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George R, Good KP, Rigby H. Limb Temperature in Parkinson's Disease: Is It Symmetric? Can J Neurol Sci 2024:1-2. [PMID: 38297493 DOI: 10.1017/cjn.2024.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Rebecca George
- Division of Neurology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kimberley P Good
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Heather Rigby
- Division of Neurology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
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Rudoler D, Lavergne MR, Marshall EG, Zaheer J, Etches S, Good KP, Grudniewicz A, Katz A, Kurdyak P, Bolton J, Kaoser R, Moravac C, Morrison J, Mulsant B, Peterson S, Tibbo PG. Pan-Canadian study of psychiatric care (PCPC): protocol for a mixed-methods study. BMJ Open 2023; 13:e073183. [PMID: 37463812 PMCID: PMC10357719 DOI: 10.1136/bmjopen-2023-073183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION The Canadian population has poor and inequitable access to psychiatric care despite a steady per-capita supply of psychiatrists in most provinces. There is some quantitative evidence that practice style and characteristics vary substantially among psychiatrists. However, how this compares across jurisdictions and implications for workforce planning require further study. A qualitative exploration of psychiatrists' preferences for practice style and the practice choices that result is also lacking. The goal of this study is to inform psychiatrist workforce planning to improve access to psychiatric care by: (1) developing and evaluating comparable indicators of supply of psychiatric care across provinces, (2) analysing variations and changes in the characteristics of the psychiatrist workforce, including demographics and practice style and (3) studying psychiatrist practice choices and intentions, and the factors that lead to these choices. METHODS AND ANALYSIS A cross-provincial mixed-methods study will be conducted in the Canadian provinces of British Columbia, Manitoba, Ontario and Nova Scotia. We will analyse linked-health administrative data within three of the four provinces to develop comparable indicators of supply and characterise psychiatric services at the regional level within provinces. We will use latent profile analysis to estimate the probability that a psychiatrist is in a particular practice style and map the geographical distribution of psychiatrist practices overlayed with measures of need for psychiatric care. We will also conduct in-depth, semistructured qualitative interviews with psychiatrists in each province to explore their preferences and practice choices and to inform workforce planning. ETHICS AND DISSEMINATION This study was approved by Ontario Tech University Research Ethics Board (16637 and 16795) and institutions affiliated with the study team. We built a team comprising experienced researchers, psychiatrists, medical educators and policymakers in mental health services and workforce planning to disseminate knowledge that will support effective human resource policies to improve access to psychiatric care in Canada.
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Affiliation(s)
- David Rudoler
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - M Ruth Lavergne
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Emily Gard Marshall
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Juveria Zaheer
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Selene Etches
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kimberley P Good
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Agnes Grudniewicz
- Telfer School of Management University of Ottawa, Ottawa, Ontario, Canada
| | - Alan Katz
- Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Family Medicine, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ridhwana Kaoser
- Faculty of Health Sciences, Simon Fraser University at Harbour Centre, Vancouver, British Columbia, Canada
| | - Catherine Moravac
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Jason Morrison
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Benoit Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Phil G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Stewart SA, Pimer L, Fisk JD, Rusak B, Leslie RA, Eskes G, Schoffer K, McKelvey JR, Rolheiser T, Khan MN, Robertson H, Good KP. Olfactory Function and Diffusion Tensor Imaging as Markers of Mild Cognitive Impairment in Early Stages of Parkinson's Disease. Clin EEG Neurosci 2023; 54:91-97. [PMID: 34841903 PMCID: PMC9693894 DOI: 10.1177/15500594211058263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 11/16/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder that is typified by motor signs and symptoms but can also lead to significant cognitive impairment and dementia Parkinson's Disease Dementia (PDD). While dementia is considered a nonmotor feature of PD that typically occurs later, individuals with PD may experience mild cognitive impairment (PD-MCI) earlier in the disease course. Olfactory deficit (OD) is considered another nonmotor symptom of PD and often presents even before the motor signs and diagnosis of PD. We examined potential links among cognitive impairment, olfactory functioning, and white matter integrity of olfactory brain regions in persons with early-stage PD. Cognitive tests were used to establish groups with PD-MCI and with normal cognition (PD-NC). Olfactory functioning was examined using the University of Pennsylvania Smell Identification Test (UPSIT) while the white matter integrity of the anterior olfactory structures (AOS) was examined using magnetic resonance imaging (MRI) diffusion tensor imaging (DTI) analysis. Those with PD-MCI demonstrated poorer olfactory functioning and abnormalities based on all DTI parameters in the AOS, relative to PD-NC individuals. OD and microstructural changes in the AOS of individuals with PD may serve as additional biological markers of PD-MCI.
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Affiliation(s)
| | - Laura Pimer
- 3688Dalhousie University, Halifax, NS, Canada
| | - John D Fisk
- 432234Nova Scotia Health, Halifax, NS, Canada
| | | | | | - Gail Eskes
- 3688Dalhousie University, Halifax, NS, Canada
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4
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Pimer LJ, Leslie RA, Phillips G, Newman AJ, Rusak B, Rolheiser TM, Schoffer K, Khan MN, McKelvey JR, Robertson HA, Good KP. Aberrant corticospinal tract characteristics in prodromal PD: A diffusion tensor imaging study. Clin Park Relat Disord 2022; 8:100182. [PMID: 36632053 PMCID: PMC9827373 DOI: 10.1016/j.prdoa.2022.100182] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Parkinson's disease (PD) is typically diagnosed when motor symptoms first occur. However, PD-related non-motor symptoms may appear several years before diagnosis. REM sleep behaviour disorder (RBD) and olfactory deficits (hyposmia) are risk factors, but they are not specific for predicting progression towards PD. Other PD-related markers, for example brain imaging markers, may help to identify preclinical PD in hyposmic RBD patients. Studies have reported abnormal structural characteristics in the corticospinal tract (CST) of PD patients, but it is unclear whether hyposmic RBD patients have similar abnormalities that may help to predict PD in these individuals. This study examined whether CST abnormalities may be a potential marker of PD risk by using diffusion tensor imaging (DTI) measures. Methods Twenty hyposmic RBD patients, 31 PD patients, and 29 healthy controls (HCs) were studied. DTI data were collected on a 1.5 T MRI scanner and CST characteristics (FA, MD, AD, and RD) were evaluated using probabilistic tractography (with seed regions in the bilateral primary motor cortex and mediolateral cerebral peduncles). Olfactory function was assessed with the University of Pennsylvania Smell Identification Test (UPSIT). Results Hyposmic RBD patients showed significantly higher mean diffusivity (MD) values of the right CST compared to HCs but did not differ from PD patients. PD patients showed a trend of higher MD values compared to HCs. Conclusions Altered diffusivity in the CST seems to be associated with RBD. The combination of RBD, hyposmia, and CST alterations may be related to later development of PD with comorbid RBD.
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Affiliation(s)
- Laura J. Pimer
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Building, 5909 Veterans’ Memorial Lane, Halifax, NS B3H 2E2, Canada
| | - Ronald A. Leslie
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Building, 5909 Veterans’ Memorial Lane, Halifax, NS B3H 2E2, Canada
| | - Gosia Phillips
- Division of Respirology, Department of Medicine, Nova Scotia Health Authority, QEII - Halifax Infirmary, Suite 4449 Halifax Infirmary Building, 1796 Summer Street, Halifax, NS B3H 3A7, Canada
| | - Aaron J. Newman
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Building, 5909 Veterans’ Memorial Lane, Halifax, NS B3H 2E2, Canada,Department of Psychology and Neuroscience, Dalhousie University, 1355 Oxford Street, Rm 3263, 3rd Floor Life Sciences Centre (Psychology Wing), P.O. Box 15000, Halifax, NS B3H 4R2, Canada
| | - Benjamin Rusak
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Building, 5909 Veterans’ Memorial Lane, Halifax, NS B3H 2E2, Canada,Department of Psychology and Neuroscience, Dalhousie University, 1355 Oxford Street, Rm 3263, 3rd Floor Life Sciences Centre (Psychology Wing), P.O. Box 15000, Halifax, NS B3H 4R2, Canada
| | - Tyler M. Rolheiser
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Building, 5909 Veterans’ Memorial Lane, Halifax, NS B3H 2E2, Canada
| | - Kerrie Schoffer
- Division of Neurology, Department of Medicine, Nova Scotia Health Authority, QEII - Halifax Infirmary Site, Suite 3822, Halifax Infirmary Building, 1796 Summer Street, Halifax, NS B3H 3A7, Canada
| | - M. Naeem Khan
- Department of Radiology, IWK Health Centre, 5850/5980 University Avenue, PO BOX 9700, Halifax, NS B3K 6R8, Canada
| | - J. Roger McKelvey
- Division of Neurology, Department of Medicine, Nova Scotia Health Authority, QEII - Halifax Infirmary Site, Suite 3822, Halifax Infirmary Building, 1796 Summer Street, Halifax, NS B3H 3A7, Canada
| | - Harold A. Robertson
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Building, 5909 Veterans’ Memorial Lane, Halifax, NS B3H 2E2, Canada,Department of Pharmacology, Dalhousie University, P.O. Box 15000, Halifax, NS B3H 4R2, Canada
| | - Kimberley P. Good
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Building, 5909 Veterans’ Memorial Lane, Halifax, NS B3H 2E2, Canada,Department of Psychology and Neuroscience, Dalhousie University, 1355 Oxford Street, Rm 3263, 3rd Floor Life Sciences Centre (Psychology Wing), P.O. Box 15000, Halifax, NS B3H 4R2, Canada,Corresponding author at: Department of Psychiatry, Abbie J. Lane Building, 5909 Veterans’ Memorial Lane, Halifax, NS B3H 2E2, Canada.
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Joyce KM, Thompson K, Good KP, Tibbo PG, O'Leary ME, Perrot TS, Hudson A, Stewart SH. The impact of depressed mood and coping motives on cannabis use quantity across the menstrual cycle in those with and without pre-menstrual dysphoric disorder. Addiction 2021; 116:2746-2758. [PMID: 33651443 DOI: 10.1111/add.15465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/11/2020] [Accepted: 02/17/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Reported rates of cannabis use among Canadian females are increasing. Female cannabis users progress to cannabis use disorder more rapidly than males (telescoping) and have higher rates of emotional disorder comorbidity. Addictive behaviors may change, along with mood and motivations, across the menstrual cycle (MC), particularly for females with pre-menstrual dysphoric disorder (PMDD). This study aimed to determine whether increases in depressed mood and coping motives would predict increased cannabis use pre-menstrually/menstrually, particularly among females with PMDD. We also assessed positive mood and enhancement motive ratings to establish specificity of predicted depressed mood and coping motive results. DESIGN Observational study using data collected across 32 days using electronic daily diary methods. SETTING Nova Scotia, Canada. PARTICIPANTS Sixty-nine naturally cycling female cannabis users (Mean (M) age = 29.25, Standard Deviation (SD) = 5.66) with and without retrospectively identified PMDD (via structured clinical interview) and prospectively identified PMDD (via elevated pre-menstrual depressed mood). Self-reported MC phase was validated using salivary progesterone concentrations. MEASUREMENTS Depressed/positive mood, coping-/enhancement-motivated cannabis use, and cannabis use quantity. FINDINGS Coping motives explained heightened cannabis use pre-menstrually/menstrually in those with retrospectively identified PMDD. Depressed mood explained increased cannabis use menstrually in those with retrospectively/prospectively identified PMDD. Moreover, prospectively identified PMDD significantly moderated the relationship between depressed mood and cannabis use quantity menstrually. In those with prospectively identified PMDD, positive mood and enhancement motives were associated with decreased cannabis use during the follicular/ovulatory phases. Females with versus without retrospectively identified PMDD also displayed greater overall cannabis use quantity (M [SD] = 3.44[2.84] standard joint equivalents versus 1.85[1.82], respectively; U = 277.50, P = 0.008). CONCLUSIONS Depressed mood may explain heightened cannabis use menstrually in females with pre-menstrual dysphoric disorder. Coping motives may explain heightened cannabis use pre-menstrually/menstrually in females with retrospectively identified with pre-menstrual dysphoric disorder.
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Affiliation(s)
- Kayla M Joyce
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Building, 5909 Veterans' Memorial Lane, Halifax, NS, Canada
| | - Kara Thompson
- Department of Psychology, St. Francis Xavier University, 2323 Notre Dame Ave., Antigonish, NS, Canada
| | - Kimberley P Good
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Building, 5909 Veterans' Memorial Lane, Halifax, NS, Canada.,Department of Psychology and Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, NS, Canada
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Building, 5909 Veterans' Memorial Lane, Halifax, NS, Canada
| | - M Elizabeth O'Leary
- Department of Psychology and Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, NS, Canada
| | - Tara S Perrot
- Department of Psychology and Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, NS, Canada
| | - Amanda Hudson
- Health PEI, Mental Health and Addictions Research Centre, 347 Church Street, Alberton, PEI, Canada
| | - Sherry H Stewart
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Building, 5909 Veterans' Memorial Lane, Halifax, NS, Canada.,Department of Psychology and Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, NS, Canada
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6
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Perry RN, Schlagintweit HE, Darredeau C, Helmick C, Newman AJ, Good KP, Barrett SP. Corrigendum to The impacts of actual and perceived nicotine administration on insula functional connectivity with the anterior cingulate cortex and nucleus accumbens. J Psychopharmacol 2020; 34:588. [PMID: 32013675 PMCID: PMC7290412 DOI: 10.1177/0269881120902733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Perry RN, Schlagintweit HE, Darredeau C, Helmick C, Newman AJ, Good KP, Barrett SP. The impacts of actual and perceived nicotine administration on insula functional connectivity with the anterior cingulate cortex and nucleus accumbens. J Psychopharmacol 2019; 33:1600-1609. [PMID: 31542980 PMCID: PMC6854612 DOI: 10.1177/0269881119872205] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Changes in resting state functional connectivity between the insula and dorsal anterior cingulate cortex as well as between the insula and nucleus accumbens have been linked to nicotine withdrawal and/or administration. However, because many of nicotine's effects in humans appear to depend, at least in part, on the belief that nicotine has been administered, the relative contribution of nicotine's pharmacological actions to such effects requires clarification. AIMS The purpose of this study was to examine the impacts of perceived and actual nicotine administration on neural responses. METHODS Twenty-six smokers were randomly assigned to receive either a nicotine inhaler (4 mg deliverable) or a nicotine-free inhaler across two sessions. Inhaler content instructions (told nicotine vs told nicotine-free) differed across sessions. Resting state functional connectivity between sub-regions of the insula and the dorsal anterior cingulate cortex and nucleus accumbens was measured using magnetic resonance imaging before and after inhaler administration. RESULTS Both actual and perceived nicotine administration independently altered resting state functional connectivity between the anterior insula and the dorsal anterior cingulate cortex, with actual administration being associated with decreased resting state functional connectivity, and perceived administration with increased resting state functional connectivity. Actual nicotine administration also contralaterally reduced resting state functional connectivity between the anterior insula and nucleus accumbens, while reductions in resting state functional connectivity between the mid-insula and right nucleus accumbens were observed when nicotine was administered unexpectedly. Changes in resting state functional connectivity associated with actual or perceived nicotine administration were unrelated to changes in subjective withdrawal and craving. Changes in withdrawal and craving were however independently associated with resting state functional connectivity between the nucleus accumbens and insula. CONCLUSIONS Our findings highlight the importance of considering non-pharmacological factors when examining drug mechanisms of action.
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Affiliation(s)
- Robin N Perry
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Hera E Schlagintweit
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Christine Darredeau
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Carl Helmick
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Aaron J Newman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Kimberley P Good
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Sean P Barrett
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Sean P. Barrett, Department of Psychology and Neuroscience, Dalhousie University, Life Sciences Centre, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada.
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8
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Good KP, Kiss I, Buiteman C, Woodley H, Rui Q, Whitehorn D, Kopala L. Improvement in cognitive functioning in patients with first-episode psychosis during treatment with quetiapine: An interim analysis. Br J Psychiatry 2018; 43:s45-9. [PMID: 12271800 DOI: 10.1192/bjp.181.43.s45] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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] [Indexed: 11/23/2022]
Abstract
BackgroundThe efficacies of second-generation antipsychotic medications in reducing symptoms are reasonably well-documented, but their effects on cognition are less clearly understood.AimsTo undertake an interim analysis of an open label, 2-year study examining the effects of quetiapine on cognition in patients with a first episode of schizophrenia and related disorders.MethodCognitive testing was performed before quetiapine was initiated and repeated after 3, 6 and 12 months of treatment. To date, 13 patients have been fully assessed (mean dose 517.9 mg/day; s.d.=225.8).ResultsStatistically significant improvement was noted on measures of attention (Continuous Performance Test; CPT), verbal productivity (Verbal Fluency Test) and executive function (Object Alternation Test) after 6 and 12 months of treatment. For the CPT, improvement was also noted after 3 months of treatment.ConclusionsDuring treatment for 1 year with quetiapine, cognitive performance was improved in young patients with psychosis. Continued controlled investigations of the effects of quetiapine on cognition are desirable.
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Affiliation(s)
- K P Good
- Department of Psychiatry, Dalhousie University, Suite 3073-AJLB, 5909 Veterans' Memorial Lane, Halifax, Nova Scotia, Canada B3H 2E2.
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9
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Joshi N, Rolheiser TM, Fisk JD, McKelvey JR, Schoffer K, Phillips G, Armstrong M, Khan MN, Leslie RA, Rusak B, Robertson HA, Good KP. Lateralized microstructural changes in early-stage Parkinson's disease in anterior olfactory structures, but not in substantia nigra. J Neurol 2017; 264:1497-1505. [PMID: 28653210 DOI: 10.1007/s00415-017-8555-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 12/17/2022]
Abstract
Parkinson's disease (PD) is a progressive neurological disorder characterized by motor symptoms as well as severe deficits in olfactory function and microstructural changes in olfactory brain regions. Because of the evidence of asymmetric neuropathological features in early-stage PD, we examined whether lateralized microstructural changes occur in olfactory brain regions and the substantia nigra in a group of early-stage PD patients. Using diffusion tensor imaging (DTI) and the University of Pennsylvania Smell Identification Test (UPSIT), we assessed 24 early-stage PD patients (Hoehn and Yahr stage 1 or 2) and 26 healthy controls (HC). We used DTI and a region of interest (ROI) approach to study the microstructure of the left and right anterior olfactory structures (AOS; comprising the olfactory bulbs and anterior end of the olfactory tracts) and the substantia nigra (SN). PD patients had reduced UPSIT scores relative to HC and showed increased mean diffusivity (MD) in the SN, with no lateralized differences. Significant group differences in fractional anisotropy (FA) and MD were seen in the AOS, but these differences were restricted to the right side and were not associated with the primary side of motor symptoms amongst PD patients. No associations were observed between lateralized motor impairment and lateralized microstructural changes in AOS. Impaired olfaction and microstructural changes in AOS are useful for early identification of PD but asymmetries in AOS microstructure seem unrelated to the laterality of PD motor symptoms.
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Affiliation(s)
- N Joshi
- Department of Psychiatry, IWK Hospital, Halifax, NS, Canada
| | - T M Rolheiser
- Department of Psychiatry, Dalhousie University, 4064 AJLB, 5909 Veterans Memorial Lane, Halifax, NS, Canada
| | - J D Fisk
- Department of Psychology, Nova Scotia Health Authority, Central Zone, Halifax, NS, Canada
| | - J R McKelvey
- Division of Neurology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - K Schoffer
- Division of Neurology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - G Phillips
- Division of Respirology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - M Armstrong
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - M N Khan
- Department of Radiology, IWK Hospital, Halifax, NS, Canada
| | - R A Leslie
- Department of Medical Neurosciences, Dalhousie University, Halifax, NS, Canada
| | - B Rusak
- Department of Psychiatry, Dalhousie University, 4064 AJLB, 5909 Veterans Memorial Lane, Halifax, NS, Canada.,Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - H A Robertson
- Department of Psychiatry, Dalhousie University, 4064 AJLB, 5909 Veterans Memorial Lane, Halifax, NS, Canada.,Division of Neurology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - K P Good
- Department of Psychiatry, Dalhousie University, 4064 AJLB, 5909 Veterans Memorial Lane, Halifax, NS, Canada. .,Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
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10
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Good KP, Tourbier IA, Moberg P, Cuzzocreo JL, Geckle RJ, Yousem DM, Pham DL, Doty RL. Unilateral olfactory sensitivity in multiple sclerosis. Physiol Behav 2016; 168:24-30. [PMID: 27780720 DOI: 10.1016/j.physbeh.2016.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 09/27/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
It is not known whether lateralized olfactory sensitivity deficits are present in MS. Since projections from the olfactory bulb to the olfactory cortex are largely ipsilateral, and since both functional imaging and psychophysical studies suggest that the right side of the brain may be more involved in olfactory processing than the left, we addressed this issue by administering well-validated tests of odor detection, along with tests of odor identification, to each side of the nose of 73 MS patients and 73 age-, gender-, and race-matched normal controls. We also determined, in 63 of the MS patients, whether correlations were present between the olfactory test measures and MRI-determined lesions in brain regions ipsilateral and contralateral to the nose side that was tested. No significant left:right differences in either olfactory sensitivity or identification were present, although in both cases mean performance was lower in the MS than in the control subjects (ps<0.0001). Scores on the two sides of the nose were positively correlated with one another (threshold r=0.56, p<0.0001; Identification r=0.71, p<0.0001). The percent of MS patients whose bilateral test scores fell below the 10th percentile of controls did not differ between the odor identification and detection threshold tests. Both left and right odor identification and detection test scores were weakly correlated with lesion volumes in temporal and frontal lobe brain regions (r's<0.40). Our findings demonstrate that MS does not differentially influence odor perception on left and right sides of the nose, regardless of whether sensitivity or identification is being measured. They also indicate that tests of odor identification and detection are similarly influenced by MS and that such influences are associated with central brain lesions.
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Affiliation(s)
- Kimberley P Good
- Department of Psychiatry and Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Isabelle A Tourbier
- Smell and Taste Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Otorhinolarynology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Paul Moberg
- Smell and Taste Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Otorhinolarynology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jennifer L Cuzzocreo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rena J Geckle
- Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - David M Yousem
- Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Dzung L Pham
- Center for Neuroscience and Regenerative Medicine, Henry Jackson Foundation, Bethesda, MD, United States
| | - Richard L Doty
- Smell and Taste Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Otorhinolarynology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
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Good KP, Sullivan RL. Olfactory function in psychotic disorders: Insights from neuroimaging studies. World J Psychiatry 2015; 5:210-221. [PMID: 26110122 PMCID: PMC4473492 DOI: 10.5498/wjp.v5.i2.210] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/06/2015] [Accepted: 03/18/2015] [Indexed: 02/05/2023] Open
Abstract
Olfactory deficits on measures of identification, familiarity, and memory are consistently noted in patients with psychotic disorders relative to age-matched controls. Olfactory intensity ratings, however, appear to remain intact while the data on hedonics and detection threshold are inconsistent. Despite the behavioral abnormalities noted, no specific regional brain hypoactivity has been identified in psychosis patients, for any of the olfactory domains. However, an intriguing finding emerged from this review in that the amygdala and pirifom cortices were not noted to be abnormal in hedonic processing (nor was the amygdala identified abnormal in any study) in psychotic disorders. This finding is in contrast to the literature in healthy individuals, in that this brain region is strongly implicated in olfactory processing (particularly for unpleasant odorants). Secondary olfactory cortex (orbitofrontal cortices, thalamus, and insula) was abnormally activated in the studies examined, particularly for hedonic processing. Further research, using consistent methodology, is required for better understanding the neurobiology of olfactory deficits. The authors suggest taking age and sex differences into consideration and further contrasting olfactory subgroups (impaired vs intact) to better our understanding of the heterogeneity of psychotic disorders.
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Balter LJT, Good KP, Barrett SP. Smoking cue reactivity in current smokers, former smokers and never smokers. Addict Behav 2015; 45:26-9. [PMID: 25635692 DOI: 10.1016/j.addbeh.2015.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 12/17/2014] [Accepted: 01/12/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Smoking related stimuli are known to increase both subjective craving and heart rate in smokers; however, little is currently known about the effects of such stimuli in former smokers. METHODS Subjective craving and heart rate were measured in 38 never smokers, 20 former smokers, and 30 current smokers exposed to video clips containing neutral and smoking related cues. RESULTS Compared with neutral cues, smoking cues significantly increased both heart rate and self-reported craving in current smokers, while in former smokers smoking cues were associated with a significant decrease in heart rate as well as with a relatively diminished increase in subjective craving. Neither craving nor heart rate was impacted by the smoking cues in never smokers. CONCLUSIONS Findings suggest that while smoking related stimuli continue to elicit modest subjective cravings in former smokers, there appears to be a marked change in the typical physiological response associated with such stimuli.
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Affiliation(s)
- Leonie J T Balter
- Department of Psychiatry, Dalhousie University, Canada; Department of Psychology and Neuroscience, Dalhousie University, Canada
| | - Kimberley P Good
- Department of Psychiatry, Dalhousie University, Canada; Department of Psychology and Neuroscience, Dalhousie University, Canada
| | - Sean P Barrett
- Department of Psychiatry, Dalhousie University, Canada; Department of Psychology and Neuroscience, Dalhousie University, Canada.
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Abstract
Reduced craving associated with nicotine replacement therapy use is frequently attributed to the effects of nicotine pharmacology, however non-pharmacological factors may also play a role. This study examined the impact of nicotine pharmacology and non-pharmacological components of an acute nicotine lozenge (4 mg) on cigarette craving, mood and heart rate in 70 daily smokers (36 male). Smoking-related stimuli were used to assess cue-induced craving. Participants were randomly assigned to one of four conditions in a balanced placebo design where half the participants were provided deceptive information regarding the nicotine content of a lozenge. Subjective ratings of craving and mood were collected and heart rate was assessed before and after neutral and smoking cues. Nicotine expectancy reduced withdrawal-related craving (p = 0.006) regardless of actual nicotine administration while combined nicotine expectancy and administration reduced intentions to smoke (p = 0.046) relative to each of the other conditions. Exposure to smoking-related stimuli increased cigarette craving (p ≤ 0.001) and negative affect (p ≤ 0.001) regardless of expectancy or pharmacology. Following the smoking cue, women reported a greater increase in withdrawal-related craving than men (p = 0.027). Findings suggest that both pharmacological and non-pharmacological components of nicotine lozenge administration contribute to its acute effects on craving, yet neither appears effective in preventing craving triggered by exposure to environmental smoking stimuli.
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Affiliation(s)
- Hera E Schlagintweit
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Kimberley P Good
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Sean P Barrett
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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Turetsky BI, Kamath V, Calkins ME, Brewer WJ, Wood SJ, Pantelis C, Seidman LJ, Malaspina D, Good KP, Kopala LC, Moberg PJ. Olfaction and schizophrenia clinical risk status: just the facts. Schizophr Res 2012; 139:260-1; author reply 262-3. [PMID: 22591778 PMCID: PMC3903322 DOI: 10.1016/j.schres.2012.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 04/11/2012] [Accepted: 04/12/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Bruce I. Turetsky
- Neuropsychiatry Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Correspondence to: Bruce Turetsky, M.D., 10 Floor, Gates Building, Department of Psychiatry, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, , phone: (215) 615-3607, fax: (215) 662-7903
| | - Vidyulata Kamath
- Neuropsychiatry Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Monica E. Calkins
- Neuropsychiatry Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Warrick J. Brewer
- Orygen Youth Health Research Centre and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Stephen J. Wood
- School of Psychology, University of Birmingham, United Kingdom
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Larry J. Seidman
- Department of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Dolores Malaspina
- New York University School of Medicine, Institute for Social and Psychiatric Initiatives, New York, New York, USA
| | - Kimberley P. Good
- Nova Scotia Early Psychosis Program, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lili C. Kopala
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul J. Moberg
- Neuropsychiatry Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Rolheiser TM, Fulton HG, Good KP, Fisk JD, McKelvey JR, Scherfler C, Khan NM, Leslie RA, Robertson HA. Diffusion tensor imaging and olfactory identification testing in early-stage Parkinson's disease. J Neurol 2011; 258:1254-60. [PMID: 21287185 DOI: 10.1007/s00415-011-5915-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 01/19/2023]
Abstract
Evidence from imaging, clinical studies, and pathology suggests that Parkinson's disease is preceded by a prodromal stage that predates clinical diagnosis by several years but there is no established method for detecting this stage. Olfactory impairment, which is common in Parkinson's disease and often predates clinical diagnosis, may be a useful biomarker for early Parkinson's. Evidence is emerging that diffusion imaging parameters might be altered in olfactory tract and substantia nigra in the early stages of clinical Parkinson's disease, possibly reflecting pathological changes. However, no study has examined olfaction and diffusion imaging in olfactory tract and substantia nigra in the same group of patients. The present study compared newly diagnosed Parkinson's disease patients with a matched control group using both olfactory testing and diffusion tensor imaging of the substantia nigra and anterior olfactory structures. Fourteen patients with stage 1-2 Hoehn & Yahr Parkinson's disease were matched to a control group by age and sex. All subjects then completed the University of Pennsylvania Smell Identification Test, as well as a series of MRI scans designed to examine diffusion characteristics of the olfactory tract and the substantia nigra. Olfactory testing revealed significant impairment in the patient group. Diffusion tensor imaging revealed significant group differences in both the substantia nigra and anterior olfactory region, with fractional anisotropy of the olfactory region clearly distinguishing the Parkinson's subjects from controls. This study suggests that there may be value in combining behavioral (olfaction) and MRI testing to identify early Parkinson's disease. Since loss of olfaction often precedes the motor symptoms in Parkinson's disease, the important question raised is "will the combination of olfactory testing and MRI (DTI) testing identify pre-motor Parkinson's disease?"
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Affiliation(s)
- Tyler M Rolheiser
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
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16
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Good KP, Tibbo P, Milliken H, Whitehorn D, Alexiadis M, Robertson N, Kopala LC. An investigation of a possible relationship between olfactory identification deficits at first episode and four-year outcomes in patients with psychosis. Schizophr Res 2010; 124:60-5. [PMID: 20692126 DOI: 10.1016/j.schres.2010.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 07/07/2010] [Accepted: 07/12/2010] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Olfactory identification deficits are found in a significant proportion of patients with schizophrenia spectrum psychotic disorders and appear to be predictive of incomplete remission of negative and cognitive symptoms. In the current study, we examined whether patients with first episode psychosis who have olfactory identification deficits (microsmic) have poorer functional outcome than those whose olfactory status is normal (normosmic). METHOD Sixty-six (66) first episode psychosis patients (46 M and 20 F) were assessed with the University of Pennsylvania Smell Identification Test (UPSIT) at baseline. UPSIT scores served to classify patients into subgroups. The patients' psychiatrists completed the Social and Occupational Functioning Assessment Scale (SOFAS) and the Levels of Functioning Scale (LOFS) after at least 6 months of treatment. The Premorbid Assessment Scale (PAS) was rated by a parent at baseline. RESULTS Thirty-eight percent (38%) of the sample was identified as 'microsmic'. LOFS and SOFAS scores were significantly lower in the microsmic group than in the normosmic group. Symptoms were significantly worse in the microsmic group in comparison to the normosmic group. PAS scores did not differ between groups. CONCLUSIONS First episode patients identified as microsmic at baseline assessment went on to demonstrate poorer functional outcome compared to normosmic patients despite no differences in premorbid adjustment. Olfactory identification deficits at first episode may provide a marker for poorer outcome. Testing olfaction is simple and inexpensive, and could provide clinically valuable information at first episode to identify those patients who might benefit from more intensive interventions promoting functional recovery.
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17
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Kreutzweiser DP, Good KP, Chartrand DT, Scarr TA, Thompson DG. Toxicity of the systemic insecticide, imidacloprid, to forest stream insects and microbial communities. Bull Environ Contam Toxicol 2008; 80:211-214. [PMID: 18188485 DOI: 10.1007/s00128-007-9347-8] [Citation(s) in RCA: 24] [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] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 12/18/2007] [Indexed: 05/25/2023]
Abstract
Imidacloprid was added to laboratory aquatic microcosms at concentrations of 12, 24, 48 and 96 microg/L to determine effects on leaf-shredding aquatic insect survival and feeding rates, and on aquatic microbial decomposition of leaf material. Survival of the stonefly, Pteronarcys dorsata, was significantly reduced at 48 and 96 microg/L. There was no significant mortality of the cranefly, Tipula sp., but most surviving tipulids were very sluggish and non-responsive to prodding at 48 and 96 microg/L. Leaf decomposition by these leaf-shredding insects was significantly reduced at all test concentrations. There were no significant adverse effects on microbial decomposition of leaf material.
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Affiliation(s)
- D P Kreutzweiser
- Canadian Forest Service, Natural Resources Canada, Marie, ON, Canada.
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Good KP, Leslie RA, McGlone J, Milliken HI, Kopala LC. Sex differences in olfactory function in young patients with psychotic disorders. Schizophr Res 2007; 97:97-102. [PMID: 17707121 DOI: 10.1016/j.schres.2007.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 04/18/2007] [Revised: 07/09/2007] [Accepted: 07/09/2007] [Indexed: 01/22/2023]
Abstract
Female superiority on many measures of olfactory function is well established, but debate remains as to whether this pattern extends to patients with psychotic disorders. The purpose of this large retrospective study was to re-examine whether male vs. female differences in olfactory identification exist in patients with psychotic disorders, and if so, whether any such differences were related to features of the psychotic disorder or could be explained by a generalized male-female difference. We examined 353 relatively young patients, recently diagnosed with a psychotic illness, (258 males and 95 females) and compared these with 89 healthy control subjects (45 males and 44 females). All individuals had been assessed birhinally using the University of Pennsylvania Smell Identification Test (UPSIT). Overall, females were superior to males, and patients underperformed healthy controls. No interaction was noted between these two variables, and there was no significant effect found as a result of age of the subjects. The data suggested that sex differences in olfactory identification ability exist in young patients with psychotic disorders. They do not appear to be related to exposure to antipsychotic medication or smoking habit. Therefore, it is likely that they represent basic male vs. female differences and not diagnosis-specific sex differences in olfactory performance-at least in those who are in the early stages of illness.
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Good KP, Whitehorn D, Rui Q, Milliken H, Kopala LC. Olfactory identification deficits in first-episode psychosis may predict patients at risk for persistent negative and disorganized or cognitive symptoms. Am J Psychiatry 2006. [PMID: 16648339 DOI: 10.1176/appi.ajp.163.5.932] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE One-third of patients with a schizophrenia spectrum disorder have a measurable olfactory identification deficit at first examination. The authors studied the relationship of this deficit to symptom remission after 1 year of treatment. METHOD Fifty-eight patients naive to antipsychotic medication who entered the Nova Scotia Early Psychosis Program were symptomatically rated with the Positive and Negative Syndrome Scale (PANSS) (at baseline and 1 year). At baseline, the University of Pennsylvania Smell Identification Test (UPSIT) was also completed. Remission was determined for four symptom factors derived from the PANSS (positive, negative, cognitive/disorganized, and anxiety/depression). Patients with and without remission were compared on UPSIT scores. RESULTS Patients with nonremission of negative and cognitive/disorganized symptoms had significantly lower baseline UPSIT scores compared with patients with remission. UPSIT scores were unrelated to remission of positive or anxiety/depression symptoms. CONCLUSIONS UPSIT scores can be used to identify patients at risk for persistent negative and disorganized/cognitive symptoms.
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Affiliation(s)
- Kimberley P Good
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
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20
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Good KP, Whitehorn D, Rui Q, Milliken H, Kopala LC. Olfactory identification deficits in first-episode psychosis may predict patients at risk for persistent negative and disorganized or cognitive symptoms. Am J Psychiatry 2006; 163:932-3. [PMID: 16648339 DOI: 10.1176/ajp.2006.163.5.932] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [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: 11/30/2022]
Abstract
OBJECTIVE One-third of patients with a schizophrenia spectrum disorder have a measurable olfactory identification deficit at first examination. The authors studied the relationship of this deficit to symptom remission after 1 year of treatment. METHOD Fifty-eight patients naive to antipsychotic medication who entered the Nova Scotia Early Psychosis Program were symptomatically rated with the Positive and Negative Syndrome Scale (PANSS) (at baseline and 1 year). At baseline, the University of Pennsylvania Smell Identification Test (UPSIT) was also completed. Remission was determined for four symptom factors derived from the PANSS (positive, negative, cognitive/disorganized, and anxiety/depression). Patients with and without remission were compared on UPSIT scores. RESULTS Patients with nonremission of negative and cognitive/disorganized symptoms had significantly lower baseline UPSIT scores compared with patients with remission. UPSIT scores were unrelated to remission of positive or anxiety/depression symptoms. CONCLUSIONS UPSIT scores can be used to identify patients at risk for persistent negative and disorganized/cognitive symptoms.
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Affiliation(s)
- Kimberley P Good
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
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Kopala LC, Good KP, Milliken H, Buiteman C, Woodley H, Rui Q, Whitehorn D, Love L, Balshaw R, Kiss I, Honer WG. Treatment of a first episode of psychotic illness with quetiapine: an analysis of 2 year outcomes. Schizophr Res 2006; 81:29-39. [PMID: 16263246 DOI: 10.1016/j.schres.2005.09.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [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: 06/27/2005] [Revised: 08/25/2005] [Accepted: 09/01/2005] [Indexed: 12/01/2022]
Abstract
BACKGROUND The first episode of a psychotic disorder provides a unique opportunity to initiate optimal treatment but when a new medication becomes available, little data exist to guide the appropriate use in this population. OBJECTIVES The objectives were to determine the optimal doses and titration of quetiapine for this group and to measure outcomes (including symptom response, social functioning, mood alterations, motor symptoms, metabolic parameters and cognitive functioning) over 2 years of treatment with quetiapine. DESIGN Thirty nine subjects with a first episode of psychosis referred to the Nova Scotia Early Psychosis Program in Halifax, Canada, were invited to participate in this study. Standardized clinical, laboratory, and neuropsychological assessments were performed at baseline and following treatment with quetiapine at intervals out to 2 years. RESULTS Quetiapine was effective in treating the psychotic and mood symptoms while not causing extra-pyramidal signs or symptoms (EPSS). Pre-existing motor dysfunction improved. No anticholinergic medications were required. Several domains of cognitive function also improved (sustained attention, the number of perseverative errors, visuomotor speed and sequencing, verbal fluency and verbal memory). Weight gain was observed along with increases in cholesterol levels but there was no glucose dysregulation. CONCLUSIONS The results of this two year, naturalistic study of people with a first episode of psychosis indicated that quetiapine was well tolerated and effective for this population. Significant improvements in cognitive functioning also provided evidence for potential longer-term benefits of early and optimal treatment with this agent. However, monitoring metabolic parameters, as recommended for other atypicals, is likely prudent.
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Affiliation(s)
- Lili C Kopala
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Good KP, Rabinowitz J, Whitehorn D, Harvey PD, DeSmedt G, Kopala LC. The relationship of neuropsychological test performance with the PANSS in antipsychotic naïve, first-episode psychosis patients. Schizophr Res 2004; 68:11-9. [PMID: 15037335 DOI: 10.1016/j.schres.2003.07.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [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: 04/29/2003] [Revised: 07/07/2003] [Accepted: 07/09/2003] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic schizophrenia patients have been sampled for factor analytic studies to identify the factor structure of the Positive and Negative Syndrome Scale (PANSS). Many of these studies have identified a cognitive factor, which may provide useful information about patients for whom formal neuropsychological testing is unavailable. However, the relationship between the clinically rated cognitive factor and performance-based cognitive test scores has not been thoroughly examined, particularly in patients who are early in the course of illness. OBJECTIVES The validity of the PANSS cognitive factor was examined in a sample of antipsychotic naïve, first-episode psychosis patients and the PANSS items that best predicted cognitive functioning were identified. METHOD PANSS scores and performance on a battery of cognitive tests from the baseline assessment of a clinical trial of 167 neuroleptic naïve patients with schizophrenia-like illnesses were analyzed. RESULTS Factor analysis revealed a five-factor model that was consistent with previously described factor models from samples of chronically treated patients. There were modest correlations (less than r=0.44) between the derived cognitive factor and six of the neuropsychological test variables (Wisconsin Card Sorting Test total errors and number of categories correctly sorted, WMS-R immediate and delayed recall scores, Category Fluency total score, and WAIS-R digit symbol). Five PANSS items (P6, N5, N6, G2, and G10) were identified that predicted global cognitive functioning; however, 66% of the variance in cognitive functioning remained unexplained. CONCLUSIONS A PANSS cognitive factor can be identified in first-episode, neuroleptic naïve patients. However, clinical ratings of cognitive deficits lack sensitivity and specificity and thus should not be relied upon fully.
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Affiliation(s)
- Kimberley P Good
- Department of Psychiatry, Dalhousie University, Suite 9216-AJLB, 5909 Veterans Memorial Lane, Halifax, NS, Canada B3H 2E2.
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Abstract
Adult normative data are presented for unirhinal administration of the University of Pennsylvania Smell Identification Test (UPSIT). Two-hundred and seventy healthy adults, aged 15-64, were administered half of the UPSIT (20 items) to each nostril. The main findings were: (1) unirhinal and birhinal performance are not equivalent necessitating the use of unirhinal norms, rather than prorated birhinal norms, (2) unirhinal performance does not differ according to nostril of presentation, (3) unirhinal performance does not differ according to sex, (4) within the age ranges studied, age accounted for only a minor proportion of the variability, and (5) being a current smoker and having lower levels of formal education contributed to reduced unirhinal UPSIT scores. Correction factors are suggested for the education and smoking variables. Unirhinal evaluation may assist in further delineating the structural integrity of specific ipsilateral brain regions and potentially aid in differential diagnosis for a number of disorders.
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Affiliation(s)
- Kimberley P Good
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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Good KP, Martzke JS, Milliken HI, Honer WG, Kopala LC. Unirhinal olfactory identification deficits in young male patients with schizophrenia and related disorders: association with impaired memory function. Schizophr Res 2002; 56:211-23. [PMID: 12072170 DOI: 10.1016/s0920-9964(01)00227-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We have observed discreet subgroups of male patients with psychotic disorders who have unirhinal olfactory identification deficits (microsmia). The purpose of this study was to examine the relationship between left or right nostril microsmia and performance on literalised neuropsychological tests sensitive to lesions in brain areas implicated in the pathogenesis of schizophrenia. Sixty-six male patients diagnosed with schizophrenia or related disorders were assessed with a battery of neuropsychological tests, sensitive to literalised and regional (temporal and frontal lobe) dysfunction. The University of Pennsylvania Smell Identification Test (UPSIT) was administered unirhinally and resultant scores were used to classify patients into olfactory subgroups. Neuropsychological test scores were compared amongst subgroups. A mixed design MANOVA was performed on cognitive domains with olfactory status (right microsmic; RM, n=8, left microsmic; LM, n=20, and normosmic schizophrenic controls; NSzC, n=38) as the between subject factor while hemisphere (left versus right) and domain (executive/fluency versus memory) were within-subject factors. A three-way (olfactory subgroup by hemisphere by region) interaction was observed. Non-verbal memory impairment was observed in the right and left microsmic subgroups. Verbal memory deficits were demonstrated in patients with left nostril microsmia. These results indicate that unirhinal olfactory performance may provide a meaningful manner by which to subtype patients with schizophrenia. Moreover, the data suggest that olfactory deficits in patients with schizophrenia are associated with dysfunction of temporal lobe, rather than frontal lobe abnormalities. The data are consistent with reports linking the right temporal lobe integrity to adequate olfactory processing.
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Affiliation(s)
- Kimberley P Good
- Department of Psychiatry, Dalhousie University, Suite 4019-5909, Jubilee Road, Halifax, NS B3H 2E2, Canada.
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Abstract
OBJECTIVE Impaired olfactory identification ability has previously been demonstrated in patients with schizophrenia. This study assessed olfactory function in psychotic and nonpsychotic members of multigenerational families with familial schizophrenia to determine whether deficits were present in both groups. METHOD The University of Pennsylvania Smell Identification Test was administered birhinally to three groups of subjects aged less than 65 years: 19 psychotic and 27 nonpsychotic members of families with familial schizophrenia and 43 age- and sex-matched healthy volunteers. RESULTS Nonpsychotic family members had significantly higher mean University of Pennsylvania Smell Identification Test scores than psychotic family members but were impaired relative to the healthy volunteer group. These group differences could not be accounted for by age, sex, or smoking habit. Fifty-eight percent of the psychotic and 34% of the nonpsychotic family members performed in the microsmic (impaired) range, compared to 9% of the healthy volunteers. CONCLUSIONS Impaired olfactory deficits may aggregate in families with schizophrenia and may be indicative of a genetic predisposition to psychosis.
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Affiliation(s)
- L C Kopala
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, Halifax, Nova Scotia, Canada B3H 2E2.
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Abstract
Abnormal structural brain asymmetries have been reported in schizophrenia in brain areas which overlap with olfactory processing regions, with abnormalities more often described within the left hemisphere. We attempted to determine whether the olfactory agnosia observed in some male patients with schizophrenia was more likely left-hemisphere based. We assessed unirhinal (single nostril) olfactory identification and detection threshold in 65 male patients who met DSM-IV criteria for the diagnosis of schizophrenia and 59 healthy male control subjects. A two-way, mixed-design ANCOVA with diagnosis as the between-group factor, nostril as the within-subject factor and age as covariate was used to compare olfactory identification ability. This analysis demonstrated that patients with schizophrenia performed more poorly than the healthy controls across nostrils, but no differences were observed in either group between nostrils. However, when patients were classified according to unirhinal olfactory status (impaired left < right, impaired right < left, normosmic left < right, normosmic right < left), impaired patients were more than twice as likely to be classified as having a left nostril disadvantage than right nostril disadvantage. In contrast, within the normosmic group of patients, this pattern was reversed. Moreover, when those patients whose unirhinal olfactory scores differed by less than two points were removed from the analysis, a 2:1 ratio of left < right versus right < left was observed in the impaired patients. These results suggest that for impaired male patients with schizophrenia, olfactory identification deficits are more likely found for the left nostril, perhaps indicative of abnormalities in olfactory processing within the left hemisphere.
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Affiliation(s)
- K P Good
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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Abstract
BACKGROUND The present study was designed to assess olfactory function in severely polydipsic/hyponatremic patients with schizophrenia who also had intermittent water intoxication. METHODS The University of Pennsylvania Smell Identification Test and an olfactory acuity battery were administered to three groups of male subjects: 9 patients with schizophrenia and severe polydipsia/hyponatremia, 9 control nonpolydipsic/normonatremic patients with schizophrenia, and 9 normal controls. RESULTS Male patients with severe polydipsia/hyponatremia and intermittent water intoxication had marked olfactory acuity and identification deficits when compared to the patient control group of similar age and age at illness onset, and to normal controls. CONCLUSIONS The finding of deficient acuity (detection threshold) in the polydipsic/hyponatremic group but not the nonpolydipsic, normonatremic group suggests that for this subgroup, abnormalities of olfactory sensory function may occur in a pattern previously reported for other brain disorders such as Alzheimer's disease.
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Affiliation(s)
- L C Kopala
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
OBJECTIVE Abnormalities of olfactory identification ability have been proposed as a marker of cerebral dysfunction in schizophrenia. The authors studied the potential role of genetic factors in olfactory dysfunction by assessing monozygotic twins discordant for schizophrenia and matched comparison subjects. METHOD The subjects were 12 pairs of monozygotic twins discordant for schizophrenia and 12 healthy subjects matched for sex and age. Each subject completed the University of Pennsylvania Smell Identification Test. RESULTS The combined twin group scored significantly lower on smell identification than did the comparison group. The affected and unaffected twin groups did not differ from each other. CONCLUSIONS Genetic factors may contribute to cerebral dysfunction as assessed by olfactory identification ability.
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Affiliation(s)
- L C Kopala
- Department of Psychiatry, Dalhousie University, Halifax, N.S., Canada.
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Affiliation(s)
- J S Martzke
- Department of Psychology, Vancouver Hospital and Health Sciences Centre, British Columbia, Canada
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Abstract
The purpose of this study was to determine the prevalence of extrapyramidal signs or symptoms (EPS) and clinical symptoms in first-episode schizophrenia, before any treatment, during and after treatment with a novel antipsychotic, risperidone. Twenty-two (17 men; 5 women) patients were examined using the Extrapyramidal Symptom Rating Scale, Positive and Negative Syndrome Scale (PANSS), Clinical Global Impressions-Severity of Illness and Improvement, and Global Assessment of Functioning. Three patients (14%) had distinct EPS at baseline, whereas all were free of EPS after treatment with risperidone. On the maximum dose of risperidone (5-8 mg), 32% of the total sample developed mild akathisia or parkinsonism, both of which diminished with dosage reduction. No clinically significant EPS were observed in patients receiving 2 to 4 mg of risperidone. Analysis of symptom response of the lower (2-4 mg) versus the higher (5-8 mg) doses of risperidone resulted in superior outcome in the 2- to 4-mg group for all three symptom clusters of the PANSS. In addition, 91% of the low-dose group achieved a 20% or greater reduction in total PANSS score compared with 27% for the high-dose group. These findings have clinical relevance directed at the early and longer-term treatment of schizophrenia.
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Affiliation(s)
- L C Kopala
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia.
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Kopala LC, Lewine R, Good KP, Fluker M, Martzke JS, Lapointe JS, Honer WG. Clinical features of schizophrenia in a woman with hyperandrogenism. J Psychiatry Neurosci 1997; 22:56-60. [PMID: 9002393 PMCID: PMC1188817] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Ample evidence supports sex differences in the clinical features of schizophrenia. In this regard, estrogen may contribute to later onset and less severe course of illness in women. Direct investigation of hormonal status in schizophrenia is extremely difficult. The present report documents the clinical features of schizophrenia in a young woman with long-standing hyperandrogenism related to polycystic ovarian disease. We postulate that hyperandrogenism contributed to a relatively early onset, olfactory dysfunction, and other clinical features of schizophrenia more commonly associated with men. Additionally, acute estrogen depletion following cessation of oral contraceptives may have precipitated psychosis, while recommencement of oral contraceptives could have contributed to subsequent improvement in symptoms.
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Affiliation(s)
- L C Kopala
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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Kopala LC, Good KP. Olfactory identification ability in patients with panic disorder. J Psychiatry Neurosci 1996; 21:340-2. [PMID: 8973054 PMCID: PMC1188799] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Deficits in olfactory identification ability have been reported in some groups of psychiatric patients, but not others. Our study examined olfactory identification ability in patients with panic disorder. Results indicate that this ability is intact in this population and, further, that psychotropic medications appear not to interfere with olfaction.
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Affiliation(s)
- L C Kopala
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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Affiliation(s)
- L C Kopala
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
Olfactory identification ability and the prevalence of olfactory hallucinations were examined in 183 hospitalized patients from three diagnostic groups. One hundred and thirty-one patients with schizophrenia, 21 patients with major depression, 31 women with eating disorders along with 77 normal control subjects were examined using the University of Pennsylvania Smell Identification Test (UPSIT) and were questioned regarding the presence of olfactory hallucinations. Olfactory identification deficits were observed only in patients with schizophrenia. In contrast, olfactory hallucinations were reported by members of all psychiatric diagnostic categories (34.6% of patients with schizophrenia; 19% of depressed patients and 29% of eating disorders patients). For patients with schizophrenia, women were more likely to report olfactory hallucinations and had higher UPSIT scores than men.
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Affiliation(s)
- L C Kopala
- Department of Psychiatry, University of British Columbia, Vancouver General Hospital, Canada
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