1
|
Postma A, Ketelaar M, van Nispen Tot Sevenaer J, Downs Z, van Rappard D, Jongmans M, Zinkstok J. Exploring individual parent-to-parent support interventions for parents caring for children with brain-based developmental disabilities: A scoping review. Child Care Health Dev 2024; 50:e13255. [PMID: 38587275 DOI: 10.1111/cch.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/21/2024] [Accepted: 03/08/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Brain-based developmental disabilities (BBDDs) comprise a large and heterogeneous group of disorders including autism, intellectual disability, cerebral palsy or genetic and neurodevelopmental disorders. Parents caring for a child with BBDD face multiple challenges that cause increased stress and high risk of mental health problems. Peer-based support by fellow parents for a various range of patient groups has shown potential to provide emotional, psychological and practical support. Here, we aim to explore existing literature on individual peer-to-peer support (iP2PS) interventions for parents caring for children with BBDD with a view to (1) explore the impact of iP2PS interventions on parents and (2) identify challenges and facilitators of iP2PS. METHOD An extensive literature search (January 2023) was performed, and a thematic analysis was conducted to synthesize findings. RESULTS Fourteen relevant articles revealed three major themes regarding the impact of iP2PS on parents: (1) emotional and psychological well-being, (2) quality of life and (3) practical issues. Four themes were identified describing challenges and facilitators of iP2PS: (1) benefits and burden of giving support, (2) matching parent-pairs, (3) logistic challenges and solutions and (4) training and supervision of parents providing peer support. CONCLUSIONS This review revealed that iP2PS has a positive impact on the emotional and psychological well-being of parents, as well as the overall quality of life for families caring for a child with a BBDD. Individual P2PS offers peer-parents an opportunity to support others who are facing challenges similar to those they have experienced themselves. However, many questions still need to be addressed regarding benefits of different iP2PS styles, methods of tailoring support to individual needs and necessity of training and supervision for peer support providers. Future research should focus on defining these components and evaluating benefits to establish effective iP2PS that can be provided as standard care practice for parents.
Collapse
Affiliation(s)
- Amber Postma
- Department of Psychiatry and Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marjolijn Ketelaar
- Department of Rehabilitation, Physical Therapy and Sports; Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
- De Hoogstraat, Rehabilitation, Utrecht, The Netherlands
| | | | - Zahra Downs
- Department of Psychiatry and Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Diane van Rappard
- Department of Psychiatry and Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marian Jongmans
- Department of Pedagogical and Educational Sciences, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Janneke Zinkstok
- Department of Psychiatry and Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry Nijmegen, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Zinkstok J. [Tieners, schermen en smartphones: wat zegt de wetenschap?]. Tijdschr Psychiatr 2024; 66:63-65. [PMID: 38512142] [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: 03/22/2024]
|
3
|
Muskens JB, Ester WA, Klip H, Zinkstok J, van Dongen-Boomsma M, Staal WG. Novel Insights into Somatic Comorbidities in Children and Adolescents Across Psychiatric Diagnoses: An Explorative Study. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01587-w. [PMID: 37656290 DOI: 10.1007/s10578-023-01587-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/02/2023]
Abstract
Many children with psychiatric disorders display somatic symptoms, although these are frequently overlooked. As somatic morbidity early in life negatively influences long-term outcomes, it is relevant to assess comorbidity. However, studies of simultaneous psychiatric and somatic assessment in children are lacking. The aim of this study was to assess the prevalence of somatic comorbidities in a clinical sample of children and adolescents with psychiatric disorders in a naturalistic design. Data were assessed from 276 children with various psychiatric disorders (neurodevelopmental disorders, affective disorders, eating disorders and psychosis) aged 6-18 years. These data were collected as part of routine clinical assessment, including physical examination and retrospectively analyzed. For a subsample (n = 97), blood testing on vitamin D3, lipid spectrum, glucose and prolactin was available. Results of this cross-sectional study revealed that food intake problems (43%) and insomnia (66%) were common. On physical examination, 20% of the children were overweight, 12% displayed obesity and 38% had minor physical anomalies. Blood testing (n = 97) highlighted vitamin D3 deficiency (< 50 nmol/L) in 73% of the children. None of the predefined variables (gender, age, medication and socioeconomic factors) contributed significantly to the prevalence of somatic comorbidities. The main somatic comorbidities in this broad child- and adolescent psychiatric population consisted of (1) problems associated with food intake, including obesity and vitamin D3 deficiency and (2) sleeping problems, mainly insomnia. Child and adolescent psychiatrists need to be aware of potential somatic comorbidities and may promote a healthy lifestyle.
Collapse
Affiliation(s)
- Jet B Muskens
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands.
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands.
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands.
| | - Wietske A Ester
- Sarr Autism Rotterdam, Youz Child and Adolescence Psychiatry, Dynamostraat 18, Rotterdam, 3083 AK, The Netherlands
- Parnassia Psychiatric Institute, Kiwistraat 30, The Hague, 2552 DH, The Netherlands
- Department of Child and Adolescent Psychiatry, Curium-LUMC, Leiden University Medical Center, Endegeesterstraatweg 27, Oegstgeest, 2342 AK, The Netherlands
| | - Helen Klip
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands
| | - Janneke Zinkstok
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martine van Dongen-Boomsma
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| |
Collapse
|
4
|
Van HL, Destoop M, Roza SJ, Baeken C, Zinkstok J. [Publiceren over open cohort- en dossieronderzoeken]. Tijdschr Psychiatr 2023; 65:457-460. [PMID: 37755923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
|
5
|
Blackmore CE, Woodhouse EL, Gillan N, Wilson E, Ashwood KL, Stoencheva V, Nolan A, McAlonan GM, Robertson DM, Whitwell S, Deeley Q, Craig MC, Zinkstok J, Wichers R, Spain D, Roberts G, Murphy DG, Murphy CM, Daly E. Adults with autism spectrum disorder and the criminal justice system: An investigation of prevalence of contact with the criminal justice system, risk factors and sex differences in a specialist assessment service. Autism 2022; 26:2098-2107. [PMID: 35261275 DOI: 10.1177/13623613221081343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
LAY ABSTRACT There has been growing interest in offending and contact with the criminal justice system (CJS) by people with autism spectrum disorder (ASD). However, it is not clear whether people with ASD offend more than those without ASD. Studies have started to look at whether there are particular offences people with ASD are more likely to commit and whether there are any factors that can affect whether someone comes into contact with the CJS as a potential suspect. This study looked at the patients who attended an ASD diagnostic service over a 17-year period to see the rate of contact with the CJS of those who were diagnosed with ASD and whether there were any particular factors that might increase the risk of CJS contact. Nearly a quarter of the ASD group had some contact with the CJS as a potential suspect. Factors that seemed to increase whether someone with ASD was more likely to have contact with the CJS were being male, being diagnosed with ADHD, and being diagnosed with psychosis. This study is one of the largest studies to investigate the rate of CJS contact as a potential suspect in a sample of adults with ASD in an attempt to give a clearer picture of what might influence someone with ASD to engage in offending behaviour in order to try to see what mental health services can offer to reduce the likelihood of someone with ASD coming into contact with the CJS, for example, treatment for another condition or support.
Collapse
Affiliation(s)
| | - Emma L Woodhouse
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK
| | - Nicola Gillan
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK
| | - Ellie Wilson
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK
| | - Karen L Ashwood
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK
| | | | | | - Grainne M McAlonan
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK
| | | | | | - Quinton Deeley
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK
| | - Michael C Craig
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK
| | - Janneke Zinkstok
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK.,University Medical Center Utrecht, The Netherlands
| | - Rob Wichers
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK
| | - Debbie Spain
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK
| | - Ged Roberts
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK.,Avon and Wiltshire Mental Health Partnership NHS Trust, UK
| | - Declan Gm Murphy
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK
| | | | | |
Collapse
|
6
|
Schippers LM, Horstman LI, van de Velde H, Pereira RR, Zinkstok J, Mostert JC, Greven CU, Hoogman M. A qualitative and quantitative study of self-reported positive characteristics of individuals with ADHD. Front Psychiatry 2022; 13:922788. [PMID: 36311492 PMCID: PMC9597197 DOI: 10.3389/fpsyt.2022.922788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
Research in Attention-deficit/hyperactivity disorder (ADHD) has had a clear focus on treatment and the dysfunction in specific situation associated with the condition. However, self-report, observational and anecdotal evidence indicates that there are also positive aspects associated with ADHD. Research on the potential positive features in individuals with an ADHD diagnosis is still limited, especially studies with larger representative samples. Here we performed qualitative research to identify positive aspects and strengths associated with ADHD in a large convenience sample from the Dutch organization for people with ADHD, dyslexia and dyscalculia. We sent out open-ended questionnaires to the members of the organization, asking what they consider to be positive aspects of their ADHD. From the responses of individuals with ADHD (n = 206), we extracted 116 codes, which were assigned to thirteen subthemes, which in turn led to five themes. These themes were: Creativity, Being dynamic, Flexibility, Socio-affective skills, and Higher-order cognitive skills. Core symptoms of ADHD such as impulsivity and hyperactivity were also considered positive aspects of ADHD by a minority of participants. After showing our results to a group of additional individuals with ADHD (focus group) they confirmed the identified positive aspects of ADHD. They also helped us with the interpretation of our findings and mentioned certain positive aspects to be a consequence of living with ADHD (being open minded and being honest). In conclusion, experiencing positive aspects seems to be common in ADHD as almost all participants reported positive aspect of ADHD, these aspects cover many different domains. Awareness about ADHD's strengths might help individuals with ADHD and their environment to better cope with, accept or embrace their diagnosis and for example make educational or occupational choices that fit them well. To incorporate these positive aspects in the understanding of ADHD, future research should focus on quantifying strengths in ADHD, and on investigating the link between these aspects and clinical characteristics and how this new knowledge can be implemented in psychoeducation and find its way to education and occupational settings.
Collapse
Affiliation(s)
- Lessa M Schippers
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - Lisa I Horstman
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - Hans van de Velde
- ADHD-Europe, Chair Science Committee Adult Patient Organization ADHD, Dyslexia and Dyscalculia, Impuls & Woortblind, Nijkerk, Netherlands
| | - Rob Rodrigues Pereira
- Medical Center Kinderplein, Rotterdam, Netherlands.,Dutch Adult Patient Organization ADHD, Dyslexia and Dyscalculia, Impuls & Woortblind, Nijkerk, Netherlands
| | - Janneke Zinkstok
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands.,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands.,Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jeanette C Mostert
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - Corina U Greven
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands.,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands.,Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, Gelderland, Netherlands.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry Centre, London, United Kingdom
| | - Martine Hoogman
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands.,Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
7
|
Lin A, Forsyth JK, Hoftman GD, Kushan-Wells L, Jalbrzikowski M, Dokuru D, Coppola G, Fiksinski A, Zinkstok J, Vorstman J, Nachun D, Bearden CE. Transcriptomic profiling of whole blood in 22q11.2 reciprocal copy number variants reveals that cell proportion highly impacts gene expression. Brain Behav Immun Health 2021; 18:100386. [PMID: 34841284 PMCID: PMC8607166 DOI: 10.1016/j.bbih.2021.100386] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 10/31/2021] [Indexed: 11/24/2022] Open
Abstract
22q11.2 reciprocal copy number variants (CNVs) offer a powerful quasi-experimental "reverse-genetics" paradigm to elucidate how gene dosage (i.e., deletions and duplications) disrupts the transcriptome to cause further downstream effects. Clinical profiles of 22q11.2 CNV carriers indicate that disrupted gene expression causes alterations in neuroanatomy, cognitive function, and psychiatric disease risk. However, interpreting transcriptomic signal in bulk tissue requires careful consideration of potential changes in cell composition. We first characterized transcriptomic dysregulation in peripheral blood from reciprocal 22q11.2 CNV carriers using differential expression analysis and weighted gene co-expression network analysis (WGCNA) to identify modules of co-expressed genes. We also assessed for group differences in cell composition and re-characterized transcriptomic differences after accounting for cell type proportions and medication usage. Finally, to explore whether CNV-related transcriptomic changes relate to downstream phenotypes associated with 22q11.2 CNVs, we tested for associations of gene expression with neuroimaging measures and behavioral traits, including IQ and psychosis or ASD diagnosis. 22q11.2 deletion carriers (22qDel) showed widespread expression changes at the individual gene as well as module eigengene level compared to 22q11.2 duplication carriers (22qDup) and controls. 22qDup showed increased expression of 5 genes within the 22q11.2 locus, and CDH6 located outside of the locus. Downregulated modules in 22qDel implicated altered immune and inflammatory processes. Celltype deconvolution analyses revealed significant differences between CNV and control groups in T-cell, mast cell, and macrophage proportions; differential expression of individual genes between groups was substantially attenuated after adjusting for cell composition. Individual gene, module eigengene, and cell proportions were not significantly associated with psychiatric or neuroanatomic traits. Our findings suggest broad immune-related dysfunction in 22qDel and highlight the importance of understanding differences in cell composition when interpreting transcriptomic changes in clinical populations. Results also suggest novel directions for future investigation to test whether 22q11.2 CNV effects on macrophages have implications for brain-related microglial function that may contribute to psychiatric phenotypes in 22q11.2 CNV carriers.
Collapse
Affiliation(s)
- Amy Lin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Neuroscience Interdepartmental Program, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jennifer K. Forsyth
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychology, University of Washington, WA, USA
| | - Gil D. Hoftman
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Leila Kushan-Wells
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Deepika Dokuru
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Giovanni Coppola
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ania Fiksinski
- Wilhelmina Children's Hospital & University Medical Center Utrecht, Brain Center, the Netherlands
- Maastricht University, Department of Psychiatry and Neuropsychology, Division of Mental Health, MHeNS, the Netherlands
| | - Janneke Zinkstok
- Department of Psychiatry and Brain Center, University Medical Center Utrecht, the Netherlands
| | - Jacob Vorstman
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Daniel Nachun
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
8
|
Fiksinski AM, Schneider M, Zinkstok J, Baribeau D, Chawner SJRA, Vorstman JAS. Neurodevelopmental Trajectories and Psychiatric Morbidity: Lessons Learned From the 22q11.2 Deletion Syndrome. Curr Psychiatry Rep 2021; 23:13. [PMID: 33625600 PMCID: PMC7904715 DOI: 10.1007/s11920-021-01225-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The 22q11.2 deletion syndrome (22q11DS) is associated with a broad spectrum of neurodevelopmental phenotypes and is the strongest known single genetic risk factor for schizophrenia. Compared to other rare structural pathogenic genetic variants, 22q11DS is relatively common and one of the most extensively studied. This review provides a state-of-the-art overview of current insights regarding associated neurodevelopmental phenotypes and potential implications for 22q11DS and beyond. RECENT FINDINGS We will first discuss recent findings with respect to neurodevelopmental phenotypic expression associated with 22q11DS, including psychotic disorders, intellectual functioning, autism spectrum disorders, as well as their interactions. Second, we will address considerations that are important in interpreting these data and propose potential implications for both the clinical care for and the empirical study of individuals with 22q11DS. Third, we will highlight variable penetrance and pleiotropy with respect to neurodevelopmental phenotypes in 22q11DS. We will discuss how these phenomena are consistently observed in the context of virtually all rare pathogenic variants and that they pose substantial challenges from both a clinical and a research perspective. We outline how 22q11DS could be viewed as a genetic model for studying neurodevelopmental phenotypes. In addition, we propose that 22q11DS research can help elucidate mechanisms underlying variable expression and pleiotropy of neurodevelopmental phenotypes, insights that are likely relevant for 22q11DS and beyond, including for individuals with other rare pathogenic genetic variants and for individuals with idiopathic neurodevelopmental conditions.
Collapse
Affiliation(s)
- Ania M. Fiksinski
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, Toronto General Hospital, University Health Network, Toronto, Canada
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Maude Schneider
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Janneke Zinkstok
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Danielle Baribeau
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Samuel J. R. A. Chawner
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Jacob A. S. Vorstman
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
- The Centre for Applied Genomics, Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON Canada
| |
Collapse
|
9
|
de Boer N, Guloksuz S, van Baal C, Willebrands L, Deenik J, Vinkers CH, Rossum IWV, Zinkstok J, Wilting I, Zantvoord JB, Backx F, Swildens WE, Schouw M, Bogers J, Hulshof F, de Knijff R, Duindam P, Veereschild M, Bak M, Frederix G, de Haan L, van Os J, Cahn W, Luykx JJ. Study protocol of a randomized, double-blind, placebo-controlled, multi-center trial to treat antipsychotic-induced weight gain: the Metformin-Lifestyle in antipsychotic users (MELIA) trial. BMC Psychiatry 2021; 21:4. [PMID: 33402159 PMCID: PMC7783702 DOI: 10.1186/s12888-020-02992-4] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/26/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Antipsychotic-induced Weight Gain (AiWG) is a debilitating and common adverse effect of antipsychotics. AiWG negatively impacts life expectancy, quality of life, treatment adherence, likelihood of developing type-2 diabetes and readmission. Treatment of AiWG is currently challenging, and there is no consensus on the optimal management strategy. In this study, we aim to evaluate the use of metformin for the treatment of AiWG by comparing metformin with placebo in those receiving treatment as usual, which includes a lifestyle intervention. METHODS In this randomized, double-blind, multicenter, placebo-controlled, pragmatic trial with a follow-up of 52 weeks, we aim to include 256 overweight participants (Body Mass Index (BMI) > 25 kg/m2) of at least 16 years of age. Patients are eligible if they have been diagnosed with schizophrenia spectrum disorder and if they have been using an antipsychotic for at least three months. Participants will be randomized with a 1:1 allocation to placebo or metformin, and will be treated for a total of 26 weeks. Metformin will be started at 500 mg b.i.d. and escalated to 1000 mg b.i.d. 2 weeks thereafter (up to a maximum of 2000 mg daily). In addition, all participants will undergo a lifestyle intervention as part of the usual treatment consisting of a combination of an exercise program and dietary consultations. The primary outcome measure is difference in body weight as a continuous trait between the two arms from treatment inception until 26 weeks of treatment, compared to baseline. Secondary outcome measures include: 1) Any element of metabolic syndrome (MetS); 2) Response, defined as ≥5% body weight loss at 26 weeks relative to treatment inception; 3) Quality of life; 4) General mental and physical health; and 5) Cost-effectiveness. Finally, we aim to assess whether genetic liability to BMI and MetS may help estimate the amount of weight reduction following initiation of metformin treatment. DISCUSSION The pragmatic design of the current trial allows for a comparison of the efficacy and safety of metformin in combination with a lifestyle intervention in the treatment of AiWG, facilitating the development of guidelines on the interventions for this major health problem. TRIAL REGISTRATION This trial was registered in the Netherlands Trial Register (NTR) at https://www.trialregister.nl/trial/8440 as NTR NL8840 on March 8, 2020.
Collapse
Affiliation(s)
- Nini de Boer
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508, Utrecht, GA, The Netherlands.
| | - Sinan Guloksuz
- grid.412966.e0000 0004 0480 1382Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands ,grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Caroline van Baal
- Department of Biostatistics and Research Support, Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Leonie Willebrands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508 Utrecht, GA The Netherlands
| | - Jeroen Deenik
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508 Utrecht, GA The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands ,grid.491215.a0000 0004 0468 1456GGz Centraal Mental Health, Amersfoort, The Netherlands
| | - Christiaan H. Vinkers
- grid.7177.60000000084992262Department of Psychiatry and Department of Anatomy and Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands ,GGZinGeest Mental Health, Amsterdam, The Netherlands
| | - Inge Winter-van Rossum
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508 Utrecht, GA The Netherlands
| | - Janneke Zinkstok
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508 Utrecht, GA The Netherlands
| | - Ingeborg Wilting
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jasper B. Zantvoord
- grid.7177.60000000084992262Department of Psychiatry and Department of Anatomy and Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Backx
- Department of Rehabilitation, Physiotherapy Science & Sport, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wilma E. Swildens
- grid.413664.2Altrecht Mental Health Care Institute, Utrecht, The Netherlands ,grid.448984.d0000 0003 9872 5642Inholland University of Applied Sciences, Interprofessional Mental Health Care, department Nursing, Amsterdam, The Netherlands
| | - Marieke Schouw
- grid.413664.2Altrecht Mental Health Care Institute, Utrecht, The Netherlands
| | - Jan Bogers
- grid.468622.c0000 0004 0501 8787GGZ Rivierduinen, Oegstgeest, The Netherlands
| | | | | | | | | | - Maarten Bak
- grid.412966.e0000 0004 0480 1382Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands ,Mondriaan Mental Health, Maastricht, The Netherlands
| | - Geert Frederix
- Department of Public Health, Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lieuwe de Haan
- grid.7177.60000000084992262Department of Psychiatry and Department of Anatomy and Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands ,Arkin GGZ, Amsterdam, The Netherlands
| | - Jim van Os
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508 Utrecht, GA The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands ,grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Wiepke Cahn
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508 Utrecht, GA The Netherlands ,grid.413664.2Altrecht Mental Health Care Institute, Utrecht, The Netherlands
| | - Jurjen J. Luykx
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508 Utrecht, GA The Netherlands ,GGNet Mental Health, Warnsveld, The Netherlands ,Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
10
|
Vingerhoets C, Tse DHY, van Oudenaren M, Hernaus D, van Duin E, Zinkstok J, Ramaekers JG, Jansen JFA, McAlonan G, van Amelsvoort T. Glutamatergic and GABAergic reactivity and cognition in 22q11.2 deletion syndrome and healthy volunteers: A randomized double-blind 7-Tesla pharmacological MRS study. J Psychopharmacol 2020; 34:856-863. [PMID: 32448020 PMCID: PMC7376622 DOI: 10.1177/0269881120922977] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Indexed: 12/30/2022]
Abstract
AIMS 22q11.2 deletion syndrome (22q11.2DS) is associated with impaired cognitive functioning. Glutamatergic pathways have been linked with cognition and are hypothesized to be disrupted in 22q11.2DS patients, possibly 'shifting' the excitatory (glutamate)/inhibitory (GABA) balance. Hence, the glutamate/GABA balance may constitute a target for pharmacological treatment. We aimed to examine alterations of glutamate/GABA metabolites in 22q11.2DS in vivo using riluzole, a compound with glutamate/GABA-modulating action, as pharmacological challenge. METHODS Seventeen 22q11.2DS patients and 20 matched healthy controls were enrolled in this randomized double-blind placebo-controlled crossover study. Glutamate and glutamine concentrations in the anterior cingulate cortex (ACC) and striatum, as well as ACC GABA concentrations were obtained after placebo and after a single dose of 50 mg riluzole using 7-Tesla magnetic resonance spectroscopy (MRS). Within the 22q11.2DS group, the relationship between metabolite concentrations and cognition was examined. RESULTS No group differences were found in ACC and striatal metabolite concentrations following placebo. Riluzole numerically decreased ACC (η2= 0.094) but not striatal glutamate concentrations as well as ACC GABA concentrations (η2= 0.176) in all subjects. In both regions, riluzole did not alter glutamine concentration. No interaction effects were found. Although not significant after Bonferroni correction, ACC glutamate concentrations were inversely correlated with cognitive functions in 22q11.2DS patients. DISCUSSION We did not demonstrate altered ACC and striatal metabolite concentrations in 22q11.2DS. Nevertheless, these results suggest that glutamate and GABA can be modulated with a single dose of riluzole. Possibly, riluzole may have memory-enhancing effects in 22q11.2DS. Future studies should examine the long-term effects of riluzole on cognition.
Collapse
Affiliation(s)
- Claudia Vingerhoets
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Desmond HY Tse
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Mathilde van Oudenaren
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Dennis Hernaus
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Esther van Duin
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Janneke Zinkstok
- Department of Psychiatry & UMC Utrecht Brain Center, University Medical Center, Utrecht, the Netherlands
| | - Johannes G Ramaekers
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Jacobus FA Jansen
- Department of Radiology, Maastricht University Medical Center, Maastricht University, Maastricht, the Netherlands
| | - Grainne McAlonan
- The Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Therese van Amelsvoort
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
11
|
Lin BD, Alkema A, Peters T, Zinkstok J, Libuda L, Hebebrand J, Antel J, Hinney A, Cahn W, Adan R, Luykx JJ. Assessing causal links between metabolic traits, inflammation and schizophrenia: a univariable and multivariable, bidirectional Mendelian-randomization study. Int J Epidemiol 2020; 48:1505-1514. [PMID: 31504541 PMCID: PMC7070229 DOI: 10.1093/ije/dyz176] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Blood immunoreactive biomarkers, such as C-reactive protein (CRP), and metabolic abnormalities have been associated with schizophrenia. Studies comprehensively and bidirectionally probing possible causal links between such blood constituents and liability to schizophrenia are lacking. METHODS To disentangle putative causal links between CRP blood levels and schizophrenia in both directions, we conducted multiple univariable Mendelian-randomization (MR) analyses, ranging from fixed-effect to inverse variance-weighted (IVW), weighted-median, MR Egger and generalized summary-data-based Mendelian-randomization (GSMR) models. To prioritize metabolic risk factors for schizophrenia, a novel multivariable approach was applied: multivariable Mendelian-randomization-Bayesian model averaging (MR-BMA). RESULTS All forward univariable MR analyses consistently showed that CRP has a protective effect on schizophrenia, whereas reverse MR analyses consistently suggested absent causal effects of schizophrenia liability on CRP blood levels. Using MR-BMA, as the top protective factors for schizophrenia we prioritized leucine and as the prime risk-factor triglycerides in medium very-low-density lipoprotein (VLDL). The five best-performing MR-BMA models provided one additional risk factor: triglycerides in large VLDL; and two additional protective factors: citrate and lactate. CONCLUSIONS Our results add to a growing body of literature hinting at metabolic changes-in particular of triglycerides-independently of medication status in schizophrenia. We also highlight the absent effects of genetic liability to schizophrenia on CRP levels.
Collapse
Affiliation(s)
- Bochao D Lin
- Department of Psychiatry, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands.,Department of Preventive Medicine, Institute of Biomedical Informatics, Bioinformatics Center, School of Basic Medical Sciences, Henan University, Kaifeng, China.,Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Anne Alkema
- Department of Psychiatry, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Triinu Peters
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Janneke Zinkstok
- Department of Psychiatry, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Lars Libuda
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Jochen Antel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Wiepke Cahn
- Department of Psychiatry, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Roger Adan
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Jurjen J Luykx
- Department of Psychiatry, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands.,Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands.,GGNet Mental Health, Apeldoorn, The Netherlands
| |
Collapse
|
12
|
de Boer J, Boot E, van Gils L, van Amelsvoort T, Zinkstok J. Adverse effects of antipsychotic medication in patients with 22q11.2 deletion syndrome: A systematic review. Am J Med Genet A 2019; 179:2292-2306. [PMID: 31407842 PMCID: PMC6851664 DOI: 10.1002/ajmg.a.61324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/17/2019] [Accepted: 07/25/2019] [Indexed: 12/29/2022]
Abstract
The 22q11.2 deletion syndrome (22q11.2DS) is a multisystem condition and the most prevalent microdeletion syndrome in humans. Approximately 25% of individuals with 22q11.2DS receive antipsychotic treatment. To assess whether patients with 22q11.2DS are vulnerable to adverse effects of antipsychotic medication, we carried out a literature review. A systematic search strategy was performed using PubMed (Medline), Embase, PsychInfo, and Cochrane Database of Systematic Reviews. Publications describing adverse effects of antipsychotic medication in patients with 22q11.2DS were included in the review and assessed for their methodological quality. A total of 11 publications reporting on eight trials, cross-sectional or cohort studies, and 30 case reports were included. The most commonly reported adverse effects can be classified into the following categories: movement disorders, weight gain, seizures, cardiac side effects, and cytopenias. Many of these symptoms are manifestations of 22q11.2DS, also in the absence of antipsychotic medication. Based on the reviewed literature, a causal relation between antipsychotic medication and the reported adverse effects could not be established in the majority of cases. Randomized clinical trials are needed to make firm conclusions regarding risk of adverse effects of antipsychotics in patients with 22q11.2DS.
Collapse
Affiliation(s)
- Janna de Boer
- Department of PsychiatryUniversity Medical Center Utrecht, Utrecht University & University Medical Center Utrecht Brain CenterUtrechtThe Netherlands
| | - Erik Boot
- 's Heeren Loo ZorggroepAmersfoortThe Netherlands
- The Dalglish Family 22q Clinic, University Health NetworkTorontoOntarioCanada
- Department of Nuclear MedicineAmsterdam UMCAmsterdamThe Netherlands
- Department of Psychiatry & NeuropsychologyMaastricht UniversityMaastrichtThe Netherlands
| | - Lissa van Gils
- Department of PsychiatryUniversity Medical Center Utrecht, Utrecht University & University Medical Center Utrecht Brain CenterUtrechtThe Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry & NeuropsychologyMaastricht UniversityMaastrichtThe Netherlands
| | - Janneke Zinkstok
- Department of PsychiatryUniversity Medical Center Utrecht, Utrecht University & University Medical Center Utrecht Brain CenterUtrechtThe Netherlands
| |
Collapse
|
13
|
Zinkstok J. [On genetics and future psychiatry]. Tijdschr Psychiatr 2018; 60:804-806. [PMID: 30536292] [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: 06/09/2023]
|
14
|
Ajram LA, Horder J, Mendez MA, Galanopoulos A, Brennan LP, Wichers RH, Robertson DM, Murphy CM, Zinkstok J, Ivin G, Heasman M, Meek D, Tricklebank MD, Barker GJ, Lythgoe DJ, Edden RAE, Williams SC, Murphy DGM, McAlonan GM. Shifting brain inhibitory balance and connectivity of the prefrontal cortex of adults with autism spectrum disorder. Transl Psychiatry 2017; 7:e1137. [PMID: 28534874 PMCID: PMC5534939 DOI: 10.1038/tp.2017.104] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/10/2017] [Indexed: 02/02/2023] Open
Abstract
Currently, there are no effective pharmacologic treatments for the core symptoms of autism spectrum disorder (ASD). There is, nevertheless, potential for progress. For example, recent evidence suggests that the excitatory (E) glutamate and inhibitory (I) GABA systems may be altered in ASD. However, no prior studies of ASD have examined the 'responsivity' of the E-I system to pharmacologic challenge; or whether E-I modulation alters abnormalities in functional connectivity of brain regions implicated in the disorder. Therefore, we used magnetic resonance spectroscopy ([1H]MRS) to measure prefrontal E-I flux in response to the glutamate and GABA acting drug riluzole in adult men with and without ASD. We compared the change in prefrontal 'Inhibitory Index'-the GABA fraction within the pool of glutamate plus GABA metabolites-post riluzole challenge; and the impact of riluzole on differences in resting-state functional connectivity. Despite no baseline differences in E-I balance, there was a significant group difference in response to pharmacologic challenge. Riluzole increased the prefrontal cortex inhibitory index in ASD but decreased it in controls. There was also a significant group difference in prefrontal functional connectivity at baseline, which was abolished by riluzole within the ASD group. Our results also show, for we believe the first time in ASD, that E-I flux can be 'shifted' with a pharmacologic challenge, but that responsivity is significantly different from controls. Further, our initial evidence suggests that abnormalities in functional connectivity can be 'normalised' by targeting E-I, even in adults.
Collapse
Affiliation(s)
- L A Ajram
- Department of Forensic and Neurodevelopmental Sciences, The Sackler Centre for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - J Horder
- Department of Forensic and Neurodevelopmental Sciences, The Sackler Centre for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - M A Mendez
- Department of Forensic and Neurodevelopmental Sciences, The Sackler Centre for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| | - A Galanopoulos
- Department of Forensic and Neurodevelopmental Sciences, The Sackler Centre for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| | - L P Brennan
- Department of Forensic and Neurodevelopmental Sciences, The Sackler Centre for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| | - R H Wichers
- Department of Forensic and Neurodevelopmental Sciences, The Sackler Centre for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| | - D M Robertson
- Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| | - C M Murphy
- Department of Forensic and Neurodevelopmental Sciences, The Sackler Centre for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| | - J Zinkstok
- Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| | - G Ivin
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - M Heasman
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - D Meek
- Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| | - M D Tricklebank
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - G J Barker
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - D J Lythgoe
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - R A E Edden
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S C Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - D G M Murphy
- Department of Forensic and Neurodevelopmental Sciences, The Sackler Centre for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| | - G M McAlonan
- Department of Forensic and Neurodevelopmental Sciences, The Sackler Centre for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| |
Collapse
|
15
|
Russell AJ, Murphy CM, Wilson E, Gillan N, Brown C, Robertson DM, Craig MC, Deeley Q, Zinkstok J, Johnston K, McAlonan GM, Spain D, Murphy DG. The mental health of individuals referred for assessment of autism spectrum disorder in adulthood: A clinic report. Autism 2016; 20:623-7. [PMID: 26471427 DOI: 10.1177/1362361315604271] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Growing awareness of autism spectrum disorders has increased the demand for diagnostic services in adulthood. High rates of mental health problems have been reported in young people and adults with autism spectrum disorder. However, sampling and methodological issues mean prevalence estimates and conclusions about specificity in psychiatric co-morbidity in autism spectrum disorder remain unclear. A retrospective case review of 859 adults referred for assessment of autism spectrum disorder compares International Classification of Diseases, Tenth Revision diagnoses in those that met criteria for autism spectrum disorder (n = 474) with those that did not (n = 385). Rates of psychiatric diagnosis (>57%) were equivalent across both groups and exceeded general population rates for a number of conditions. The prevalence of anxiety disorders, particularly obsessive compulsive disorder, was significantly higher in adults with autism spectrum disorder than adults without autism spectrum disorder. Limitations of this observational clinic study, which may impact generalisability of the findings, include the lack of standardised structured psychiatric diagnostic assessments by assessors blind to autism spectrum disorder diagnosis and inter-rater reliability. The implications of this study highlight the need for careful consideration of mental health needs in all adults referred for autism spectrum disorder diagnosis.
Collapse
Affiliation(s)
| | - Clodagh M Murphy
- Kings College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Ellie Wilson
- Kings College London, UK South London and Maudsley NHS Foundation Trust, UK
| | | | | | - Dene M Robertson
- Kings College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Michael C Craig
- Kings College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Quinton Deeley
- Kings College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Janneke Zinkstok
- Kings College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Kate Johnston
- Kings College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Grainne M McAlonan
- Kings College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Deborah Spain
- Kings College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Declan Gm Murphy
- Kings College London, UK South London and Maudsley NHS Foundation Trust, UK
| |
Collapse
|
16
|
Wilson CE, Murphy CM, McAlonan G, Robertson DM, Spain D, Hayward H, Woodhouse E, Deeley PQ, Gillan N, Ohlsen JC, Zinkstok J, Stoencheva V, Faulkner J, Yildiran H, Bell V, Hammond N, Craig MC, Murphy DG. Does sex influence the diagnostic evaluation of autism spectrum disorder in adults? Autism 2016; 20:808-19. [PMID: 26802113 PMCID: PMC5363500 DOI: 10.1177/1362361315611381] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
It is unknown whether sex influences the diagnostic evaluation of autism spectrum disorder, or whether male and female adults within the spectrum have different symptom profiles. This study reports sex differences in clinical outcomes for 1244 adults (935 males and 309 females) referred for autism spectrum disorder assessment. Significantly, more males (72%) than females (66%) were diagnosed with an autism spectrum disorder of any subtype (x(2) = 4.09; p = 0.04). In high-functioning autism spectrum disorder adults (IQ > 70; N = 827), there were no significant sex differences in severity of socio-communicative domain symptoms. Males had significantly more repetitive behaviours/restricted interests than females (p = 0.001, d = 0.3). A multivariate analysis of variance indicated a significant interaction between autism spectrum disorder subtype (full-autism spectrum disorder/partial-autism spectrum disorder) and sex: in full-autism spectrum disorder, males had more severe socio-communicative symptoms than females; for partial-autism spectrum disorder, the reverse was true. There were no sex differences in prevalence of co-morbid psychopathologies. Sex influenced diagnostic evaluation in a clinical sample of adults with suspected autism spectrum disorder. The sexes may present with different manifestations of the autism spectrum disorder phenotype and differences vary by diagnostic subtype. Understanding and awareness of adult female repetitive behaviours/restricted interests warrant attention and sex-specific diagnostic assessment tools may need to be considered.
Collapse
Affiliation(s)
- C Ellie Wilson
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK University of Seville, Spain
| | - Clodagh M Murphy
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Grainne McAlonan
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Dene M Robertson
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Debbie Spain
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Hannah Hayward
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Emma Woodhouse
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - P Quinton Deeley
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK Bethlem Royal Hospital, UK
| | - Nicola Gillan
- South London and Maudsley NHS Foundation Trust, UK Bristol Autism Spectrum Service, UK University of Bristol, UK
| | | | - Janneke Zinkstok
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | | | - Jessica Faulkner
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | | | - Vaughan Bell
- South London and Maudsley NHS Foundation Trust, UK University College London, UK
| | - Neil Hammond
- South London and Maudsley NHS Foundation Trust, UK
| | - Michael C Craig
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK Bethlem Royal Hospital, UK
| | - Declan Gm Murphy
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| |
Collapse
|
17
|
Wilson CE, Gillan N, Spain D, Robertson D, Roberts G, Murphy CM, Maltezos S, Zinkstok J, Johnston K, Dardani C, Ohlsen C, Deeley PQ, Craig M, Mendez MA, Happé F, Murphy DGM. Comparison of ICD-10R, DSM-IV-TR and DSM-5 in an adult autism spectrum disorder diagnostic clinic. J Autism Dev Disord 2014; 43:2515-25. [PMID: 23504376 DOI: 10.1007/s10803-013-1799-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
An Autism Spectrum Disorder (ASD) diagnosis is often used to access services. We investigated whether ASD diagnostic outcome varied when DSM-5 was used compared to ICD-10R and DSM-IV-TR in a clinical sample of 150 intellectually able adults. Of those diagnosed with an ASD using ICD-10R, 56 % met DSM-5 ASD criteria. A further 19 % met DSM-5 (draft) criteria for Social Communication Disorder. Of those diagnosed with Autistic Disorder/Asperger Syndrome on DSM-IV-TR, 78 % met DSM-5 ASD criteria. Sensitivity of DSM-5 was significantly increased by reducing the number of criteria required for a DSM-5 diagnosis, or by rating 'uncertain' criteria as 'present', without sacrificing specificity. Reduced rates of ASD diagnosis may mean some ASD individuals will be unable to access clinical services.
Collapse
Affiliation(s)
- C Ellie Wilson
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, King's College, London, SE5 8AF, UK,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Zinkstok J, Buitelaar J. [DSM-5: neurodevelopmental disorders]. Tijdschr Psychiatr 2014; 56:162-166. [PMID: 24643824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was published in May, 2013. AIM To review the changes in the diagnostic criteria for autism spectrum disorder (ASD) and ADHD in DSM-5, compared to DSM-IV. METHOD The diagnostic criteria for ASD and ADHD in DSM-IV and DSM-5 are compared. The new diagnostic criteria are summarised and relevant literature is discussed. RESULTS The new category ASD includes the majority of the pervasive developmental disorders; however, in DSM-5, patients without stereotypical patterns of behaviour or interests will, from now on, be classified as having Social Communication Disorder. The threshold for meeting the diagnostic criteria for adhd has been lowered slightly. However, this is supported by clinical and epidemiological data and is unlikely to result in over-diagnosis. CONCLUSION Research into subtypes of asd may stagnate as a result of the changes introduced in DSM-5. For clinicians, the diagnostic criteria for ASD and ADHD may be more clear-cut and possibly more user-friendly than the diagnostic criteria for these disorders as given in dsm-iv.
Collapse
|
19
|
Boot E, Booij J, Abeling N, Meijer J, da Silva Alves F, Zinkstok J, Baas F, Linszen D, van Amelsvoort T. Dopamine metabolism in adults with 22q11 deletion syndrome, with and without schizophrenia--relationship with COMT Val¹⁰⁸/¹⁵⁸Met polymorphism, gender and symptomatology. J Psychopharmacol 2011; 25:888-95. [PMID: 21447540 DOI: 10.1177/0269881111400644] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [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] [Indexed: 01/22/2023]
Abstract
22q11 Deletion syndrome (22q11DS) is a major risk factor for schizophrenia. In addition, both conditions are associated with alterations of the dopaminergic system. The catechol-O-methyltransferase (COMT) gene, located within the deleted region, encodes for the enzyme COMT that is important for degradation of catecholamines, including dopamine (DA). COMT activity is sexually dimorphic and its gene contains a functional polymorphism, Val¹⁰⁸/¹⁵⁸ Met; the Met allele is associated with lower enzyme activity. We report the first controlled catecholamine study in 22q11DS-related schizophrenia. Twelve adults with 22q11DS with schizophrenia (SCZ+) and 22 adults with 22q11DS without schizophrenia (SCZ-) were genotyped for the COMT Val¹⁰⁸/¹⁵⁸ Met genotype. We assessed dopaminergic markers in urine and plasma. We also correlated these markers with scores on the Positive and Negative Symptom Scale (PANSS). Contrary to our expectations, we found SCZ+ subjects to be more often Val hemizygous and SCZ- subjects more often Met hemizygous. Significant COMT cross gender interactions were found on dopaminergic markers. In SCZ+ subjects there was a negative correlation between prolactin levels and scores on the general psychopathology subscale of the PANSS scores. These findings suggest intriguing, but complex, interactions of the COMT Val¹⁰⁸/¹⁵⁸ Met polymorphism, gender and additional factors on DA metabolism, and its relationship with schizophrenia.
Collapse
Affiliation(s)
- Erik Boot
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Boot E, Booij J, Zinkstok J, Abeling N, de Haan L, Baas F, Linszen D, van Amelsvoort T. Disrupted dopaminergic neurotransmission in 22q11 deletion syndrome. Neuropsychopharmacology 2008; 33:1252-8. [PMID: 17653112 DOI: 10.1038/sj.npp.1301508] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [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: 11/08/2022]
Abstract
22q11 Deletion syndrome (22q11DS) is associated with chromosome 22q11 microdeletions and high rates of psychiatric disorders. Susceptibility for these disorders could be explained by haploinsufficiency of the catechol-O-methyltransferase gene, which encodes an enzyme involved in dopamine (DA) breakdown. It is unknown how dopaminergic neurotransmission is affected in people with 22q11DS. To date, there have been no controlled studies investigating dopaminergic neurotransmission in people with 22q11DS. We report the results of a challenge study in high-functioning adults with 22q11DS and age- and gender-matched controls using neuro-endocrine and peripheral dopaminergic markers. At baseline, 22q11DS subjects compared to controls had higher urine DA levels and lower plasma levels of the predominant DA metabolite homovanillic acid (HVA). Following DA depletion, 22q11DS subjects showed lower urine and plasma HVA levels and a lower prolactin response than controls. The ratio of DA/HVA, a rough index of DA turnover, was significantly higher in the 22q11DS subjects at baseline and after DA depletion. Our results suggest that adults with 22q11DS have disrupted dopaminergic neurotransmission, which might explain their susceptibility for psychiatric disorders.
Collapse
Affiliation(s)
- Erik Boot
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Zinkstok J, van Nimwegen L, van Amelsvoort T, de Haan L, Yusuf MA, Baas F, Linszen D. Catechol-O-methyltransferase gene and obsessive-compulsive symptoms in patients with recent-onset schizophrenia: preliminary results. Psychiatry Res 2008; 157:1-8. [PMID: 17850881 DOI: 10.1016/j.psychres.2007.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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: 04/28/2006] [Revised: 01/26/2007] [Accepted: 02/01/2007] [Indexed: 11/25/2022]
Abstract
The catechol-O-methyltransferase (COMT) gene is a candidate gene for schizophrenia because of its role in the breakdown of dopamine in the prefrontal cortex. The COMT gene contains a functional polymorphism changing enzyme activity that has been associated with some neuropsychiatric (endo)phenotypes, e.g. cognitive performance and anxiety. In this study we investigated the association between the COMT Val(158)Met polymorphism and obsessive-compulsive symptoms in patients with schizophrenia. Severity of obsessive-compulsive symptoms in 77 male patients with recent-onset schizophrenia was assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and the COMT Val(158)Met polymorphism was genotyped for these patients. We found a significant effect of the COMT genotype on Y-BOCS scores: the Val/Val genotype was associated with the highest Y-BOCS scores, whereas patients with the Met/Met genotype had the lowest Y-BOCS scores. Our data suggest that the COMT high-activity Val allele is associated with more obsessive-compulsive symptoms in young patients with schizophrenia. These results support the hypothesis that the COMT Val(158)Met polymorphism may be a modifier gene for the symptomatology of schizophrenia.
Collapse
Affiliation(s)
- Janneke Zinkstok
- Department of Psychiatry, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
22
|
van Amelsvoort T, Zinkstok J, Figee M, Daly E, Morris R, Owen MJ, Murphy KC, De Haan L, Linszen DH, Glaser B, Murphy DGM. Effects of a functional COMT polymorphism on brain anatomy and cognitive function in adults with velo-cardio-facial syndrome. Psychol Med 2008; 38:89-100. [PMID: 17493297 DOI: 10.1017/s0033291707000700] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Velo-cardio-facial syndrome (VCFS) is associated with deletions at chromosome 22q11, abnormalities in brain anatomy and function, and schizophrenia-like psychosis. Thus it is assumed that one or more genes within the deleted region are crucial to brain development. However, relatively little is known about how genetic variation at 22q11 affects brain structure and function. One gene on 22q11 is catechol-O-methyltransferase (COMT): an enzyme that degrades dopamine and contains a functional polymorphism (Val158Met) affecting enzyme activity. Here, we investigated the effect of COMT Val158Met polymorphism on brain anatomy and cognition in adults with VCFS. METHOD The COMT Val158Met polymorphism was genotyped for 26 adults with VCFS on whom DNA was available. We explored its effects on regional brain volumes using hand tracing approaches; on regional grey- and white-matter density using computerized voxel-based analyses; and measures of attention, IQ, memory, executive and visuospatial function using a comprehensive neuropsychological test battery. RESULTS After corrections for multiple comparisons Val-hemizygous subjects, compared with Met-hemizygotes, had a significantly larger volume of frontal lobes. Also, Val-hemizygotes had significantly increased grey matter density in cerebellum, brainstem, and parahippocampal gyrus, and decreased white matter density in the cerebellum. No significant effects of COMT genotype on neurocognitive performance were found. CONCLUSIONS COMT genotype effects on brain anatomy in VCFS are not limited to frontal regions but also involve other structures previously implicated in VCFS. This suggests variation in COMT activity is implicated in brain development in VCFS.
Collapse
Affiliation(s)
- T van Amelsvoort
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Demily C, Legallic S, Bou J, Houy-Durand E, Van Amelsvoort T, Zinkstok J, Manouvrier-Hanue S, Vogels A, Drouin-Garraud V, Philip N, Philippe A, Héron D, Sarda P, Petit M, Thibaut F, Frébourg T, Campion D. ZDHHC8 single nucleotide polymorphism rs175174 is not associated with psychiatric features of the 22q11 deletion syndrome or schizophrenia. Psychiatr Genet 2007; 17:311-2. [PMID: 17728672 DOI: 10.1097/ypg.0b013e328133f369] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Zinkstok J, Schmitz N, van Amelsvoort T, Moeton M, Baas F, Linszen D. Genetic variation in COMT and PRODH is associated with brain anatomy in patients with schizophrenia. Genes Brain Behav 2007; 7:61-9. [PMID: 17504246 DOI: 10.1111/j.1601-183x.2007.00326.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Haploinsufficiency of 22q11 genes including catechol-O-methyltransferase (COMT) and proline dehydrogenase (PRODH) may result in structural and functional brain abnormalities and increased vulnerability to schizophrenia as observed in patients with microdeletions of 22q11. Thus, COMT and PRODH could be modifier genes for schizophrenia. We examined association of polymorphisms in COMT and PRODH with brain anatomy in young patients with schizophrenia and schizoaffective disorder. We acquired structural magnetic resonance imaging data from 51 male patients and genotyped two single nucleotide polymorphisms (SNPs) in the COMT gene and three in the PRODH gene. Statistical Parametric Mapping software and optimized voxel-based morphometry were used to determine regional gray matter (GM) and white matter (WM) density differences, and total GM and WM volume differences between genotype groups. Two nonsynonymous SNPs in the PRODH gene were associated with bilateral frontal WM density reductions and an SNP in the P2 promoter region of COMT (rs2097603) was associated with GM increase in the right superior temporal gyrus. Furthermore, we found evidence for COMT and PRODH epistasis: in patients with a COMT Val allele (rs4680) and with one or two mutated PRODH alleles, we observed increased WM density in the left inferior frontal lobe. Our results suggest that genetic variation in COMT and PRODH has significant effects on brain regions known to be affected in schizophrenia. Further research is needed to investigate the role of 22q11 genes on brain structure and function and their role in vulnerability for schizophrenia.
Collapse
Affiliation(s)
- J Zinkstok
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
25
|
Abstract
22q11.2 Deletion Syndrome is associated with cognitive, behavioural, and psychiatric problems and is known to affect brain structure. Recently, 22q11.2 Deletion Syndrome has been proposed as a disease model for a genetic subtype of schizophrenia. In this paper we discuss the currently available literature on neurocognitive functioning and brain anatomy in patients with 22q11.2 Deletion Syndrome, and how this contributes to our understanding of the neurobiology of schizophrenia. Research on cognitive functioning in 22q11.2 Deletion Syndrome patients suggests a specific cognitive profile with impairments on arithmetical, visuo-spatial, and executive tasks and relatively preserved language skills. Prominent findings of neuroimaging studies in 22q11.2 Deletion Syndrome patients are: reduction of overall brain volume, midline defects, structural alterations of cerebellum and frontal lobe, white matter abnormalities, and decreased grey matter volumes in parietal and temporal areas. We describe how brain abnormalities in patients with 22q11.2 Deletion Syndrome may contribute to the understanding of the clinical syndrome including cognitive impairments, psychotic symptoms, and social and communication problems.
Collapse
Affiliation(s)
- Janneke Zinkstok
- Department of Psychiatry, Academic Medical Centre, Tafelbergweg 25, 1105 BC Amsterdam, The Netherlands.
| | | |
Collapse
|
26
|
Raux G, Bumsel E, Hecketsweiler B, van Amelsvoort T, Zinkstok J, Manouvrier-Hanu S, Fantini C, Brévière GMM, Di Rosa G, Pustorino G, Vogels A, Swillen A, Legallic S, Bou J, Opolczynski G, Drouin-Garraud V, Lemarchand M, Philip N, Gérard-Desplanches A, Carlier M, Philippe A, Nolen MC, Heron D, Sarda P, Lacombe D, Coizet C, Alembik Y, Layet V, Afenjar A, Hannequin D, Demily C, Petit M, Thibaut F, Frebourg T, Campion D. Involvement of hyperprolinemia in cognitive and psychiatric features of the 22q11 deletion syndrome. Hum Mol Genet 2006; 16:83-91. [PMID: 17135275 DOI: 10.1093/hmg/ddl443] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Microdeletions of the 22q11 region, responsible for the velo-cardio-facial syndrome (VCFS), are associated with an increased risk for psychosis and mental retardation. Recently, it has been shown in a hyperprolinemic mouse model that an interaction between two genes localized in the hemideleted region, proline dehydrogenase (PRODH) and catechol-o-methyl-transferase (COMT), could be involved in this phenotype. Here, we further characterize in eight children the molecular basis of type I hyperprolinemia (HPI), a recessive disorder resulting from reduced activity of proline dehydrogenase (POX). We show that these patients present with mental retardation, epilepsy and, in some cases, psychiatric features. We next report that, among 92 adult or adolescent VCFS subjects, a subset of patients with severe hyperprolinemia has a phenotype distinguishable from that of other VCFS patients and reminiscent of HPI. Forward stepwise multiple regression analysis selected hyperprolinemia, psychosis and COMT genotype as independent variables influencing IQ in the whole VCFS sample. An inverse correlation between plasma proline level and IQ was found. In addition, as predicted from the mouse model, hyperprolinemic VCFS subjects bearing the Met-COMT low activity allele are at risk for psychosis (OR = 2.8, 95% CI = 1.04-7.4). Finally, from the extensive analysis of the PRODH gene coding sequence variations, it is predicted that POX residual activity in the 0-30% range results into HPI, whereas residual activity in the 30-50% range is associated either with normal plasma proline levels or with mild-to-moderate hyperprolinemia.
Collapse
Affiliation(s)
- Grégory Raux
- Department of Genetics and Inserm U614, IFRMP, Faculty of Medicine, Rouen, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|