS Thirty-five per cent of plasma levels were subtherapeutic, and of these, 34% were undetectable. Black ethnicity (P = 0.006) and lower dose (P < 0.001) were significantly associated with subtherapeutic/undetectable plasma levels. Individuals with subtherapeutic/undetectable levels were significantly more likely to be admitted to hospital (P = 0.02). CONCLUSION A significant proportion of patients considered treatment-resistant have subtherapeutic antipsychotic plasma levels, and this is associated with subsequent admission. The presence of subtherapeutic plasma levels may suggest a need to address adherence or pharmacokinetic factors as opposed to commencing clozapine treatment. While antipsychotic levels are not recommended for the routine adjustment of dosing, they may assist with the assessment of potential treatment resistance in schizophrenia.
Collapse
Affiliation(s)
- R. McCutcheon
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - K. Beck
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
| | - E. D'Ambrosio
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - J. Donocik
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - C. Gobjila
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - S. Jauhar
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - S. Kaar
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - T. Pillinger
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - T. Reis Marques
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - M. Rogdaki
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - O. D. Howes
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| |
Collapse
|
5
|
Abstract
IMPORTANCE Schizophrenia is associated with an increased risk of type 2 diabetes. However, it is not clear whether schizophrenia confers an inherent risk for glucose dysregulation in the absence of the effects of chronic illness and long-term treatment. OBJECTIVE To conduct a meta-analysis examining whether individuals with first-episode schizophrenia already exhibit alterations in glucose homeostasis compared with controls. DATA SOURCES The EMBASE, MEDLINE, and PsycINFO databases were systematically searched for studies examining measures of glucose homeostasis in antipsychotic-naive individuals with first-episode schizophrenia compared with individuals serving as controls. STUDY SELECTION Case-control studies reporting on fasting plasma glucose levels, plasma glucose levels after an oral glucose tolerance test, fasting plasma insulin levels, insulin resistance, and hemoglobin A1c (HbA1c) levels in first-episode antipsychotic-naive individuals with first-episode schizophrenia compared with healthy individuals serving as controls. Two independent investigators selected the studies. DATA EXTRACTION Two independent investigators extracted study-level data for a random-effects meta-analysis. Standardized mean differences in fasting plasma glucose levels, plasma glucose levels after an oral glucose tolerance test, fasting plasma insulin levels, insulin resistance, and HbA1c levels were calculated. Sensitivity analyses examining the effect of body mass index, diet and exercise, race/ethnicity, and minimal (≤2 weeks) antipsychotic exposure were performed. DATA SYNTHESIS Of 3660 citations retrieved, 16 case-control studies comprising 15 samples met inclusion criteria. The overall sample included 731 patients and 614 controls. Fasting plasma glucose levels (Hedges g = 0.20; 95% CI, 0.02 to 0.38; P = .03), plasma glucose levels after an oral glucose tolerance test (Hedges g = 0.61; 95% CI, 0.16 to 1.05; P = .007), fasting plasma insulin levels (Hedges g = 0.41; 95% CI, 0.09 to 0.72; P = .01), and insulin resistance (homeostatic model assessment of insulin resistance) (Hedges g = 0.35; 95% CI, 0.14 to 0.55; P = .001) were all significantly elevated in patients compared with controls. However, HbA1c levels (Hedges g = -0.08; CI, -0.34 to 0.18; P = .55) were not altered in patients compared with controls. CONCLUSIONS AND RELEVANCE These findings show that glucose homeostasis is altered from illness onset in schizophrenia, indicating that patients are at increased risk of diabetes as a result. This finding has implications for the monitoring and treatment choice for patients with schizophrenia.
Collapse
Affiliation(s)
- Toby Pillinger
- IoPPN, King’s College London, De Crespigny Park, London, SE5 8AF, UK
| | - Katherine Beck
- IoPPN, King’s College London, De Crespigny Park, London, SE5 8AF, UK
| | - Cristian Gobjila
- IoPPN, King’s College London, De Crespigny Park, London, SE5 8AF, UK
| | - Jacek Donocik
- IoPPN, King’s College London, De Crespigny Park, London, SE5 8AF, UK
| | - Sameer Jauhar
- IoPPN, King’s College London, De Crespigny Park, London, SE5 8AF, UK
| | - Oliver Howes
- IoPPN, King’s College London, De Crespigny Park, London, SE5 8AF, UK,MRC Clinical Sciences Centre (CSC), Du Cane Road, London W12 0NN,Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, Du Cane Road, London W12 0NN
| |
Collapse
|
6
|
Wooderson SC, Juruena MF, Fekadu A, Commane C, Donaldson C, Cowan M, Tomlinson M, Poon L, Markopoulou K, Rane L, Donocik J, Tunnard C, Masterson B, Cleare AJ. Prospective evaluation of specialist inpatient treatment for refractory affective disorders. J Affect Disord 2011; 131:92-103. [PMID: 21144591 DOI: 10.1016/j.jad.2010.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 10/06/2010] [Accepted: 11/02/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Little data exist to inform the treatment of severe and resistant affective disorders. We report here the effectiveness of specialist multimodal inpatient treatment for refractory affective disorders. METHODS Prospective evaluation of 225 consecutive patients admitted to the National Affective Disorders Unit between 2001 and 2008. RESULTS Patients were highly treatment-resistant: most had already received ECT, lithium augmentation and over 10 prior treatment trials. Even so, sequential assessment with the Hamilton Depression Rating Scale found that 69% showed a clinical response (≥ 50% reduction in Hamilton score) to intensive therapy during admission; 50% continued to sustain a full response and 71% at least a partial response on discharge. Patients' self-ratings (57% very much or much improved, 24% slightly improved) and relative and referrer reports (75% and 68% respectively rated patients as improved) gave similar levels of improvement. LIMITATIONS This was an observational study, without any untreated control group. The generalisability of the findings is limited by the highly specialised nature of the unit. CONCLUSIONS Most patients with depression highly resistant to prior treatment respond to specialist and intensive multimodal inpatient therapy.
Collapse
Affiliation(s)
- Sarah C Wooderson
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, Section of Neurobiology of Mood Disorders, London SE5 8AZ, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Kokocińska D, Widala E, Donocik J, Nolewajka E. [The value of evaluating tumor markers: CA 15-3 and ferritin in blood serum of patients grouped as "high risk" for breast cancer]. Przegl Lek 2000; 56:664-7. [PMID: 10695382] [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: 02/15/2023]
Abstract
We studied 127 patients. 35 patients (group I) with mastopathy disease (average 44.3 years old) included 9 patients with a breast cancer family history (subgroup I A), 26 patients without a breast cancer family history (subgroup I B) and 92 patients (group II) with a breast cancer of I-IV grade (average 49.25 years old). The results of the study revealed statistically significant higher level of CA 15-3 in serum of patients with mastopathy compared to patients with a breast cancer of I grade (p < 0.05). CA 15-3 level in patients with a breast cancer of III, IV grade in serum, was considerably higher and there was significant difference comparing to the patients with a breast cancer of I, II grade (p < 0.001) and patients with mastopathy disease. There were also higher average levels of CA 15-3 in patients with mastopathy disease with a breast cancer family history (subgroup I A) compared to patients without an oncological risk (subgroup I B), however there were not significant differences. There were also higher average levels of ferritin revealed in patients with a breast cancer of III, IV grade and which shows significant difference between patients with breast cancer of I, II grade and with mastopathy patients (p < 0.001). It seems that determination of CA 15-3 and ferritin in patients of a high risk group of a breast cancer could be a useful diagnostic tool for early determination of a breast cancer.
Collapse
Affiliation(s)
- D Kokocińska
- Samodzielnej Pracowni Immunodiagnostyki Klinicznej, Szpital Górniczy w Sosnowcu
| | | | | | | |
Collapse
|
8
|
Kuśmierski S, Kokot F, Dyaczyńska-Herman A, Owczarski K, Donocik J, Kwiatkowska-Molenda B. [Adrenal gland diseases--results of surgical treatment]. Wiad Lek 1998; 50 Suppl 1 Pt 1:37-41. [PMID: 9446387] [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: 02/05/2023]
Abstract
The aim of the study is presentation of own remarks, related to surgical treatment of 183 patients with adrenal glands pathology in the years 1976-1996. The diagnosis was based on typical clinical symptoms and hormonal studies. The localisation of lesion was determined initially by X-ray examinations, mostly arteriography, later by ultra-sound and computer tomography, recently also by nuclear magnetic resonance and scintigraphy. The paper discusses methods of preparing the patients for surgery, tactics of surgical treatment, intra- and postoperative complications (8.2%), problem of incidentalomas.
Collapse
Affiliation(s)
- S Kuśmierski
- I Katedry i Kliniki Chirurgii Ogólnej, Slaskiej Akademii Medycznej w Katowicach
| | | | | | | | | | | |
Collapse
|
9
|
Kokocińska D, Kuśmierski S, Donocik J. [Production of human anti-ferritin antibodies and RIA tests for determining ferritin in serum]. Pol Tyg Lek 1993; 48:128-31. [PMID: 8361909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- D Kokocińska
- I Katedry i Kliniki Chirurgii Ogólnej Sl. AM, Katowicach
| | | | | |
Collapse
|
10
|
Kuśmierski S, Kawecki M, Madejski T, Hadasik F, Donocik J, Chmiel B. [Abdominal resection of rectal cancer]. Pol Tyg Lek 1992; 47:631-3. [PMID: 1488345] [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: 12/27/2022]
Abstract
Preservation of anal sphincters in the surgical treatment of rectal cancer is often controversial as far as an extent of surgery, incidence of complications and an increase in mortality rate in perioperative period are concerned. The study was aimed at results of the retrospective analysis of patients, who undergone abdominal excision of the rectum for malignant tumours. Totally 136 patients were operated. Perioperative mortality rate was 5.14%. Totally 26.4% of patients survived for at least 5 years, including 80% of patients operated in A stage of cancer, according to Duke, and 43.3% of patients with tumour in B stage. An emphasis is on the necessity to leave a 2-centimeter margin of healthy tissues around the tumour, provided, that the result of intraoperative histological examination was negative. Such a margin is sufficient for anastomosis. Low anastomoses do not produce early complications and recurrences.
Collapse
Affiliation(s)
- S Kuśmierski
- I Katedry i Kliniki Chirurgii Ogólnej Slaskiej AM, Katowicach
| | | | | | | | | | | |
Collapse
|
11
|
Donocik J, Kawecki M. [Difficulties in the diagnosis of bleeding cancer of the small intestine and colonic polyp]. Wiad Lek 1990; 43:979-80. [PMID: 2075742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- J Donocik
- I Katedry i Kliniki Chirurgii Ogólnej Sl. Ak. Med. w Katowicach
| | | |
Collapse
|
12
|
Samochowiec E, Rogoszewski M, Donocik J, Nowińska A, Ulfik A. [Autoimmunization in chronic adnexitis]. Ginekol Pol 1981; 52:339-43. [PMID: 7271930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
|
13
|
Hałatek R, Szaflik J, Donocik J, Rogoszewski M. [A trial of assessing the allergic aspects of primary glaucoma (author's transl)]. Klin Oczna 1978; 48:639-41. [PMID: 732210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
14
|
Samochowiec E, Nowińska-Romankiewicz A, Rogoszewski M, Donocik J. [Importance of the immunological factor in the pathogenesis of marital sterility]. Ginekol Pol 1978; 49:343-50. [PMID: 355060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
15
|
Samochowiec E, Rogoszewski M, Donocik J, Rzempoluch J, Nowinska A. [Role of antileukocytic antibodies in the course of normal and complicated pregnancy]. Ginekol Pol 1977; 48:289-94. [PMID: 858525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|