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Kendler KS, Keefe RSE, Ohlsson H, Sundquist J, Sundquist K. Risk for psychiatric and substance use disorders as a function of transitions in Sweden's public educational system: a national study. Psychol Med 2024; 54:117-124. [PMID: 36878890 PMCID: PMC10916708 DOI: 10.1017/s003329172300048x] [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] [Indexed: 03/08/2023]
Abstract
BACKGROUND To clarify, in a national sample, associations between risk for seven psychiatric and substance use disorders and five key transitions in Sweden's public educational system. METHODS Swedish-born individuals (1972-1995, N = 1 997 910) were followed through 12-31-2018, at mean age 34.9. We predicted, from these educational transitions, risk for major depression (MD), obsessive-compulsive disorder (OCD), bipolar disorder (BD), schizophrenia (SZ), anorexia nervosa (AN), alcohol use disorder (AUD), and drug use disorder (DUD), assessed from Swedish national registers, by Cox regression, censoring individuals with onsets ⩽17. We also predicted risk from the deviation of grades from family-genetic expectations (deviation 1) and from changes in grades from ages 16 to 19 (deviation 2). RESULTS We observed four major risk patterns across transitions in our disorders: (i) MD and BD, (ii) OCD and SZ, (iii) AUD and DUD, and (iv) AN. Failing early educational transitions had the greatest impact on risk for OCD and SZ while for other disorders, not progressing from basic to upper high school had the largest effect. Completing vocational v. college-prep upper high school was strongly associated with risk for AUD and DUD, had little relation with MD, OCD, BD, and SZ risk, and was protective for AN. Deviation 1 predicted risk most strongly for SZ, AN, and MD. Deviation 2 predicted risk most strongly for SZ, AUD, and DUD. CONCLUSIONS The pattern of educational transitions and within family and within person development deviations are strongly and relatively specifically associated with future risk for seven psychiatric and substance-use disorders.
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Affiliation(s)
- Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, New York, USA
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2
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Darrow SM, Pizzagalli DA, Smoski M, Mathew SJ, Nurnberger J, Lisanby SH, Iosifescu D, Murrough JW, Yang H, Weiner RD, Sanacora G, Keefe RSE, Song A, Goodman W, Whitton AE, Potter WZ, Krystal AD. Using latent profile analyses to classify subjects with anhedonia based on reward-related measures obtained in the FAST-MAS study. J Affect Disord 2023; 339:584-592. [PMID: 37467805 DOI: 10.1016/j.jad.2023.07.081] [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: 03/28/2022] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Growing evidence indicates that anhedonia is a multifaceted construct. This study examined the possibility of identifying subgroups of people with anhedonia using multiple reward-related measures to provide greater understanding the Research Domain Criteria's Positive Valence Systems Domain and pathways for developing treatments. METHODS Latent profile analysis of baseline data from a study that examined the effects of a novel kappa opioid receptor (KOR) antagonist drug on measures and biomarkers associated with anhedonia was used to identify subgroups. Measures included ventral striatal activation during the Monetary Incentive Delay task, response bias in the Probabilistic Reward Task, reward valuation scores from the Effort-Expenditure for Rewards Task, and scores from reward-related self-report measures. RESULTS Two subgroups were identified, which differed on self-report measures of reward. Participants in the subgroup reporting more anhedonia also reported more depression and had greater illness severity and functional impairments. Graphs of change with treatment showed a trend for the less severe subgroup to demonstrate higher response to KOR antagonist treatment on the neuroimaging measure, probabilistic reward task, and ratings of functioning; the subgroup with greater severity showed a trend for higher treatment response on reward-related self-report measures. LIMITATIONS The main limitations include the small sample size and exploratory nature of analyses. CONCLUSIONS Evidence of possible dissociation between self-reported measures of anhedonia and other measures with respect to treatment response emerged. These results highlight the importance for future research to consider severity of self-reported reward-related deficits and how the relationship across measurement methods may vary with severity.
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Affiliation(s)
- Sabrina M Darrow
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, United States of America.
| | | | - Moria Smoski
- Department of Psychiatry and Behavioral Sciences, Duke University, United States of America
| | | | - John Nurnberger
- Institute of Psychiatric Research, Indiana University Medical Center, United States of America
| | - Sarah H Lisanby
- National Institute of Mental Health, United States of America
| | | | - James W Murrough
- Department of Psychiatry, Mount Sinai School of Medicine, United States of America
| | | | | | - Gerard Sanacora
- Department of Psychiatry, Yale University, United States of America
| | - Richard S E Keefe
- Department of Psychiatry, Duke University Medical Center, United States of America
| | - Allen Song
- Duke University, United States of America
| | - Wayne Goodman
- Department of Psychiatry, Baylor College of Medicine, United States of America
| | | | | | - Andrew D Krystal
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, United States of America
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3
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Zhang L, Lizano P, Xu Y, Rubin LH, Lee AM, Lencer R, Reilly JL, Keefe RSE, Keedy SK, Pearlson GD, Clementz BA, Keshavan MS, Gershon ES, Tamminga CA, Sweeney JA, Hill SK, Bishop JR. Peripheral inflammation is associated with impairments of inhibitory behavioral control and visual sensorimotor function in psychotic disorders. Schizophr Res 2023; 255:69-78. [PMID: 36965362 PMCID: PMC10175233 DOI: 10.1016/j.schres.2023.03.030] [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: 08/17/2022] [Revised: 02/08/2023] [Accepted: 03/13/2023] [Indexed: 03/27/2023]
Abstract
Elevated markers of peripheral inflammation are common in psychosis spectrum disorders and have been associated with brain anatomy, pathology, and physiology as well as clinical outcomes. Preliminary evidence suggests a link between inflammatory cytokines and C-reactive protein (CRP) with generalized cognitive impairments in a subgroup of individuals with psychosis. Whether these patients with elevated peripheral inflammation demonstrate deficits in specific cognitive domains remains unclear. To examine this, seventeen neuropsychological and sensorimotor tasks and thirteen peripheral inflammatory and microvascular markers were quantified in a subset of B-SNIP consortium participants (129 psychosis, 55 healthy controls). Principal component analysis was conducted across the inflammatory markers, resulting in five inflammation factors. Three discrete latent cognitive domains (Visual Sensorimotor, General Cognitive Ability, and Inhibitory Behavioral Control) were characterized based on the neurobehavioral battery and examined in association with inflammation factors. Hierarchical clustering analysis identified cognition-sensitive high/low inflammation subgroups. Among persons with psychotic disorders but not healthy controls, higher inflammation scores had significant associations with impairments of Inhibitory Control (R2 = 0.100, p-value = 2.69e-4, q-value = 0.004) and suggestive associations with Visual Sensorimotor function (R2 = 0.039, p-value = 0.024, q-value = 0.180), but not with General Cognitive Ability (R2 = 0.015, p-value = 0.162). Greater deficits in Inhibitory Control were observed in the high inflammation patient subgroup, which represented 30.2 % of persons with psychotic disorders, as compared to the low inflammation psychosis subgroup. These findings indicate that inflammation dysregulation may differentially impact specific neurobehavioral domains across psychotic disorders, particularly performance on tasks requiring ongoing behavioral monitoring and control.
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Affiliation(s)
- Lusi Zhang
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | - Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, United States
| | - Leah H Rubin
- Department of Neurology, Psychiatry, and Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Adam M Lee
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - James L Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, United States
| | - Richard S E Keefe
- Departments of Psychiatry, Neuroscience, and Psychology, Duke University, Durham, NC, United States
| | - Sarah K Keedy
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States
| | - Godfrey D Pearlson
- Departments of Psychiatry and Neurobiology, School of Medicine, Yale University, New Haven, CT, United States
| | - Brett A Clementz
- Department of Psychology and Neuroscience, University of Georgia, Athens, GA, United States
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Elliot S Gershon
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States
| | - Carol A Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical Center Dallas, TX, United States
| | - John A Sweeney
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, United States
| | - S Kristian Hill
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Jeffrey R Bishop
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States.
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McCutcheon RA, Keefe RSE, McGuire PK. Correction: Cognitive impairment in schizophrenia: aetiology, pathophysiology, and treatment. Mol Psychiatry 2023; 28:1919. [PMID: 36732589 PMCID: PMC10575768 DOI: 10.1038/s41380-023-01984-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Robert A McCutcheon
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
- Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Richard S E Keefe
- Departments of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Philip K McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford, UK
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5
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McCutcheon RA, Keefe RSE, McGuire PK. Cognitive impairment in schizophrenia: aetiology, pathophysiology, and treatment. Mol Psychiatry 2023; 28:1902-1918. [PMID: 36690793 PMCID: PMC10575791 DOI: 10.1038/s41380-023-01949-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [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: 08/19/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/25/2023]
Abstract
Cognitive deficits are a core feature of schizophrenia, account for much of the impaired functioning associated with the disorder and are not responsive to existing treatments. In this review, we first describe the clinical presentation and natural history of these deficits. We then consider aetiological factors, highlighting how a range of similar genetic and environmental factors are associated with both cognitive function and schizophrenia. We then review the pathophysiological mechanisms thought to underlie cognitive symptoms, including the role of dopamine, cholinergic signalling and the balance between GABAergic interneurons and glutamatergic pyramidal cells. Finally, we review the clinical management of cognitive impairments and candidate novel treatments.
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Affiliation(s)
- Robert A McCutcheon
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
- Oxford health NHS Foundation Trust, Oxford health NHS Foundation Trust, Oxford, UK.
| | - Richard S E Keefe
- Departments of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Philip K McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford health NHS Foundation Trust, Oxford health NHS Foundation Trust, Oxford, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford, UK
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6
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Feber L, Peter N, Schneider-Thoma J, Siafis S, Bighelli I, Hansen WP, Prates Baldez D, Salanti G, Keefe RSE, Engel RR, Leucht S. Antipsychotic drugs and their effects on cognitive function: protocol for a systematic review, pairwise, and network meta-analysis. Syst Rev 2023; 12:54. [PMID: 36959619 PMCID: PMC10037873 DOI: 10.1186/s13643-023-02213-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/06/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND There is evidence that antipsychotic drugs differ in their effect on the cognitive symptoms of schizophrenia. So far, there is no comprehensive systematic review available that would enable providers and patients to make informed choices regarding this important aspect of treatment. With a large number of substances available, conventional pairwise meta-analyses will not be sufficient to inform this choice. To fill this gap, we will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomized controlled trials (RCTs) to rank antipsychotics according to their effect on cognitive functioning. METHODS In our NMA, we will include RCTs in patients with schizophrenia or schizophrenia-like psychoses comparing one antipsychotic agent with another antipsychotic agent or placebo that measures cognitive function. We will include studies on patients of every age group, in any phase of illness (e.g., acute or stable, first episode or chronic schizophrenia, in- or outpatients) with an intervention time of at least 3 weeks. The primary outcome will be the composite score of cognitive functioning, preferentially measured with the test battery developed by the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative. The secondary outcomes include the seven cognitive domains that the composite score is composed of, as well as functioning and quality of life. Study selection and data extraction will be conducted by at least two independent reviewers. We will use the Cochrane Risk of Bias tool 2 to determine the risk of bias in studies, and we will evaluate the confidence in the results using Confidence in Network Meta-Analysis (CINeMA). We will perform NMA using R (package netmeta). We will conduct subgroup and sensitivity analyses to explore the heterogeneity and assess the robustness of our findings. DISCUSSION This systematic review and network meta-analysis aims to inform evidence-based antipsychotic treatment choice for cognitive deficits in schizophrenia patients by analyzing existing RCTs on this subject. The results have the potential to support patients' and physicians' decision-making processes based on the latest available evidence. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022312483.
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Affiliation(s)
- Lena Feber
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Natalie Peter
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Irene Bighelli
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Daniel Prates Baldez
- Hospital de Clinicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Georgia Salanti
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Rolf R Engel
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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7
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Cecchi M, Adachi M, Basile A, Buhl DL, Chadchankar H, Christensen S, Christian E, Doherty J, Fadem KC, Farley B, Forman MS, Honda S, Johannesen J, Kinon BJ, Klamer D, Marino MJ, Missling C, O'Donnell P, Piser T, Puryear CB, Quirk MC, Rotte M, Sanchez C, Smith DG, Uslaner JM, Javitt DC, Keefe RSE, Mathalon D, Potter WZ, Walling DP, Ereshefsky L. Validation of a suite of ERP and QEEG biomarkers in a pre-competitive, industry-led study in subjects with schizophrenia and healthy volunteers. Schizophr Res 2023; 254:178-189. [PMID: 36921403 DOI: 10.1016/j.schres.2023.02.018] [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] [Received: 07/02/2022] [Revised: 11/23/2022] [Accepted: 02/10/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Complexity and lack of standardization have mostly limited the use of event-related potentials (ERPs) and quantitative EEG (QEEG) biomarkers in drug development to small early phase trials. We present results from a clinical study on healthy volunteers (HV) and patients with schizophrenia (SZ) that assessed test-retest, group differences, variance, and correlation with functional assessments for ERP and QEEG measures collected at clinical and commercial trial sites with standardized instrumentation and methods, and analyzed through an automated data analysis pipeline. METHODS 81 HV and 80 SZ were tested at one of four study sites. Subjects were administered two ERP/EEG testing sessions on separate visits. Sessions included a mismatch negativity paradigm, a 40 Hz auditory steady-state response paradigm, an eyes-closed resting state EEG, and an active auditory oddball paradigm. SZ subjects were also tested on the Brief Assessment of Cognition (BAC), Positive and Negative Syndrome Scale (PANSS), and Virtual Reality Functional Capacity Assessment Tool (VRFCAT). RESULTS Standardized ERP/EEG instrumentation and methods ensured few test failures. The automated data analysis pipeline allowed for near real-time analysis with no human intervention. Test-retest reliability was fair-to-excellent for most of the outcome measures. SZ subjects showed significant deficits in ERP and QEEG measures consistent with published academic literature. A subset of ERP and QEEG measures correlated with functional assessments administered to the SZ subjects. CONCLUSIONS With standardized instrumentation and methods, complex ERP/EEG testing sessions can be reliably performed at clinical and commercial trial sites to produce high-quality data in near real-time.
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Affiliation(s)
| | | | - A Basile
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | | | | | | | | | | | | | | | | | | | - D Klamer
- Anavex Life Sciences Corp., NY, USA
| | | | | | | | - T Piser
- Onsero Therapeutics, MA, USA
| | | | | | | | | | | | | | | | | | - D Mathalon
- University of California, San Francisco, CA, USA
| | - W Z Potter
- Independent Consultant, Philadelphia, PA, USA
| | | | - L Ereshefsky
- CenExel Research, USA; University of Texas Health Science Center at San Antonio, TX, USA
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8
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Horan WP, Depp CA, Hurst S, Linthicum J, Vargas G, Klein H, Keefe RSE, Harvey PD. Qualitative Analysis of the Content Validity of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) in Schizophrenia: A Multi-Stakeholder Perspective. Schizophr Bull Open 2023; 4:sgad012. [PMID: 38026054 PMCID: PMC10664622 DOI: 10.1093/schizbullopen/sgad012] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
The US Food and Drug Agency (FDA) requires clinical trials targeting cognitive impairment associated with schizophrenia (CIAS) to demonstrate the functional relevance of cognitive improvements by employing a functional co-primary measure. Although quantitative evidence supports the suitability of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) for this purpose, FDA guidelines for qualification of clinical outcome assessments require evidence of content validity, defined as qualitative evidence that key stakeholders view the measure as relevant and important. To collect this important qualitative data, semi-structured interviews were conducted with outpatients with schizophrenia (n = 24), caregivers (n = 12), and professional peer support specialists (n = 12) to elicit their views about the definition and importance of functional independence, the importance of the functional domains assessed by the VRFCAT (meal planning, using transportation, handling money, shopping), and the relevance of the VRFCAT tasks to these domains. Qualitative thematic analyses revealed consistent themes across groups in defining functional independence, including performing instrumental self-care, financial, and social tasks; making decisions autonomously; and not depending on others to carry out daily activities. There were, however, notable differences in their views regarding the importance of and barriers to functional independence. All groups viewed the VRFCAT as assessing skill domains that are central to independent functioning and, with some minor differences, the VRFCAT tasks were viewed as relevant and meaningful examples of the domains. These qualitative results provide converging evidence that key stakeholders view the VRFCAT as a content-valid measure.
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Affiliation(s)
- William P Horan
- WCG Clinical Endpoint Solutions, Cary, NC
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Colin A Depp
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego, CA
| | - Samantha Hurst
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego, CA
| | | | - Gabriela Vargas
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Research Service Bruce W. Carter VA Medical Center, Miami, FL
| | - Hans Klein
- WCG Clinical Endpoint Solutions, Cary, NC
| | | | - Philip D Harvey
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Research Service Bruce W. Carter VA Medical Center, Miami, FL
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9
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Keefe RSE, Cañadas E, Farlow D, Etkin A. Digital Intervention for Cognitive Deficits in Major Depression: A Randomized Controlled Trial to Assess Efficacy and Safety in Adults. Am J Psychiatry 2022; 179:482-489. [PMID: 35410496 DOI: 10.1176/appi.ajp.21020125] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 11/30/2022]
Abstract
OBJECTIVE The authors evaluated AKL-T03, an investigational digital intervention delivered through a video game-based interface, designed to target the fronto-parietal network to enhance functional domains for attentional control. AKL-T03 was tested in adult patients with major depressive disorder and a demonstrated cognitive impairment at baseline. METHODS Adults ages 25-55 years on a stable antidepressant medication regimen with residual mild to moderate depression and an objective impairment in cognition (as measured using the symbol coding test) were enrolled in a double-blind randomized controlled study. Participants were randomized either to AKL-T03 or to an expectation-matched digital control intervention. Participants were assessed at baseline and after completion of their 6-week at-home intervention. The primary outcome measure was improvement in sustained attention, as measured by the Test of Variables of Attention (TOVA). RESULTS AKL-T03 (N=37) showed a statistically significant medium-effect-size improvement in sustained attention compared with the control intervention on the TOVA primary outcome (N=37) (partial eta-squared=0.11). Additionally, a composite score derived from all cognitive measures demonstrated significant improvement with AKL-T03 over the control intervention. Individual secondary and exploratory endpoints did not demonstrate statistically significant between-group differences. No serious adverse events were reported, and two patients (5.5%) in the AKL-T03 group reported an intervention-related adverse event (headache). CONCLUSIONS Treatment with AKL-T03 resulted in significant improvement in sustained attention, as well as in cognitive functioning as a whole, compared with a control intervention. AKL-T03 is a safe digital intervention that is effective in the treatment of cognitive impairment associated with major depression. Further research will be needed to understand the clinical consequences of this treatment-induced change.
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Affiliation(s)
- Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C. (Keefe); VeraSci, Durham, N.C. (Keefe); Akili Interactive, Boston (Cañadas, Farlow); Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, Calif. (Etkin); Alto Neuroscience, Los Altos, Calif. (Etkin)
| | - Elena Cañadas
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C. (Keefe); VeraSci, Durham, N.C. (Keefe); Akili Interactive, Boston (Cañadas, Farlow); Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, Calif. (Etkin); Alto Neuroscience, Los Altos, Calif. (Etkin)
| | - Deborah Farlow
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C. (Keefe); VeraSci, Durham, N.C. (Keefe); Akili Interactive, Boston (Cañadas, Farlow); Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, Calif. (Etkin); Alto Neuroscience, Los Altos, Calif. (Etkin)
| | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C. (Keefe); VeraSci, Durham, N.C. (Keefe); Akili Interactive, Boston (Cañadas, Farlow); Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, Calif. (Etkin); Alto Neuroscience, Los Altos, Calif. (Etkin)
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10
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Zhang L, Hill SK, Guo B, Wu B, Alliey-Rodriguez N, Eum S, Lizano P, Ivleva EI, Reilly JL, Keefe RSE, Keedy SK, Tamminga CA, Pearlson GD, Clementz BA, Keshavan MS, Gershon ES, Sweeney JA, Bishop JR. Impact of polygenic risk for coronary artery disease and cardiovascular medication burden on cognitive impairment in psychotic disorders. Prog Neuropsychopharmacol Biol Psychiatry 2022; 113:110464. [PMID: 34756932 PMCID: PMC8932335 DOI: 10.1016/j.pnpbp.2021.110464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/06/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cognitive impairment is a core deficit across psychotic disorders, the causes and therapeutics of which remain unclear. Epidemiological observations have suggested associations between cognitive dysfunction in psychotic disorders and cardiovascular risk factors, but an underlying etiology has not been established. METHODS Neuropsychological performance using the Brief Assessment of Cognition in Schizophrenia (BACS) was assessed in 616 individuals of European ancestry (403 psychosis, 213 controls). Polygenic risk scores for coronary artery disease (PRSCAD) were quantified for each participant across 13 p-value thresholds (PT 0.5-5e-8). Cardiovascular and psychotropic medications were categorized for association analyses. Each PRSCAD was examined in relation to the BACS and the optimized PT was confirmed with five-fold cross-validation and independent validation. Functional enrichment analyses were used to identify biological mechanisms linked to PRSCAD-cognition associations. Multiple regression analyses examined PRSCAD under the optimal PT and medication burden in relation to the BACS composite and subtest scores. RESULTS Higher PRSCAD was associated with lower BACS composite scores (p = 0.001) in the psychosis group, primarily driven by the Verbal Memory subtest (p < 0.001). Genes linked to multiple nervous system related processes and pathways were significantly enriched in PRSCAD. After controlling for PRSCAD, a greater number of cardiovascular medications was also correlated with worse BACS performance in patients with psychotic disorders (p = 0.029). CONCLUSIONS Higher PRSCAD and taking more cardiovascular medications were both significantly associated with cognitive impairment in psychosis. These findings indicate that cardiovascular factors may increase the risk for cognitive dysfunction and related functional outcomes among individuals with psychotic disorders.
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Affiliation(s)
- Lusi Zhang
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States of America
| | - Scot Kristian Hill
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States of America
| | - Bin Guo
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Baolin Wu
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Ney Alliey-Rodriguez
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States of America
| | - Seenae Eum
- Department of Pharmacogenomics, School of Pharmacy, Shenandoah University, Fairfax, VA, United States of America
| | - Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Elena I Ivleva
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, United States of America
| | - James L Reilly
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Richard S E Keefe
- Departments of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - Sarah K Keedy
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States of America
| | - Carol A Tamminga
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, United States of America
| | - Godfrey D Pearlson
- Departments of Psychiatry and Neurobiology, School of Medicine, Yale University, New Haven, CT, United States of America
| | - Brett A Clementz
- Department of Psychology and Neuroscience, University of Georgia, Athens, GA, United States of America
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Elliot S Gershon
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States of America
| | - John A Sweeney
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, United States of America
| | - Jeffrey R Bishop
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States of America; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America.
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11
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Lim K, Rapisarda A, Keefe RSE, Lee J. Social skills, negative symptoms and real-world functioning in individuals at ultra-high risk of psychosis. Asian J Psychiatr 2022; 69:102996. [PMID: 35026654 DOI: 10.1016/j.ajp.2021.102996] [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] [Received: 08/24/2021] [Revised: 11/28/2021] [Accepted: 12/27/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Impairment in real-world social functioning is observed in individuals at Ultra-High Risk (UHR) of psychosis. Both social skills and negative symptoms appear to influence real-world functioning. This study aims to examine the psychometric properties of a social skills measure, the High-Risk Social Challenge task (HiSoC), and evaluate the relationship between social skills, negative symptoms, and real-world functioning in UHR individuals. METHODS HiSoC data was analysed in 87 UHR individuals and 358 healthy controls. Exploratory factor analysis (EFA) was used to evaluate the factor structure of the HiSoC task. Convergent and divergent validity were assessed. Negative symptoms were assessed on the Positive and Negative Syndrome Scale (PANSS) and real-world functioning was indexed by the Global Assessment of Functioning (GAF). Commonality analysis was used to partition unique and shared variance of HiSoC and negative symptoms with real-world functioning. RESULTS EFA yielded a three-factor structure of HiSoC consisting of Affect, Odd behaviour and language, and Social-interpersonal. The HiSoC task discriminated UHR and healthy controls (p < 0.001, Cohen's d = 0.437-0.598). Commonality analysis revealed that the unique variance of the social amotivation subdomain of negative symptoms was the strongest predictor of GAF (p < .001, R2 = .480). Shared variance of 3.7% between HiSoC Social-interpersonal and social amotivation was observed in relation to functioning. CONCLUSION The HiSoC is a psychometrically valid task that is sensitive to identify social skill deficits in UHR. While social skills are related to functioning, experiential negative symptoms appear to be an important target for improving real-world functional outcomes.
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Affiliation(s)
- Keane Lim
- Research Division, Institute of Mental Health, Singapore
| | - Attilio Rapisarda
- Research Division, Institute of Mental Health, Singapore; Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore
| | - Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore; Department of Psychosis, Institute of Mental Health, Singapore; Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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12
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Atkins AS, Kraus MS, Welch M, Yuan Z, Stevens H, Welsh-Bohmer KA, Keefe RSE. Remote self-administration of digital cognitive tests using the Brief Assessment of Cognition: Feasibility, reliability, and sensitivity to subjective cognitive decline. Front Psychiatry 2022; 13:910896. [PMID: 36090378 PMCID: PMC9448897 DOI: 10.3389/fpsyt.2022.910896] [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: 04/01/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Cognitive impairment is a common and pervasive feature of etiologically diverse disorders of the central nervous system, and a target indication for a growing number of symptomatic and disease modifying drugs. Remotely acquired digital endpoints have been recognized for their potential in providing frequent, real-time monitoring of cognition, but their ultimate value will be determined by the reliability and sensitivity of measurement in the populations of interest. To this end, we describe initial validation of remote self-administration of cognitive tests within a regulatorily compliant tablet-based platform. Participants were 61 older adults (age 55+), including 20 individuals with subjective cognitive decline (SCD). To allow comparison between remote (in-home) and site-based testing, participants completed 2 testing sessions 1 week apart. Results for three of four cognitive domains assessed demonstrated equivalence between remote and site-based tests, with high cross-modality ICCs (absolute agreement) for Symbol Coding (ICC = 0.75), Visuospatial Working Memory (ICC = 0.70) and Verbal Fluency (ICC > 0.73). Group differences in these domains were significant and reflected sensitivity to objective cognitive impairment in the SCD group for both remote and site-based testing (p < 0.05). In contrast, performance on tests of verbal episodic memory suggested inflated performance during unmonitored testing and indicate reliable use of remote cognitive assessments may depend on the construct, as well as the population being tested.
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Affiliation(s)
| | | | | | | | | | - Kathleen A Welsh-Bohmer
- WCG-VeraSci, Durham, NC, United States.,Duke University Medical Center, Durham, NC, United States
| | - Richard S E Keefe
- WCG-VeraSci, Durham, NC, United States.,Duke University Medical Center, Durham, NC, United States
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13
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Keefe RSE, Woods SW, Cannon TD, Ruhrmann S, Mathalon DH, McGuire P, Rosenbrock H, Daniels K, Cotton D, Roy D, Pollentier S, Sand M. A randomized Phase II trial evaluating efficacy, safety, and tolerability of oral BI 409306 in attenuated psychosis syndrome: Design and rationale. Early Interv Psychiatry 2021; 15:1315-1325. [PMID: 33354862 PMCID: PMC8451588 DOI: 10.1111/eip.13083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/23/2020] [Accepted: 11/14/2020] [Indexed: 12/17/2022]
Abstract
AIM Attenuated psychosis syndrome (APS), a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders-5, comprises psychotic symptoms that are qualitatively similar to those observed in schizophrenia but are less severe. Patients with APS are at high risk of converting to first-episode psychosis (FEP). As evidence for effective pharmacological interventions in APS is limited, novel treatments may provide symptomatic relief and delay/prevent psychotic conversion. This trial aims to investigate the efficacy, safety, and tolerability of BI 409306, a potent and selective phosphodiesterase-9 inhibitor, versus placebo in APS. Novel biomarkers of psychosis are being investigated. METHODS In this Phase II, multinational, double-blind, parallel-group trial, randomized (1:1) patients will receive BI 409306 50 mg or placebo twice daily for 52 weeks. Patients (n = 300) will be enrolled to determine time to remission of APS, time to FEP, change in everyday functional capacity (Schizophrenia Cognition Rating Scale), and change from baseline in Brief Assessment of Cognition composite score and Positive and Negative Syndrome Scale scores. Potential biomarkers of psychosis under investigation include functional measures of brain activity and automated speech analyses. Safety is being assessed throughout. CONCLUSIONS This trial will determine whether BI 409306 is superior to placebo in achieving sustainable remission of APS and improvements in cognition and functional capacity. These advances may provide evidence-based treatment options for symptomatic relief in APS. Furthermore, the study will assess the effect of BI 409306 on psychotic conversion and explore the identification of patients at risk for conversion using novel biomarkers.
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Affiliation(s)
- Richard S. E. Keefe
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNorth CarolinaUSA
- VeraSciDurhamNCUSA
| | - Scott W. Woods
- Department of PsychiatryYale UniversityNew HavenConnecticutUSA
| | - Tyrone D. Cannon
- Department of PsychiatryYale UniversityNew HavenConnecticutUSA
- Department of PsychologyYale UniversityNew HavenConnecticutUSA
| | - Stephan Ruhrmann
- Department of Psychiatry and PsychotherapyUniversity of CologneCologneGermany
| | - Daniel H. Mathalon
- Department of PsychologyUCSF School of MedicineSan FranciscoCaliforniaUSA
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | | | - Kristen Daniels
- Boehringer Ingelheim Pharmaceuticals Inc.RidgefieldConnecticutUSA
| | - Daniel Cotton
- Boehringer Ingelheim Pharmaceuticals Inc.RidgefieldConnecticutUSA
| | - Dooti Roy
- Boehringer Ingelheim Pharmaceuticals Inc.RidgefieldConnecticutUSA
| | | | - Michael Sand
- Boehringer Ingelheim Pharmaceuticals Inc.RidgefieldConnecticutUSA
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14
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Eskridge CLM, Hochberger WC, Kaseda ET, Lencer R, Reilly JL, Keedy SK, Keefe RSE, Pearlson GD, Keshavan MS, Tamminga CA, Sweeney JA, Hill SK. Deficits in generalized cognitive ability, visual sensorimotor function, and inhibitory control represent discrete domains of neurobehavioral deficit in psychotic disorders. Schizophr Res 2021; 236:54-60. [PMID: 34392106 PMCID: PMC8464494 DOI: 10.1016/j.schres.2021.07.036] [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] [Received: 11/10/2020] [Revised: 05/06/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
Psychotic disorders are characterized by impaired cognition, yet some reports indicate specific deficits extend beyond reduced general cognitive ability. This study utilized exploratory and confirmatory factor analytic methods to evaluate the latent structure of a broad neurocognitive battery used in the Bipolar-Schizophrenia Network of Intermediate Phenotypes (B-SNIP) study, which included neuropsychological and neurophysiological measures in psychotic disorder probands and their unaffected first-degree relatives. Findings indicate that the factor structure of data from this set of assessments is more complex than the unitary factor of global cognitive ability underlying the Brief Assessment of Cognition in Schizophrenia (BACS). In addition to assessing generalized cognitive ability, two other factors were identified: visual sensorimotor function and inhibitory behavioral control. This complex cognitive architecture, derived in controls, generalized to patients across the psychosis spectrum and to their unaffected relatives. These findings highlight the need for a more differentiated assessment of neurobehavioral functions in studies designed to test for diagnostically specific biomarkers, endophenotypes for gene discovery and beneficial effects of therapeutics on cognitive function.
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Affiliation(s)
- Courtney L M Eskridge
- Rosalind Franklin University of Medicine and Science, Department of Psychology, North Chicago, IL, United States.
| | - William C Hochberger
- Advanced Neurobehavioral Health of Southern California, San Diego, CA, United States
| | - Erin T Kaseda
- Rosalind Franklin University of Medicine and Science, Department of Psychology, North Chicago, IL, United States
| | - Rebekka Lencer
- University of Muenster, Department of Psychiatry and Psychotherapy, Munster, Germany
| | - James L Reilly
- Northwestern University, Department of Psychiatry and Behavioral Sciences, Chicago, IL, United States
| | - Sarah K Keedy
- University of Chicago, Department of Psychiatry, Chicago, IL, United States
| | - Richard S E Keefe
- Duke University, Departments of Psychiatry, Neuroscience, and Psychology, Durham, NC, United States
| | - Godfrey D Pearlson
- Yale University School of Medicine, Departments of Psychiatry and Neurobiology, New Haven, CT, United States
| | - Matcheri S Keshavan
- Beth Israel Deaconess Medical Center and Harvard Medical School, Department of Psychiatry, Boston, MA, United States
| | - Carol A Tamminga
- University of Texas-Southwestern University Hospital, Department of Psychiatry, Dallas, TX, United States
| | - John A Sweeney
- University of Cincinnati, Department of Psychiatry and Behavioral Neuroscience, Cincinnati, OH, United States
| | - S Kristian Hill
- Rosalind Franklin University of Medicine and Science, Department of Psychology, North Chicago, IL, United States
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15
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Eum S, Hill SK, Alliey-Rodriguez N, Stevenson JM, Rubin LH, Lee AM, Mills LJ, Reilly JL, Lencer R, Keedy SK, Ivleva E, Keefe RSE, Pearlson GD, Clementz BA, Tamminga CA, Keshavan MS, Gershon ES, Sweeney JA, Bishop JR. Genome-wide association study accounting for anticholinergic burden to examine cognitive dysfunction in psychotic disorders. Neuropsychopharmacology 2021; 46:1802-1810. [PMID: 34145405 PMCID: PMC8358015 DOI: 10.1038/s41386-021-01057-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/17/2021] [Accepted: 06/03/2021] [Indexed: 12/13/2022]
Abstract
Identifying genetic contributors to cognitive impairments in psychosis-spectrum disorders can advance understanding of disease pathophysiology. Although CNS medications are known to affect cognitive performance, they are often not accounted for in genetic association studies. In this study, we performed a genome-wide association study (GWAS) of global cognitive performance, measured as composite z-scores from the Brief Assessment of Cognition in Schizophrenia (BACS), in persons with psychotic disorders and controls (N = 817; 682 cases and 135 controls) from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) study. Analyses accounting for anticholinergic exposures from both psychiatric and non-psychiatric medications revealed five significantly associated variants located at the chromosome 3p21.1 locus, with the top SNP rs1076425 in the inter-alpha-trypsin inhibitor heavy chain 1 (ITIH1) gene (P = 3.25×E-9). The inclusion of anticholinergic burden improved association models (P < 0.001) and the number of significant SNPs identified. The effect sizes and direction of effect of the top variants remained consistent when investigating findings within individuals receiving specific antipsychotic drugs and after accounting for antipsychotic dose. These associations were replicated in a separate study sample of untreated first-episode psychosis. The chromosome 3p21.1 locus was previously reported to have association with the risk for psychotic disorders and cognitive performance in healthy individuals. Our findings suggest that this region may be a psychosis risk locus that is associated with cognitive mechanisms. Our data highlight the general point that the inclusion of medication exposure information may improve the detection of gene-cognition associations in psychiatric genetic research.
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Affiliation(s)
- Seenae Eum
- grid.412555.20000 0001 0511 4494Department of Pharmacogenomics, Shenandoah University, Fairfax, VA USA
| | - S. Kristian Hill
- grid.262641.50000 0004 0388 7807Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL USA
| | - Ney Alliey-Rodriguez
- grid.170205.10000 0004 1936 7822Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL USA
| | - James M. Stevenson
- grid.21107.350000 0001 2171 9311Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Leah H. Rubin
- grid.21107.350000 0001 2171 9311Departments of Neurology, Psychiatry, and Epidemiology, Johns Hopkins University, Baltimore, MD USA
| | - Adam M. Lee
- grid.17635.360000000419368657Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN USA
| | - Lauren J. Mills
- grid.17635.360000000419368657Masonic Cancer Center and Department of Pediatrics, University of Minnesota, Minneapolis, MN USA
| | - James L. Reilly
- grid.16753.360000 0001 2299 3507Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL USA
| | - Rebekka Lencer
- grid.5949.10000 0001 2172 9288Institute of Translational Psychiatry and Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany ,grid.4562.50000 0001 0057 2672Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Sarah K. Keedy
- grid.170205.10000 0004 1936 7822Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL USA
| | - Elena Ivleva
- grid.267313.20000 0000 9482 7121Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX USA
| | - Richard S. E. Keefe
- grid.26009.3d0000 0004 1936 7961Department of Psychiatry, Duke University School of Medicine, Durham, NC USA
| | - Godfrey D. Pearlson
- grid.277313.30000 0001 0626 2712Departments of Psychiatry and Neuroscience, Yale School of Medicine, Olin Center, Institute of Living, Hartford Healthcare, Hartford, CT USA
| | - Brett A. Clementz
- grid.213876.90000 0004 1936 738XDepartment of Psychology, University of Georgia, Athens, GA USA
| | - Carol A. Tamminga
- grid.267313.20000 0000 9482 7121Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX USA
| | - Matcheri S. Keshavan
- grid.239395.70000 0000 9011 8547Beth Israel Deaconess Medical Center, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Elliot S. Gershon
- grid.170205.10000 0004 1936 7822Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL USA
| | - John A. Sweeney
- grid.413561.40000 0000 9881 9161Department of Psychiatry, University of Cincinnati Medical Center, Cincinnati, OH USA
| | - Jeffrey R. Bishop
- grid.17635.360000000419368657Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN USA ,grid.17635.360000000419368657Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN USA
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16
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Abstract
Background: Cognitive impairment is common in Parkinson’s disease (PD) and highly associated with loss of independence, caregiver burden, and assisted living placement. The need for cognitive functional capacity tools validated for use in PD clinical and research applications has thus been emphasized in the literature. The Virtual Reality Functional Capacity Assessment Tool (VRFCAT-SL) is a tablet-based instrument that assesses proficiency for performing real world tasks in a highly realistic environment. Objective: The present study explored application of the VRFCAT-SL in clinical assessments of patients with PD. Specifically, we examined associations between VRFCAT-SL performance and measures of cognition, motor severity, and self-reported cognitive functioning. Methods: The VRFCAT-SL was completed by a sample of 29 PD patients seen in clinic for a comprehensive neuropsychological evaluation. Fifteen patients met Movement Disorders Society Task Force criteria for mild cognitive impairment (PD-MCI); no patients were diagnosed with dementia. Non-parametric correlations between VRFCAT-SL performance and standardized neuropsychological tests and clinical measures were examined. Results: VRFCAT-SL performance was moderately associated with global rank on neuropsychological testing and discriminated PD-MCI. Follow-up analyses found completion time was associated with visual memory, sustained attention, and set-switching, while errors were associated with psychomotor inhibition. No clinical or motor measures were associated with VRFCAT-SL performance. Self-report was not associated with VRFCAT-SL or neuropsychological test performance. Conclusion: The VRFCAT-SL appears to provide a useful measure of cognitive functional capacity that is not confounded by PD motor symptoms. Future studies will examine utility in PD dementia.
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Affiliation(s)
- Travis H Turner
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Richard S E Keefe
- VeraSci, Inc., Durham, NC, USA.,Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
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17
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Abstract
Cognitive dysfunction is a core feature of schizophrenia. The subtyping of cognitive performance in schizophrenia may aid the refinement of disease heterogeneity. The literature on cognitive subtyping in schizophrenia, however, is limited by variable methodologies and neuropsychological tasks, lack of validation, and paucity of studies examining longitudinal stability of profiles. It is also unclear if cognitive profiles represent a single linear severity continuum or unique cognitive subtypes. Cognitive performance measured with the Brief Assessment of Cognition in Schizophrenia was analyzed in schizophrenia patients (n = 767). Healthy controls (n = 1012) were included as reference group. Latent profile analysis was performed in a schizophrenia discovery cohort (n = 659) and replicated in an independent cohort (n = 108). Longitudinal stability of cognitive profiles was evaluated with latent transition analysis in a 10-week follow-up cohort. Confirmatory factor analysis (CFA) was carried out to investigate if cognitive profiles represent a unidimensional structure. A 4-profile solution was obtained from the discovery cohort and replicated in an independent cohort. It comprised of a "less-impaired" cognitive subtype, 2 subtypes with "intermediate cognitive impairment" differentiated by executive function performance, and a "globally impaired" cognitive subtype. This solution showed relative stability across time. CFA revealed that cognitive profiles are better explained by distinct meaningful profiles than a severity linear continuum. Associations between profiles and negative symptoms were observed. The subtyping of schizophrenia patients based on cognitive performance and its associations with symptomatology may aid phenotype refinement, mapping of specific biological mechanisms, and tailored clinical treatments.
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Affiliation(s)
- Keane Lim
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Jason Smucny
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, Psychiatry, and Radiology, Washington University in St. Louis, St. Louis, MO
| | - Max Lam
- Research Division, Institute of Mental Health, Singapore, Singapore
- Feinstein Institute of Medical Research, The Zucker Hillside Hospital, New York, NY
- Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, MA
| | - Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore
- Department of Psychosis, Institute of Mental Health, Singapore, Singapore
- Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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18
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Fleischhacker WW, Podhorna J, Gröschl M, Hake S, Zhao Y, Huang S, Keefe RSE, Desch M, Brenner R, Walling DP, Mantero-Atienza E, Nakagome K, Pollentier S. Efficacy and safety of the novel glycine transporter inhibitor BI 425809 once daily in patients with schizophrenia: a double-blind, randomised, placebo-controlled phase 2 study. Lancet Psychiatry 2021; 8:191-201. [PMID: 33610228 DOI: 10.1016/s2215-0366(20)30513-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [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: 07/30/2020] [Revised: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cognitive impairment associated with schizophrenia predicts poor functional outcomes, but currently no approved pharmacotherapy is available. This study investigated whether the glycine transporter-1 inhibitor BI 425809 improves cognition in patients with schizophrenia. METHODS This phase 2, randomised, double-blind, placebo-controlled, parallel-group trial (81 centres, 11 countries), randomly assigned outpatients (aged 18-50 years) with schizophrenia on stable treatment to add-on once-daily oral BI 425809 2 mg, 5 mg, 10 mg, or 25 mg or placebo (1:1:1:1:2) for 12 weeks. Treatment was assigned in blocks using interactive response technology; patients, investigators, and all trial personnel were masked to group assignment. The primary endpoint was change from baseline in MATRICS Consensus Cognitive Battery (MCCB) overall composite T-score at week 12. Six predefined dose-response models were evaluated using a multiple comparison procedure and modelling approach with mixed model repeated measures to assess evidence for a non-flat dose-response relationship for cognitive improvements with BI 425809. Adverse events were monitored. Safety analyses included all randomly allocated patients who received one or more doses of trial medication; efficacy analyses included patients from this set who also had available baseline data and at least one post-baseline on-treatment measurement for the primary or secondary endpoint. This study is registered with ClinicalTrials.gov, number NCT02832037. FINDINGS 509 patients were randomly assigned between April 25, 2018, and Oct 4, 2019 (BI 425809 2 mg, n=85; 5 mg, n=84; 10 mg, n=85; 25 mg, n=85; placebo, n=170 444 (87%) completed the 12-week treatment. Five of six dose-response models showed a statistically significant benefit of BI 425809 over placebo (linear [t=2·55, p=0·015], linear in log [t=2·56, p=0·015]; Emax [t=2·75, p=0·0089], sigmoid Emax [t=2·98, p=0·0038], logistic [t=2·77, p=0·0085]). Pairwise comparisons showed greater mean improvement from baseline in MCCB overall composite T-score at week 12 with BI 425809 10 mg and 25 mg versus placebo (adjusted mean difference 1·98 [95% CI 0·43-3·53] for 10 mg and 1·73 [0·18-3·28] for 25 mg; standardised effect size 0·34 for 10 mg and 0·30 for 25 mg). Adverse events were balanced across groups, reported in 50 (59%) of 85 patients on BI 425809 2 mg, 44 (52%) of 84 on 5 mg, 35 (41%) of 85 on 10 mg, 36 (42%) of 85 on 25 mg, and 74 (44%) of 170 on placebo. INTERPRETATION BI 425809 improved cognition after 12 weeks in patients with schizophrenia; doses of 10 mg and 25 mg showed the largest separation from placebo. If these encouraging results are confirmed in phase 3 trials, BI 425809 could provide an effective treatment for cognitive impairment associated with schizophrenia. FUNDING Boehringer Ingelheim.
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Affiliation(s)
| | - Jana Podhorna
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany.
| | | | | | - Yihua Zhao
- Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT, USA
| | - Songqiao Huang
- Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT, USA
| | - Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; VeraSci, Durham, NC, USA
| | - Michael Desch
- Boehringer Ingelheim Pharma, Biberach an der Riss, Germany
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19
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Affiliation(s)
- Richard S E Keefe
- Department of Psychiatry, Duke University Medical Center, DUMC Box 3270, Durham, NC 27710, United States of America.
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20
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Seccomandi B, Agbedjro D, Bell M, Keefe RSE, Keshavan M, Galderisi S, Fiszdon J, Mucci A, Cavallaro R, Ojeda N, Peña J, Müller D, Roder V, Wykes T, Cella M. Exploring the role of age as a moderator of cognitive remediation for people with schizophrenia. Schizophr Res 2021; 228:29-35. [PMID: 33429151 DOI: 10.1016/j.schres.2020.11.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/05/2020] [Accepted: 11/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND While Cognitive Remediation (CR) is effective in reducing cognitive and functioning difficulties in people with schizophrenia, there is variability in treatment response. Previous research suggested that participants' age may be a significant moderator of CR response. AIM To examine the impact of participants' age on CR outcomes. METHOD Individual participant data were accessed from fourteen CR randomised controlled trials. We tested the moderating effect of participants' age on cognitive and functioning outcomes using multivariate linear models. RESULTS Data from 1084 people with a diagnosis of schizophrenia were considered. Participants had a mean age of 36.6 years (SD 11), with 11.6 years of education (SD 2.8), and an average duration of illness of 13.5 years (SD 10.7). Multivariate models showed that participants' age, when considered as a continuous variable, was not a significant moderator of treatment effect for cognitive and functioning outcomes. However, when participants were split by median age, younger participants showed higher gains in executive functions following CR compared to older participants (p=0.02). CONCLUSION These results suggest that participants' age does not moderate most CR outcomes. However, larger age differences may influence the effect of CR on executive function. This may suggest some adaptation of CR practice according to participants' age. These findings inform the CR personalisation agenda.
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Affiliation(s)
- Benedetta Seccomandi
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
| | - Deborah Agbedjro
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Morris Bell
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Richard S E Keefe
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Silvana Galderisi
- Department of Psychiatry, Seconda Universita degli Studi di Napoli, Naples, Italy
| | - Joanna Fiszdon
- Department of Psychology, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Armida Mucci
- Department of Psychiatry, Seconda Universita degli Studi di Napoli, Naples, Italy
| | - Roberto Cavallaro
- Department of Clinical Neurosciences, Scientific Institute San Raffaele, Milan, Italy
| | - Natalia Ojeda
- Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Javier Peña
- Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Daniel Müller
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Volker Roder
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London SE5 8AZ, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London SE5 8AZ, UK
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21
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Seccomandi B, Agbedjro D, Bell M, Keefe RSE, Keshavan M, Galderisi S, Fiszdon J, Mucci A, Cavallaro R, Bechi M, Ojeda N, Peña J, Wykes T, Cella M. Can IQ moderate the response to cognitive remediation in people with schizophrenia? J Psychiatr Res 2021; 133:38-45. [PMID: 33307353 DOI: 10.1016/j.jpsychires.2020.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/29/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND IQ and IQ decline are considered risk factors for poor prognosis in people with a diagnosis of schizophrenia. However, it is still not clear if, at least in part, IQ and IQ decline influence long-term outcomes via a negative effect on interventions. AIM To identify whether current IQ, estimated premorbid IQ, or IQ decline moderate the response to cognitive remediation (CR). METHOD Individual participant data from twelve randomised controlled trials of CR were considered. Hierarchical and k-means analyses were carried out to identify different IQ clusters. The moderating effect of estimated premorbid IQ, current IQ, and different IQ clusters (preserved, deteriorated and compromised trajectories) on cognitive outcomes at post-therapy and follow-up were evaluated using multiple linear regression. RESULTS Data from 984 participants (CR = 544, control = 440) with schizophrenia and schizoaffective disorders were considered. The sample had a mean current IQ of 84.16 (SD 15.61) and estimated premorbid IQ of 95.82 (SD 10.63). Current IQ moderated working memory outcomes: people with higher IQ had larger working memory gains after therapy compared to those with a lower IQ. Those with a preserved IQ had better cognitive outcomes compared to either the deteriorated or compromised IQ groups, and those with a deteriorated IQ had better outcomes compared to those in the compromised IQ group. CONCLUSION Current IQ is a significant moderator of cognitive gains after CR. These findings highlight the need to evaluate whether therapy adaptations (e.g. offering more sessions) can attenuate this effect so that those with lower IQ may derive benefit similar to those with higher IQ.
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Affiliation(s)
- Benedetta Seccomandi
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
| | - Deborah Agbedjro
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Morris Bell
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Richard S E Keefe
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Joanna Fiszdon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychology Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Roberto Cavallaro
- Department of Clinical Neurosciences, Vita Salute San Raffaele University and Scientific Institute San Raffaele Hospital, Milan, Italy
| | - Margherita Bechi
- Department of Clinical Neurosciences, Vita Salute San Raffaele University and Scientific Institute San Raffaele Hospital, Milan, Italy
| | - Natalia Ojeda
- Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Javier Peña
- Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, SE5 8AZ, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, SE5 8AZ, UK
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22
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Keefe RSE, Green MF, Harvey PD. Requisite Skills and the Meaningful Measurement of Cognition. JAMA Psychiatry 2020; 77:1103-1104. [PMID: 32639514 DOI: 10.1001/jamapsychiatry.2020.1618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles
| | - Philip D Harvey
- Miller School of Medicine, University of Miami, Miami, Florida.,Research Service, Bruce W. Carter VA Medical Center, Miami, Florida
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23
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Lindenmayer JP, Goldring A, Borne S, Khan A, Keefe RSE, Insel BJ, Thanju A, Ljuri I, Foreman B. Assessing instrumental activities of daily living (iADL) with a game-based assessment for individuals with schizophrenia. Schizophr Res 2020; 223:166-172. [PMID: 32690346 DOI: 10.1016/j.schres.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/02/2020] [Accepted: 07/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is an "applied" game-based assessment that uses a multi-level functional task to assess instrumental activities of daily living (iADL). This study examines the feasibility, convergent validity, and predictive ability of the VRFCAT in a sample of inpatients with chronic schizophrenia. METHODS Inpatients with a DSM-5 diagnosis of schizophrenia or schizoaffective disorder, completed the VRFCAT prior to discharge. The UPSA-B, SLOF, and PSP were administered, both at baseline and after four-weeks in the community. VRFCAT performance scores were compared to published data from the VRFCAT validation study. RESULTS All 62 participants completed the VRFCAT. Compared to the performance of stable outpatients, participants performed 1.50 SDs below the VRFCAT mean adjusted total time (ATT) (Validation study: Mean T Score = 32.5, SD = 16.59) with more errors. The VRFCAT ATT T-score was significantly correlated with baseline UPSA-B total score (p = 0.005) and PSP Global score (p = 0.010). 34 participants completed the follow-up period (55%), and 28 were lost to follow-up. There were no statistically significant differences in VRFCAT scores between these two groups (all p > 0.29). The VRFCAT composite score at baseline was significantly associated with the UPSA-B total score (p = 0.010) and the PSP total score (p = 0.008) at four-weeks, as was the PSP Socially Useful Activities subscale score (p = 0.006). CONCLUSION The VRFCAT is a valid measure of iADLs in inpatients with chronic schizophrenia. The VRFCAT predicted instrumental functioning four-weeks post-discharge. Future studies should examine other moderators of measures of functional capacity pre-discharge, predicting function later in the community.
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Affiliation(s)
- Jean-Pierre Lindenmayer
- Manhattan Psychiatric Center, United States of America; New York University, Department of Psychiatry, United States of America; Nathan S. Kline Institute for Psychiatric Research, United States of America
| | - Abraham Goldring
- Manhattan Psychiatric Center, United States of America; Nathan S. Kline Institute for Psychiatric Research, United States of America; Medgar Evers College, CUNY, United States of America.
| | - Sophia Borne
- New School for Social Research, United States of America
| | - Anzalee Khan
- Manhattan Psychiatric Center, United States of America; Nathan S. Kline Institute for Psychiatric Research, United States of America
| | - Richard S E Keefe
- VeraSci, Inc, United States of America; Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America
| | | | - Amod Thanju
- Manhattan Psychiatric Center, United States of America; Nathan S. Kline Institute for Psychiatric Research, United States of America
| | - Isidora Ljuri
- Manhattan Psychiatric Center, United States of America
| | - Bronwen Foreman
- Manhattan Psychiatric Center, United States of America; Duke University School of Medicine, United States of America
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24
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Chaturvedi R, Kraus M, Keefe RSE. A new measure of authentic auditory emotion recognition: Application to patients with schizophrenia. Schizophr Res 2020; 222:450-454. [PMID: 32616360 DOI: 10.1016/j.schres.2019.11.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/10/2019] [Accepted: 11/24/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many social processes such as emotion recognition are severely impaired in patients with schizophrenia. While basic auditory processing seems to play a key role in identifying emotions, research in this field is limited due to the lack of proper assessment batteries. Many of the widely accepted tests utilize actors to portray certain emotions-these batteries are less ecologically and face valid. METHODS This study utilized a newly developed auditory emotion recognition test that contained natural stimuli from spontaneous displays of emotions to assess 28 patients with schizophrenia and 16 healthy controls. RESULTS The results indicate that the newly developed test, referred to as the INTONATION Test, is more sensitive to the emotion recognition deficits in patients with schizophrenia than previously used measures. The correlations of the INTONATION Test measures with basic auditory processes were similar to established tests of auditory emotion. Particular emotion sub scores from the INTONTATION test, such as happiness, demonstrated the strongest correlations with specific auditory processing skills, such as formant discrimination and sinusoidal amplitude modulation detection (SAM60). CONCLUSIONS The results from this study indicate that auditory emotion recognition impairments are more pronounced in patients with schizophrenia when perceiving authentic displays of emotion. Understanding these deficits could help specify the nature of auditory emotion recognition deficits in patients with schizophrenia and those at risk.
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Affiliation(s)
- Rahul Chaturvedi
- Duke University, Trinity College of Arts & Sciences, United States
| | - Michael Kraus
- Duke University Medical Center, Department of Psychiatry & Behavioral Sciences, United States.
| | - Richard S E Keefe
- Duke University Medical Center, Department of Psychiatry & Behavioral Sciences, United States.
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25
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Goldberg TE, Harvey PD, Devanand DP, Keefe RSE, Gomar JJ. Development of an UPSA Short Form for Use in Longitudinal Studies in the Early Alzheimer's Disease Spectrum. J Prev Alzheimers Dis 2020; 7:179-183. [PMID: 32463071 DOI: 10.14283/jpad.2019.51] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In individuals with only mild or very mild cognitive attenuations (i.e., so-called pre-clinical AD), performance-based measures of function may be superior to informant-based measures because of increased sensitivity, greater reliability, and fewer ceiling effects. OBJECTIVE We sought to determine if a performance-based measure of everyday function would demonstrate adequate psychometric properties and validity in the context of serial assessment over a one-year period in patients with Mild Cognitive Impairment (MCI) and early stage Alzheimer's disease (AD). DESIGN Participants were assessed with the performance-based measure at baseline, six weeks, and one year. SETTING A specialized center for the assessment and treatment of AD. PARTICIPANTS Three groups of subjects participated: a healthy subjects (HS) older cognitively intact group (N=43), an MCI group (N=20), and an AD group (N=26). MEASUREMENTS A three subtest short form of the UCSD Performance-Based Skills Assessment (UPSA) (called the UPSA-3) was the measure of interest. It consisted of the Communication, Planning, and Finance subtests. RESULTS Mixed model repeated measures were used to assess performance over time. Large group effects were present (HS>MCI>AD). Additionally, the AD and MCI groups demonstrated declines over one year, while the HS group remained stable (group x time interaction p=.11). The MCI/AD group demonstrated adequate test-retest reliability and did not demonstrate ceiling or floor effects. CONCLUSION Our data indicate that the UPSA-3 is suitable for clinical trials in that it has adequate ecological coverage and reasonable psychometric properties, and perhaps most importantly, demonstrates validity in serial assessments.
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Affiliation(s)
- T E Goldberg
- Dr. Jesus J. Gomar, Litwin-Zucker Alzheimer's Disease Center, Feinstein Institute, Manhassett, NY, USA, , Telephone: 516-562-0420, Fax: 516-562-0401
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26
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Krystal AD, Pizzagalli DA, Smoski M, Mathew SJ, Nurnberger J, Lisanby SH, Iosifescu D, Murrough JW, Yang H, Weiner RD, Calabrese JR, Sanacora G, Hermes G, Keefe RSE, Song A, Goodman W, Szabo ST, Whitton AE, Gao K, Potter WZ. A randomized proof-of-mechanism trial applying the 'fast-fail' approach to evaluating κ-opioid antagonism as a treatment for anhedonia. Nat Med 2020; 26:760-768. [PMID: 32231295 PMCID: PMC9949770 DOI: 10.1038/s41591-020-0806-7] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 02/20/2020] [Indexed: 12/28/2022]
Abstract
The National Institute of Mental Health (NIMH) 'fast-fail' approach seeks to improve too-often-misleading early-phase drug development methods by incorporating biomarker-based proof-of-mechanism (POM) testing in phase 2a. This first comprehensive application of the fast-fail approach evaluated the potential of κ-opioid receptor (KOR) antagonism for treating anhedonia with a POM study determining whether robust target engagement favorably impacts the brain circuitry hypothesized to mediate clinical effects. Here we report the results from a multicenter, 8-week, double-blind, placebo-controlled, randomized trial in patients with anhedonia and a mood or anxiety disorder (selective KOR antagonist (JNJ-67953964, 10 mg; n = 45) and placebo (n = 44)). JNJ-67953964 significantly increased functional magnetic resonance imaging (fMRI) ventral striatum activation during reward anticipation (primary outcome) as compared to placebo (baseline-adjusted mean: JNJ-67953964, 0.72 (s.d. = 0.67); placebo, 0.33 (s.d. = 0.68); F(1,86) = 5.58, P < 0.01; effect size = 0.58 (95% confidence interval, 0.13-0.99)). JNJ-67953964, generally well tolerated, was not associated with any serious adverse events. This study supports proceeding with assessment of the clinical impact of target engagement and serves as a model for implementing the 'fast-fail' approach.
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Affiliation(s)
- Andrew D. Krystal
- University of California San Francisco, San Francisco, CA,Duke University School of Medicine, Durham, NC,Address Correspondence to: Andrew D. Krystal, MD, MS, Department of Psychiatry, University of California San Francisco, Box 0984-F, 401 Parnassus Ave, San Francisco, CA 94143-0984, , 415-823-3227
| | | | | | - Sanjay J. Mathew
- Baylor College of Medicine, Houston TX;,Michael E. Debakey VA Medical Center, Houston, TX
| | | | | | - Dan Iosifescu
- New York University School of Medicine, New York, NY
| | | | | | | | | | | | | | | | - Allen Song
- Duke University School of Medicine, Durham, NC
| | | | - Steven T. Szabo
- Duke University School of Medicine, Durham, NC,Durham VA Health Care System, Durham, NC
| | - Alexis E. Whitton
- McLean Hospital, Harvard Medical School, Belmont MA,The University of Sydney, Sydney, Australia
| | - Keming Gao
- Case Western Reserve School of Medicine, Cleveland, OH
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27
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Ho NF, Lee BJH, Tng JXJ, Lam MZY, Chen G, Wang M, Zhou J, Keefe RSE, Sim K. Corticolimbic brain anomalies are associated with cognitive subtypes in psychosis: A longitudinal study. Eur Psychiatry 2020; 63:e40. [PMID: 32336305 PMCID: PMC7355174 DOI: 10.1192/j.eurpsy.2020.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/31/2022] Open
Abstract
Background. Earlier studies examining structural brain abnormalities associated with cognitively derived subgroups were mainly cross-sectional in design and had mixed findings. Thus, we obtained cross-sectional and longitudinal data to characterize the extent and trajectory of brain structure abnormalities underlying distinct cognitive subtypes (“preserved,” “deteriorated,” and “compromised”) seen in psychotic spectrum disorders. Methods. Data from 364 subjects (225 patients with psychotic conditions and 139 healthy controls) were first used to determine the relationship of cognitive subtypes with cross-sectional measures of subcortical volume and cortical thickness. To probe neurodevelopmental abnormalities, brain structure laterality was examined. To examine whether neuroprogressive abnormalities persist, longitudinal brain structural changes over 5 years were examined within a subset of 101 subjects. Subsequent discriminant analysis using the identified brain measures was performed on an independent subject group. Results. Cross-sectional comparisons showed that cortical thinning and limbic volume reductions were most widespread in “deteriorated” cognitive subtype. Laterality comparisons showed more rightward amygdala lateralization in “compromised” than “preserved” subtype. Longitudinal comparisons revealed progressive hippocampal shrinkage in “deteriorated” compared with healthy controls and “preserved” subtype, which correlated with worse negative symptoms, cognitive and psychosocial functioning. Post-hoc discrimination analysis on an independent group of 52 subjects using the identified brain structures found an overall accuracy of 71% for classification of cognitive subtypes. Conclusion. These findings point toward distinct extent and trajectory of corticolimbic abnormalities associated with cognitive subtypes in psychosis, which can allow further understanding of the biological course of cognitive functioning over illness course and with treatment.
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Affiliation(s)
- New Fei Ho
- Institute of Mental Health, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Benjamin J H Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Max Z Y Lam
- Institute of Mental Health, Singapore, Singapore
| | - Guoyang Chen
- Institute of Mental Health, Singapore, Singapore
| | | | - Juan Zhou
- Duke-National University of Singapore Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Richard S E Keefe
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Kang Sim
- Institute of Mental Health, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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28
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Kollins SH, DeLoss DJ, Cañadas E, Lutz J, Findling RL, Keefe RSE, Epstein JN, Cutler AJ, Faraone SV. A novel digital intervention for actively reducing severity of paediatric ADHD (STARS-ADHD): a randomised controlled trial. Lancet Digit Health 2020; 2:e168-e178. [PMID: 33334505 DOI: 10.1016/s2589-7500(20)30017-0] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is a common paediatric neurodevelopmental disorder with substantial effect on families and society. Alternatives to traditional care, including novel digital therapeutics, have shown promise to remediate cognitive deficits associated with this disorder and may address barriers to standard therapies, such as pharmacological interventions and behavioural therapy. AKL-T01 is an investigational digital therapeutic designed to target attention and cognitive control delivered through a video game-like interface via at-home play for 25 min per day, 5 days per week for 4 weeks. This study aimed to assess whether AKL-T01 improved attentional performance in paediatric patients with ADHD. METHODS The Software Treatment for Actively Reducing Severity of ADHD (STARS-ADHD) was a randomised, double-blind, parallel-group, controlled trial of paediatric patients (aged 8-12 years, without disorder-related medications) with confirmed ADHD and Test of Variables of Attention (TOVA) Attention Performance Index (API) scores of -1·8 and below done by 20 research institutions in the USA. Patients were randomly assigned 1:1 to AKL-T01 or a digital control intervention. The primary outcome was mean change in TOVA API from pre-intervention to post-intervention. Safety, tolerability, and compliance were also assessed. Analyses were done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT02674633 and is completed. FINDINGS Between July 15, 2016, and Nov 30, 2017, 857 patients were evaluated and 348 were randomly assigned to receive AKL-T01 or control. Among patients who received AKL-T01 (n=180 [52%]; mean [SD] age, 9·7 [1·3] years) or control (n=168 [48%]; mean [SD] age, 9·6 [1·3] years), the non-parametric estimate of the population median change from baseline TOVA API was 0·88 (95% CI 0·24-1·49; p=0·0060). The mean (SD) change from baseline on the TOVA API was 0·93 (3·15) in the AKL-T01 group and 0·03 (3·16) in the control group. There were no serious adverse events or discontinuations. Treatment-related adverse events were mild and included frustration (5 [3%] of 180) and headache (3 [2%] of 180). Patient compliance was a mean of 83 (83%) of 100 expected sessions played (SD, 29·2 sessions). INTERPRETATION Although future research is needed for this digital intervention, this study provides evidence that AKL-T01 might be used to improve objectively measured inattention in paediatric patients with ADHD, while presenting minimal adverse events. FUNDING Sponsored by Akili Interactive Labs.
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Affiliation(s)
- Scott H Kollins
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA.
| | | | | | | | - Robert L Findling
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Richard S E Keefe
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; VeraSci, Durham, NC, USA
| | - Jeffery N Epstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew J Cutler
- Meridien Research & Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA
| | - Stephen V Faraone
- Psychiatry and Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
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29
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Ventura J, Welikson T, Ered A, Subotnik KL, Keefe RSE, Hellemann GS, Nuechterlein KH. Virtual reality assessment of functional capacity in the early course of schizophrenia: Associations with cognitive performance and daily functioning. Early Interv Psychiatry 2020; 14:106-114. [PMID: 31183960 PMCID: PMC6901817 DOI: 10.1111/eip.12831] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/22/2019] [Accepted: 04/14/2019] [Indexed: 12/01/2022]
Abstract
AIM Computer-based virtual reality assessments of functional capacity have shown promise as a reliable and valid way to assess individuals with multi-episode schizophrenia. However, there has been little research utilizing this innovative approach with young patients who are in the early phase of schizophrenia. METHODS Outpatients in the early course of schizophrenia (n = 42) were compared to controls (n = 13) at cross-sectional study points. Patients were within 2 years of their first psychotic episode, were an average of 22.2 years old and had an average of 12.3 years of education. We used the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) and the University of California, San Diego (UCSD) Performance-Based Skills Assessment-2 (UPSA-2) to assess functional capacity. The MATRICS Consensus Cognitive Battery (MCCB) and the Cognitive Assessment Interview (CAI) were the measures of cognitive functioning. The Global Functioning Scale: Role (GFS-R) and Social (GFS-S), and the Role Functioning Scale (RFS) were the measures of daily functioning. RESULTS Early course patients vs controls were slower (patient M = 830.41 seconds vs control M = 716.84 seconds; t = 3.0, P < .01) and committed more errors (patient M = 3.2 vs control M = 1.7 seconds, t = 2.9, P < .01) on the VRFCAT. Total time was significantly correlated with the UPSA (r = -0.66, P < .01), MCCB (r = -0.70, P < .01), CAI (r = -0.51, P < .01), and GFS role (r = -0.52, P <. 01) and social functioning (r = -0.43, P = .03). CONCLUSIONS We extend previous findings to patients with first-episode schizophrenia. Virtual-reality-based performance was correlated with a standard test of functional capacity, indicating VRFCAT validity. Furthermore, correlations with cognitive functioning and occupational/school and social functioning indicate promise as a co-primary measure to track changes in response to treatment.
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Affiliation(s)
- Joseph Ventura
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| | - Tamara Welikson
- Department of Psychology, Alliant University, Alhambra, California
| | - Arielle Ered
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Kenneth L Subotnik
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| | - Richard S E Keefe
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina
| | - Gerhard S Hellemann
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| | - Keith H Nuechterlein
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California.,Department of Psychology, University of California at Los Angeles, Los Angeles, California
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30
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Kraus MS, Gold JM, Barch DM, Walker TM, Chun CA, Buchanan RW, Csernansky JG, Goff DC, Green MF, Jarskog LF, Javitt DC, Kimhy D, Lieberman JA, McEvoy JP, Mesholam-Gately RI, Seidman LJ, Ball MP, Kern RS, McMahon RP, Robinson J, Marder SR, Keefe RSE. The characteristics of cognitive neuroscience tests in a schizophrenia cognition clinical trial: Psychometric properties and correlations with standard measures. Schizophr Res Cogn 2019; 19:100161. [PMID: 31832342 PMCID: PMC6889798 DOI: 10.1016/j.scog.2019.100161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 07/24/2019] [Accepted: 08/25/2019] [Indexed: 11/28/2022]
Abstract
In comparison to batteries of standard neuropsychological tests, cognitive neuroscience tests may offer a more specific assessment of discrete neurobiological processes that may be aberrant in schizophrenia. However, more information regarding psychometric properties and correlations with standard neuropsychological tests and functional measures is warranted to establish their validity as treatment outcome measures. The N-back and AX-Continuous Performance Task (AX-CPT) are two promising cognitive neuroscience tests designed to measure specific components of working memory and contextual processing respectively. In the current study, we report the psychometric properties of multiple outcome measures from these two tests as well as their correlations with standard neuropsychological measures and functional capacity measures. The results suggest that while the AX-CPT and N-back display favorable psychometric properties, they do not exhibit greater sensitivity or specificity with functional measures than standard neurocognitive tests.
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Affiliation(s)
- Michael S Kraus
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Deanna M Barch
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States of America
| | - Trina M Walker
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | | | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - John G Csernansky
- Department of Psychiatry, Northwestern Feinberg School of Medicine, Chicago, IL, United States of America
| | - Donald C Goff
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States of America
| | - Michael F Green
- UCLA Semel Institute for Neuroscience and Human Behavior, United States of America.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America
| | - L Fredrik Jarskog
- North Carolina Psychiatric Research Center, Department of Psychiatry, University of North Carolina at Chapel Hill, United States of America
| | - Daniel C Javitt
- Department of Psychiatry, Nathan Kline Institute for Psychiatric Research, New York University School of Medicine, New York, NY, United States of America
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jeffrey A Lieberman
- Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons, Columbia University, United States of America
| | - Joseph P McEvoy
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - Raquelle I Mesholam-Gately
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Larry J Seidman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States of America.,Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - M Patricia Ball
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Robert S Kern
- UCLA Semel Institute for Neuroscience and Human Behavior, United States of America.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America
| | - Robert P McMahon
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - James Robinson
- Department of Psychiatry, Nathan Kline Institute for Psychiatric Research, New York University School of Medicine, New York, NY, United States of America
| | - Stephen R Marder
- UCLA Semel Institute for Neuroscience and Human Behavior, United States of America.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America
| | - Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
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Keefe RSE, Harvey PD, Khan A, Saoud JB, Staner C, Davidson M, Luthringer R. Cognitive Effects of MIN-101 in Patients With Schizophrenia and Negative Symptoms: Results From a Randomized Controlled Trial. J Clin Psychiatry 2019; 79. [PMID: 29873956 DOI: 10.4088/jcp.17m11753] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 06/15/2017] [Accepted: 11/01/2017] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Current dopamine-blocking antipsychotic drugs have little impact on the cognitive deficits associated with schizophrenia. We evaluated whether MIN-101, a molecule that combines sigma-2 antagonism and 5-HT2A antagonism, might improve cognitive deficits in individuals with moderate to severe negative symptoms in schizophrenia. METHODS Individuals (N = 244) aged 18 to 60 years with stable symptoms of DSM-5-defined schizophrenia and moderate to severe negative symptoms were randomized to placebo (n = 83), MIN-101 32 mg (n = 78), or MIN-101 64 mg (n = 83) in a 12-week, phase 2b, prospective, double-blind, placebo-controlled, parallel-group trial between May 2015 and December 2015. In a post hoc analysis, mean z and T score changes from baseline at 12 weeks of treatment in the cognitive composite score and individual tests on the Brief Assessment of Cognition in Schizophrenia (BACS) Battery were compared between MIN-101 and placebo. RESULTS A total of 79 patients (95.2%) from the placebo group, 76 (97.4%) from the MIN-101 32 mg group, and 79 (95.2%) from the MIN-101 64 mg group completed the BACS at baseline. The BACS token motor (P = .04), verbal fluency (P = .01), and composite z scores (P = .05) showed significant improvements in the MIN-101 32 mg group compared to the placebo group. At week 4, the clinical improvements from baseline in the Positive and Negative Syndrome Scale (PANSS) negative factor showed a significant correlation with improvements from baseline on the BACS composite in the 64 mg group (r = -0.292, P = .020). At week 12, improvement in the PANSS negative factor showed significant correlations with improvements in the BACS composite (r = -0.408, P = .002), Trail Making Test (r = -0.394, P = .003), and verbal memory (r = -0.322, P = .017) for the 64 mg group. CONCLUSIONS Results suggest a possible benefit of MIN-101 on cognitive performance in individuals with schizophrenia with stable positive symptoms and concurrent clinically significant negative symptoms. TRIAL REGISTRATION EU Clinical Trials Register identifier: 2014-004878-42.
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Affiliation(s)
- Richard S E Keefe
- Duke University Medical Center, Box 3270, Durham, NC 27710. .,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA.,NeuroCog Trials, Durham, North Carolina, USA
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA
| | - Anzalee Khan
- NeuroCog Trials, Durham, North Carolina, USA.,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Jay B Saoud
- PPRS RESEARCH, Inc, Colmar, France.,Minerva Neurosciences, Inc., Waltham, Massachusetts, USA
| | | | - Michael Davidson
- Minerva Neurosciences, Inc., Waltham, Massachusetts, USA.,Department of Psychiatry, Sackler Medical School Tel Aviv University, Tel Aviv, Israel
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Mahncke HW, Kim SJ, Rose A, Stasio C, Buckley P, Caroff S, Duncan E, Yasmin S, Jarskog LF, Lamberti JS, Nuechterlein K, Strassnig M, Velligan D, Ventura J, Walker T, Stroup TS, Keefe RSE. Evaluation of a plasticity-based cognitive training program in schizophrenia: Results from the eCaesar trial. Schizophr Res 2019; 208:182-189. [PMID: 30930034 PMCID: PMC6544484 DOI: 10.1016/j.schres.2019.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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] [Received: 11/30/2018] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Cognitive impairment in schizophrenia is a core feature of the disorder. Computerized cognitive training has shown promise in pilot studies. A 26-week randomized blinded placebo-controlled trial was conducted to investigate the effect of a novel computerized cognitive training program on cognitive and functional capacity outcomes. METHOD The study followed MATRICS guidelines for the evaluation of interventions designed to improve cognitive function in schizophrenia. Participants (N = 150) were randomized to experimental (computerized cognitive training in a game-like format) or active control (computer games) groups. Training was conducted in-clinic, with an intended training schedule of 5 days per week, 1 h per day, for 26 weeks. Co-primary outcome measures were the MATRICS Consensus Cognitive Battery (MCCB) composite score and the UCSD Performance-Based Skills Assessment (UPSA-2) total score, secondary outcome measures included the Cognitive Assessment Interview (CAI) and the Short-Form-12 Mental Composite Score (SF-12 MCS). Target engagement was assessed with task-learning based assessment. RESULTS At baseline, the groups were well matched. No significant effect of the experimental treatment was seen on the primary or secondary outcome measures compared to the active control. Review of the task learning/target engagement data suggested inadequate target engagement. CONCLUSIONS Results do not support a cognitive or functional capacity benefit from this implementation of a computerized cognitive training program in people with schizophrenia. In future trials, careful consideration is merited of the assessment of task learning/target engagement, the effects of making the cognitive training game-like on motivation, and the implicit effects of trial requirements on participant selection.
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Affiliation(s)
| | | | | | | | - Peter Buckley
- Virginia Commonwealth University, United States of America
| | - Stanley Caroff
- Corporal Michael J. Crescenz VA Medical Center, The Perelman School of Medicine, University of Pennsylvania, United States of America
| | - Erica Duncan
- Atlanta Veterans Affairs Medical Center, Emory University, United States of America
| | - Sarah Yasmin
- Palo Alto Veterans Affairs Medical Center, United States of America
| | - L Fredrik Jarskog
- University of North Carolina at Chapel Hill, United States of America
| | | | | | | | - Dawn Velligan
- University of Texas Health Science Center in Austin, United States of America
| | - Joseph Ventura
- University of California, Los Angeles, United States of America
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33
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Affiliation(s)
- Richard S E Keefe
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
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34
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Brown D, Nakagome K, Cordes J, Brenner R, Gründer G, Keefe RSE, Riesenberg R, Walling DP, Daniels K, Wang L, McGinniss J, Sand M. Evaluation of the Efficacy, Safety, and Tolerability of BI 409306, a Novel Phosphodiesterase 9 Inhibitor, in Cognitive Impairment in Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled, Phase II Trial. Schizophr Bull 2019; 45:350-359. [PMID: 29718385 PMCID: PMC6403090 DOI: 10.1093/schbul/sby049] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients with cognitive impairment associated with schizophrenia may benefit from treatments targeting dysfunctional glutamatergic neurotransmission. BI 409306, a potent and selective phosphodiesterase 9 inhibitor, was assessed in patients with schizophrenia using a learn-and-confirm adaptive trial design. METHODS This double-blind, parallel-group trial randomized patients 2:1:1:1:1 to once-daily placebo or BI 409306 (10, 25, 50, or 100 mg) for 12 weeks. Stage 1 (learn) assessed change from baseline in Cambridge Neuropsychological Test Automated Battery (CANTAB) scores (week 12) to identify ≥1 meaningful endpoints for stage 2 (confirm). If no domains showed efficacy, change from baseline in Measurements and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) composite scores (week 12) was the primary endpoint. The key secondary endpoint was change from baseline in Schizophrenia Cognition Rating Scale (SCoRS) total score. Safety was monitored. RESULTS Five hundred eighteen patients were randomized. In stage 1, CANTAB did not differentiate between BI 409306 and placebo (n = 120), so the primary endpoint of change from baseline in MCCB composite score was analyzed in 450 patients in stage 2. There was no significant difference between BI 409306 (1.2-2.8) and placebo (2.5) in MCCB composite score change. BI 409306 did not significantly improve change from baseline in SCoRS total score (-3.1 to -2.0) vs placebo (-2.5). Adverse events were dose-dependent, increasing from 33.3% (10 mg) to 53.5% (100 mg), vs 36.4% for placebo. CONCLUSION The primary endpoint of cognitive function improvement was not met. BI 409306 was well-tolerated, with an acceptable safety profile.
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Affiliation(s)
- David Brown
- Community Clinical Research, Inc, Austin, TX
| | - Kazuyuki Nakagome
- Department of Forensic Psychiatry, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC
| | | | | | | | - Lara Wang
- Boehringer Ingelheim Taiwan Limited, Taipei, Taiwan
| | | | - Michael Sand
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT
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Kraus MS, Walker TM, Jarskog LF, Millet RA, Keefe RSE. Basic auditory processing deficits and their association with auditory emotion recognition in schizophrenia. Schizophr Res 2019; 204:155-161. [PMID: 30268821 DOI: 10.1016/j.schres.2018.08.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Individuals with schizophrenia are impaired in their ability to recognize emotions based on vocal cues and these impairments are associated with poor global outcome. Basic perceptual processes, such as auditory pitch processing, are impaired in schizophrenia and contribute to difficulty identifying emotions. However, previous work has focused on a relatively narrow assessment of auditory deficits and their relation to emotion recognition impairment in schizophrenia. METHODS We have assessed 87 patients with schizophrenia and 73 healthy controls on a comprehensive battery of tasks spanning the five empirically derived domains of auditory function. We also explored the relationship between basic auditory processing and auditory emotion recognition within the patient group using correlational analysis. RESULTS Patients exhibited widespread auditory impairments across multiple domains of auditory function, with mostly medium effect sizes. Performance on all of the basic auditory tests correlated with auditory emotion recognition at the p < .01 level in the patient group, with 9 out of 13 tests correlating with emotion recognition at r = 0.40 or greater. After controlling for cognition, many of the largest correlations involved spectral processing within the phase-locking range and discrimination of vocally based stimuli. CONCLUSIONS While many auditory skills contribute to this impairment, deficient formant discrimination appears to be a key skill contributing to impaired emotion recognition as this was the only basic auditory skill to enter a step-wise multiple regression after first entering a measure of cognitive impairment, and formant discrimination accounted for significant unique variance in emotion recognition performance after accounting for deficits in pitch processing.
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Affiliation(s)
- Michael S Kraus
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, 10 Duke Medicine Circle, Durham, NC 27710, USA.
| | - Trina M Walker
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, 10 Duke Medicine Circle, Durham, NC 27710, USA
| | - L Fredrik Jarskog
- North Carolina Psychiatric Research Center, Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Dr # 1, Chapel Hill, NC 27514, USA
| | - Robert A Millet
- Carolina Behavioral Care, 4102 Ben Franklin Blvd Durham, NC 27704, USA
| | - Richard S E Keefe
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, 10 Duke Medicine Circle, Durham, NC 27710, USA
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Keefe RSE, Pani L. Take This Cognitive Training Efficacy Bar Fight Outside (to a Regulatory Agency). Biol Psychiatry Cogn Neurosci Neuroimaging 2018; 3:900-902. [PMID: 30409386 DOI: 10.1016/j.bpsc.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Richard S E Keefe
- Duke University Medical Center, Durham, North Carolina; NeuroCog Trials, Inc., Durham, North Carolina.
| | - Luca Pani
- NeuroCog Trials, Inc., Durham, North Carolina; University of Miami Miller School of Medicine, Miami, Florida
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Atkins AS, Khan A, Ulshen D, Vaughan A, Balentin D, Dickerson H, Liharska LE, Plassman B, Welsh-Bohmer K, Keefe RSE. Assessment of Instrumental Activities of Daily Living in Older Adults with Subjective Cognitive Decline Using the Virtual Reality Functional Capacity Assessment Tool (VRFCAT). J Prev Alzheimers Dis 2018; 5:216-234. [PMID: 30298179 DOI: 10.14283/jpad.2018.28] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Continuing advances in the understanding of Alzheimer's disease progression have inspired development of disease-modifying therapeutics intended for use in preclinical populations. However, identification of clinically meaningful cognitive and functional outcomes for individuals who are, by definition, asymptomatic remains a significant challenge. Clinical trials for prevention and early intervention require measures with increased sensitivity to subtle deficits in instrumental activities of daily living (IADL) that comprise the first functional declines in prodromal disease. Validation of potential endpoints is required to ensure measure sensitivity and reliability in the populations of interest. OBJECTIVES The present research validates use of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) for performance-based assessment of IADL functioning in older adults (age 55+) with subjective cognitive decline. DESIGN Cross-sectional validation study. SETTING All participants were evaluated on-site at NeuroCog Trials, Durham, NC, USA. PARTICIPANTS Participants included 245 healthy younger adults ages 20-54 (131 female), 247 healthy older adults ages 55-91 (151 female) and 61 older adults with subjective cognitive decline (SCD) ages 56-97 (45 female). MEASURES Virtual Reality Functional Capacity Assessment Tool; Brief Assessment of Cognition App; Alzheimer's Disease Cooperative Study Prevention Instrument Project - Mail-In Cognitive Function Screening Instrument; Alzheimer's Disease Cooperative Study Instrumental Activities of Daily Living - Prevention Instrument, University of California, San Diego Performance-Based Skills Assessment - Validation of Intermediate Measures; Montreal Cognitive Assessment; Trail Making Test- Part B. RESULTS Participants with SCD performed significantly worse than age-matched normative controls on all VRFCAT endpoints, including total completion time, errors and forced progressions (p≤0001 for all, after Bonferonni correction). Consistent with prior findings, both groups performed significantly worse than healthy younger adults (age 20-54). Participants with SCD also performed significantly worse than controls on objective cognitive measures. VRFCAT performance was strongly correlated with cognitive performance. In the SCD group, VRFCAT performance was strongly correlated with cognitive performance across nearly all tests with significant correlation coefficients ranging from 0.3 to 0.7; VRFCAT summary measures all had correlations greater than r=0.5 with MoCA performance and BAC App Verbal Memory (p<0.01 for all). CONCLUSIONS Findings suggest the VRFCAT provides a sensitive tool for evaluation of IADL functioning in individuals with subjective cognitive decline. Strong correlations with cognition across groups suggest the VRFCAT may be uniquely suited for clinical trials in preclinical AD, as well as longitudinal investigations of the relationship between cognition and function.
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Affiliation(s)
- A S Atkins
- Alexandra S. Atkins, Ph.D., Vice President- Scientific Development, NeuroCog Trials, 3211 Shannon Road, Suite 300, Durham, NC 27707, USA, ph. (919) 401-4642, fx. (919) 401-4644,
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Lam M, Lee J, Rapisarda A, See YM, Yang Z, Lee SA, Abdul-Rashid NA, Kraus M, Subramaniam M, Chong SA, Keefe RSE. Longitudinal Cognitive Changes in Young Individuals at Ultrahigh Risk for Psychosis. JAMA Psychiatry 2018; 75:929-939. [PMID: 30046827 PMCID: PMC6142925 DOI: 10.1001/jamapsychiatry.2018.1668] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Cognitive deficits are a key feature of risk for psychosis. Longitudinal changes in cognitive architecture may be associated with the social and occupational functioning in young people. OBJECTIVES To examine longitudinal profiles of cognition in individuals at ultrahigh risk (UHR) for psychosis, compared with healthy controls, and to investigate the association of cognition with functioning. DESIGN, SETTING, AND PARTICIPANTS This study has a multiple-group prospective design completed in 24 months and was conducted from January 1, 2009, to November 11, 2012, as part of the Longitudinal Youth at-Risk Study conducted in Singapore. Participants either were recruited from psychiatric outpatient clinics, educational institutions, and community mental health agencies or self-referred. Follow-up assessments were performed every 6 months for 2 years or until conversion to psychosis. Individuals with medical causes for psychosis, current illicit substance use, or color blindness were excluded. Data analysis was conducted from June 2014 to May 2018. MAIN OUTCOMES AND MEASURES Neuropsychological, perceptual, and social cognitive tasks; semi-structured interviews, and the Structured Clinical Interview for DSM-IV Axis I disorders were administered every 6 months. The UHR status of nonconverters, converters, remitters, and nonremitters was monitored. Cognitive domain scores and functioning were investigated longitudinally. RESULTS In total, 384 healthy controls and 173 UHR individuals between ages 14 and 29 years were evaluated prospectively. Of the 384 healthy controls, 153 (39.8%) were female and 231 (60.2%) were male with a mean (SD) age of 21.69 (3.26) years. Of the 173 individuals at UHR for psychosis, 56 (32.4%) were female and 117 (67.6%) were male with a mean (SD) age of 21.27 (3.52) years). After 24 months of follow-up, 383 healthy controls (99.7%) and 122 individuals at UHR for psychosis (70.5%) remained. Baseline cognitive deficits were associated with psychosis conversion later (mean odds ratio [OR], 1.66; combined 95% CI, 1.08-2.83; P = .04) and nonremission of UHR status (mean OR, 1.67; combined 95% CI, 1.09-2.95; P = .04). Five cognitive components-social cognition, attention, verbal fluency, general cognitive function, and perception-were obtained from principal components analysis. Longitudinal component structure change was observed in general cognitive function (maximum vertical deviation = 0.59; χ2 = 8.03; P = .01). Group-by-time interaction on general cognitive function (F = 12.23; η2 = 0.047; P < .001) and perception (F = 8.33; η2 = 0.032; P < .001) was present. Changes in attention (F = 5.65; η2 = 0.013; P = .02) and general cognitive function (F = 7.18; η2 = 0.014; P = .01) accounted for longitudinal changes in social and occupational functioning. CONCLUSIONS AND RELEVANCE Individuals in this study who met the UHR criteria appeared to demonstrate cognitive deficits, and those whose UHR status remitted were seen to recover cognitively. Cognition appeared as poor in nonremitters and appeared to be associated with poor functional outcome. This study suggests that cognitive dimensions are sensitive to the identification of young individuals at risk for psychosis and to the longitudinal course of those at highest risk.
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Affiliation(s)
- Max Lam
- Research Division, Institute of Mental Health,
Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health,
Singapore, Singapore,Department of General Psychiatry 1, Institute of
Mental Health, Singapore, Singapore
| | - Attilio Rapisarda
- Research Division, Institute of Mental Health,
Singapore, Singapore,Neuroscience and Behavioural Disorders, Duke-NUS
Medical School, Singapore, Singapore
| | - Yuen Mei See
- Research Division, Institute of Mental Health,
Singapore, Singapore
| | - Zixu Yang
- Research Division, Institute of Mental Health,
Singapore, Singapore
| | - Sara-Ann Lee
- Research Division, Institute of Mental Health,
Singapore, Singapore
| | | | - Michael Kraus
- Department of Psychiatry and Behavioral Sciences, Duke
University Medical Center, Durham, North Carolina
| | | | - Siow-Ann Chong
- Research Division, Institute of Mental Health,
Singapore, Singapore
| | - Richard S. E. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke
University Medical Center, Durham, North Carolina
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Romero HR, Monsch AU, Hayden KM, Plassman BL, Atkins AS, Keefe RSE, Brewster S, Chiang C, O'Neil J, Runyan G, Atkinson MJ, Crawford S, Budur K, Burns DK, Welsh-Bohmer KA. TOMMORROW neuropsychological battery: German language validation and normative study. Alzheimers Dement (N Y) 2018; 4:314-323. [PMID: 30094331 PMCID: PMC6076367 DOI: 10.1016/j.trci.2018.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction Assessment of preclinical Alzheimer's disease (AD) requires reliable and validated methods to detect subtle cognitive changes. The battery of standardized cognitive assessments that is used for diagnostic criteria for mild cognitive impairment due to AD in the TOMMORROW study have only been fully validated in English-speaking countries. We conducted a validation and normative study of the German language version of the TOMMORROW neuropsychological test battery, which tests episodic memory, language, visuospatial ability, executive function, and attention. Methods German-speaking cognitively healthy controls (NCs) and subjects with AD were recruited from a memory clinic at a Swiss medical center. Construct validity, test-retest, and alternate form reliability were assessed in NCs. Criterion and discriminant validities of the cognitive measures were tested using logistic regression and discriminant analysis. Cross-cultural equivalency of performance of the German language tests was compared with English language tests. Results A total of 198 NCs and 25 subjects with AD (aged 65-88 years) were analyzed. All German language tests discriminated NCs from persons with AD. Episodic memory tests had the highest potential to discriminate with almost twice the predictive power of any other domain. Test-retest reliability of the test battery was adequate, and alternate form reliability for episodic memory tests was supported. For most tests, age was a significant predictor of group effect sizes; therefore, normative data were stratified by age. Validity and reliability results were similar to those in the published US cognitive testing literature. Discussion This study establishes the reliability and validity of the German language TOMMORROW test battery, which performed similarly to the English language tests. Some variations in test performance underscore the importance of regional normative values. The German language battery and normative data will improve the precision of measuring cognition and diagnosing incident mild cognitive impairment due to AD in clinical settings in German-speaking countries.
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Affiliation(s)
- Heather R Romero
- Joseph & Kathleen Bryan Alzheimer's Disease Research Center (Bryan ADRC), Duke University, Durham, NC, USA.,Department of Psychiatry, Duke University, Durham, NC, USA
| | - Andreas U Monsch
- University Center for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland
| | - Kathleen M Hayden
- Joseph & Kathleen Bryan Alzheimer's Disease Research Center (Bryan ADRC), Duke University, Durham, NC, USA.,Department of Psychiatry, Duke University, Durham, NC, USA.,Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Brenda L Plassman
- Joseph & Kathleen Bryan Alzheimer's Disease Research Center (Bryan ADRC), Duke University, Durham, NC, USA.,Department of Psychiatry, Duke University, Durham, NC, USA
| | | | - Richard S E Keefe
- Department of Psychiatry, Duke University, Durham, NC, USA.,NeuroCog Trials, Durham, NC, USA
| | | | - Carl Chiang
- Zinfandel Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Janet O'Neil
- Takeda Development Center, Americas, Inc., Deerfield, IL, USA
| | - Grant Runyan
- Takeda Development Center, Americas, Inc., Deerfield, IL, USA
| | - Mark J Atkinson
- Covance Inc., Princeton, NJ, USA.,Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | | | - Kumar Budur
- Takeda Development Center, Americas, Inc., Deerfield, IL, USA
| | | | - Kathleen A Welsh-Bohmer
- Joseph & Kathleen Bryan Alzheimer's Disease Research Center (Bryan ADRC), Duke University, Durham, NC, USA.,Department of Psychiatry, Duke University, Durham, NC, USA
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40
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Blokland GAM, del Re EC, Mesholam-Gately RI, Jovicich J, Trampush JW, Keshavan MS, DeLisi LE, Walters JTR, Turner JA, Malhotra AK, Lencz T, Shenton ME, Voineskos AN, Rujescu D, Giegling I, Kahn RS, Roffman JL, Holt DJ, Ehrlich S, Kikinis Z, Dazzan P, Murray RM, Di Forti M, Lee J, Sim K, Lam M, Wolthusen RPF, de Zwarte SMC, Walton E, Cosgrove D, Kelly S, Maleki N, Osiecki L, Picchioni MM, Bramon E, Russo M, David AS, Mondelli V, Reinders AATS, Falcone MA, Hartmann AM, Konte B, Morris DW, Gill M, Corvin AP, Cahn W, Ho NF, Liu JJ, Keefe RSE, Gollub RL, Manoach DS, Calhoun VD, Schulz SC, Sponheim SR, Goff DC, Buka SL, Cherkerzian S, Thermenos HW, Kubicki M, Nestor PG, Dickie EW, Vassos E, Ciufolini S, Marques TR, Crossley NA, Purcell SM, Smoller JW, van Haren NEM, Toulopoulou T, Donohoe G, Goldstein JM, Seidman LJ, McCarley RW, Petryshen TL. The Genetics of Endophenotypes of Neurofunction to Understand Schizophrenia (GENUS) consortium: A collaborative cognitive and neuroimaging genetics project. Schizophr Res 2018; 195:306-317. [PMID: 28982554 PMCID: PMC5882601 DOI: 10.1016/j.schres.2017.09.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/15/2017] [Accepted: 09/20/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Schizophrenia has a large genetic component, and the pathways from genes to illness manifestation are beginning to be identified. The Genetics of Endophenotypes of Neurofunction to Understand Schizophrenia (GENUS) Consortium aims to clarify the role of genetic variation in brain abnormalities underlying schizophrenia. This article describes the GENUS Consortium sample collection. METHODS We identified existing samples collected for schizophrenia studies consisting of patients, controls, and/or individuals at familial high-risk (FHR) for schizophrenia. Samples had single nucleotide polymorphism (SNP) array data or genomic DNA, clinical and demographic data, and neuropsychological and/or brain magnetic resonance imaging (MRI) data. Data were subjected to quality control procedures at a central site. RESULTS Sixteen research groups contributed data from 5199 psychosis patients, 4877 controls, and 725 FHR individuals. All participants have relevant demographic data and all patients have relevant clinical data. The sex ratio is 56.5% male and 43.5% female. Significant differences exist between diagnostic groups for premorbid and current IQ (both p<1×10-10). Data from a diversity of neuropsychological tests are available for 92% of participants, and 30% have structural MRI scans (half also have diffusion-weighted MRI scans). SNP data are available for 76% of participants. The ancestry composition is 70% European, 20% East Asian, 7% African, and 3% other. CONCLUSIONS The Consortium is investigating the genetic contribution to brain phenotypes in a schizophrenia sample collection of >10,000 participants. The breadth of data across clinical, genetic, neuropsychological, and MRI modalities provides an important opportunity for elucidating the genetic basis of neural processes underlying schizophrenia.
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Affiliation(s)
- Gabriëlla A. M. Blokland
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic
Medicine, Massachusetts General Hospital, Boston, MA, United States,Department of Psychiatry, Massachusetts General Hospital, Boston,
MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Stanley Center for Psychiatric Research, Broad Institute of MIT and
Harvard, Cambridge, MA, United States
| | - Elisabetta C. del Re
- Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Department of Psychiatry, Veterans Affairs Boston Healthcare System,
Brockton, MA, United States,Psychiatry Neuroimaging Laboratory, Department of Psychiatry,
Brigham and Women’s Hospital, Boston, MA, United States
| | - Raquelle I. Mesholam-Gately
- Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Massachusetts Mental Health Center Public Psychiatry Division, Beth
Israel Deaconess Medical Center, Boston, MA, United States
| | - Jorge Jovicich
- Center for Mind/Brain Sciences (CiMEC), University of Trento,
Trento, Italy
| | - Joey W. Trampush
- Center for Psychiatric Neuroscience, The Feinstein Institute for
Medical Research, Division of Northwell Health, Manhasset, NY, United States;
Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell
Health, Glen Oaks, NY, United States; Hofstra Northwell School of Medicine,
Departments of Psychiatry and Molecular Medicine, Hempstead, NY, United States,BrainWorkup, LLC, Los Angeles, CA, United States
| | - Matcheri S. Keshavan
- Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Massachusetts Mental Health Center Public Psychiatry Division, Beth
Israel Deaconess Medical Center, Boston, MA, United States,University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
| | - Lynn E. DeLisi
- Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Department of Psychiatry, Veterans Affairs Boston Healthcare System,
Brockton, MA, United States
| | - James T. R. Walters
- Department of Psychological Medicine, Cardiff University, Cardiff,
United Kingdom
| | - Jessica A. Turner
- The Mind Research Network, Albuquerque, NM, United States,Department of Psychology and Neuroscience Institute, Georgia State
University, GA, United States
| | - Anil K. Malhotra
- Center for Psychiatric Neuroscience, The Feinstein Institute for
Medical Research, Division of Northwell Health, Manhasset, NY, United States;
Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell
Health, Glen Oaks, NY, United States; Hofstra Northwell School of Medicine,
Departments of Psychiatry and Molecular Medicine, Hempstead, NY, United States
| | - Todd Lencz
- Center for Psychiatric Neuroscience, The Feinstein Institute for
Medical Research, Division of Northwell Health, Manhasset, NY, United States;
Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell
Health, Glen Oaks, NY, United States; Hofstra Northwell School of Medicine,
Departments of Psychiatry and Molecular Medicine, Hempstead, NY, United States
| | - Martha E. Shenton
- Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Department of Psychiatry, Veterans Affairs Boston Healthcare System,
Brockton, MA, United States,Psychiatry Neuroimaging Laboratory, Department of Psychiatry,
Brigham and Women’s Hospital, Boston, MA, United States,Department of Radiology, Brigham and Women’s Hospital,
Harvard Medical School, Boston, MA, United States
| | - Aristotle N. Voineskos
- Kimel Family Translational Imaging Genetics Laboratory, Research
Imaging Centre, Campbell Family Mental Health Institute, Centre for Addiction and
Mental Health, Department of Psychiatry, Faculty of Medicine, University of Toronto,
Toronto, ON, Canada,Department of Psychiatry and Institute of Medical Science,
University of Toronto, Toronto, ON, Canada
| | - Dan Rujescu
- Department of Psychiatry, Psychotherapy and Psychosomatics,
University of Halle-Wittenberg, Halle an der Saale, Germany,Department of Psychiatry, Ludwig Maximilians University, Munich,
Germany
| | - Ina Giegling
- Department of Psychiatry, Psychotherapy and Psychosomatics,
University of Halle-Wittenberg, Halle an der Saale, Germany
| | - René S. Kahn
- Brain Centre Rudolf Magnus, Department of Psychiatry, University
Medical Centre Utrecht, Utrecht, The Netherlands
| | - Joshua L. Roffman
- Department of Psychiatry, Massachusetts General Hospital, Boston,
MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,MGH/HST Athinoula A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Charlestown, MA, United States
| | - Daphne J. Holt
- Department of Psychiatry, Massachusetts General Hospital, Boston,
MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,MGH/HST Athinoula A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Charlestown, MA, United States
| | - Stefan Ehrlich
- Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,MGH/HST Athinoula A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Charlestown, MA, United States,Division of Psychological & Social Medicine and Developmental
Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden,
Germany
| | - Zora Kikinis
- Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Psychiatry Neuroimaging Laboratory, Department of Psychiatry,
Brigham and Women’s Hospital, Boston, MA, United States
| | - Paola Dazzan
- Institute of Psychiatry, Psychology, and Neuroscience,
King’s College London, London, United Kingdom,National Institute for Health Research (NIHR) Mental Health
Biomedical Research Centre at South London and Maudsley NHS Foundation Trust,
London, United Kingdom
| | - Robin M. Murray
- Institute of Psychiatry, Psychology, and Neuroscience,
King’s College London, London, United Kingdom,National Institute for Health Research (NIHR) Mental Health
Biomedical Research Centre at South London and Maudsley NHS Foundation Trust,
London, United Kingdom
| | - Marta Di Forti
- Institute of Psychiatry, Psychology, and Neuroscience,
King’s College London, London, United Kingdom,National Institute for Health Research (NIHR) Mental Health
Biomedical Research Centre at South London and Maudsley NHS Foundation Trust,
London, United Kingdom
| | - Jimmy Lee
- Institute of Mental Health, Woodbridge Hospital, Singapore
| | - Kang Sim
- Institute of Mental Health, Woodbridge Hospital, Singapore
| | - Max Lam
- Institute of Mental Health, Woodbridge Hospital, Singapore
| | - Rick P. F. Wolthusen
- Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,MGH/HST Athinoula A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Charlestown, MA, United States,Division of Psychological & Social Medicine and Developmental
Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden,
Germany
| | - Sonja M. C. de Zwarte
- Brain Centre Rudolf Magnus, Department of Psychiatry, University
Medical Centre Utrecht, Utrecht, The Netherlands
| | - Esther Walton
- Division of Psychological & Social Medicine and Developmental
Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden,
Germany
| | - Donna Cosgrove
- The Cognitive Genetics and Cognitive Therapy Group, Department of
Psychology, National University of Ireland, Galway, Ireland
| | - Sinead Kelly
- Neuropsychiatric Genetics Research Group, Department of Psychiatry,
Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland; Trinity
College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland,Laboratory of NeuroImaging, Keck School of Medicine, University of
Southern California, Los Angeles, CA, United States
| | - Nasim Maleki
- Department of Psychiatry, Massachusetts General Hospital, Boston,
MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,MGH/HST Athinoula A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Charlestown, MA, United States
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic
Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Marco M. Picchioni
- Institute of Psychiatry, Psychology, and Neuroscience,
King’s College London, London, United Kingdom,National Institute for Health Research (NIHR) Mental Health
Biomedical Research Centre at South London and Maudsley NHS Foundation Trust,
London, United Kingdom
| | - Elvira Bramon
- Institute of Psychiatry, Psychology, and Neuroscience,
King’s College London, London, United Kingdom,National Institute for Health Research (NIHR) Mental Health
Biomedical Research Centre at South London and Maudsley NHS Foundation Trust,
London, United Kingdom,Mental Health Neuroscience Research Department, UCL Division of
Psychiatry, University College London, United Kingdom
| | - Manuela Russo
- Institute of Psychiatry, Psychology, and Neuroscience,
King’s College London, London, United Kingdom,National Institute for Health Research (NIHR) Mental Health
Biomedical Research Centre at South London and Maudsley NHS Foundation Trust,
London, United Kingdom
| | - Anthony S. David
- Institute of Psychiatry, Psychology, and Neuroscience,
King’s College London, London, United Kingdom,National Institute for Health Research (NIHR) Mental Health
Biomedical Research Centre at South London and Maudsley NHS Foundation Trust,
London, United Kingdom
| | - Valeria Mondelli
- Institute of Psychiatry, Psychology, and Neuroscience,
King’s College London, London, United Kingdom,National Institute for Health Research (NIHR) Mental Health
Biomedical Research Centre at South London and Maudsley NHS Foundation Trust,
London, United Kingdom
| | - Antje A. T. S. Reinders
- Institute of Psychiatry, Psychology, and Neuroscience,
King’s College London, London, United Kingdom,National Institute for Health Research (NIHR) Mental Health
Biomedical Research Centre at South London and Maudsley NHS Foundation Trust,
London, United Kingdom
| | - M. Aurora Falcone
- Institute of Psychiatry, Psychology, and Neuroscience,
King’s College London, London, United Kingdom,National Institute for Health Research (NIHR) Mental Health
Biomedical Research Centre at South London and Maudsley NHS Foundation Trust,
London, United Kingdom
| | - Annette M. Hartmann
- Department of Psychiatry, Psychotherapy and Psychosomatics,
University of Halle-Wittenberg, Halle an der Saale, Germany
| | - Bettina Konte
- Department of Psychiatry, Psychotherapy and Psychosomatics,
University of Halle-Wittenberg, Halle an der Saale, Germany
| | - Derek W. Morris
- Cognitive Genetics and Cognitive Therapy Group, Neuroimaging and
Cognitive Genomics (NICOG) Centre and NCBES Galway Neuroscience Centre, School of
Psychology and Discipline of Biochemistry, National University of Ireland, Galway,
Ireland
| | - Michael Gill
- Neuropsychiatric Genetics Research Group, Department of Psychiatry,
Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland; Trinity
College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Aiden P. Corvin
- Neuropsychiatric Genetics Research Group, Department of Psychiatry,
Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland; Trinity
College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Wiepke Cahn
- Brain Centre Rudolf Magnus, Department of Psychiatry, University
Medical Centre Utrecht, Utrecht, The Netherlands
| | - New Fei Ho
- Institute of Mental Health, Woodbridge Hospital, Singapore
| | | | - Richard S. E. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University
Medical Center, Durham, NC, United States
| | - Randy L. Gollub
- Department of Psychiatry, Massachusetts General Hospital, Boston,
MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,MGH/HST Athinoula A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Charlestown, MA, United States
| | - Dara S. Manoach
- Department of Psychiatry, Massachusetts General Hospital, Boston,
MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,MGH/HST Athinoula A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Charlestown, MA, United States
| | - Vince D. Calhoun
- The Mind Research Network, Albuquerque, NM, United States,Department of Electrical and Computer Engineering, University of
New Mexico, Albuquerque, NM, United States
| | - S. Charles Schulz
- Department of Psychiatry, University of Minnesota, Minneapolis, MN,
United States
| | - Scott R. Sponheim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN,
United States
| | - Donald C. Goff
- Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Nathan S. Kline Institute for Psychiatric Research, Department of
Psychiatry, New York University Langone Medical Center, New York, NY, United
States
| | - Stephen L. Buka
- Department of Epidemiology, Brown University, Providence, RI,
United States
| | - Sara Cherkerzian
- Department of Medicine, Division of Women’s Health, Brigham
and Women’s Hospital, Harvard Medical School, Boston, MA, United
States
| | - Heidi W. Thermenos
- Department of Psychiatry, Massachusetts General Hospital, Boston,
MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Massachusetts Mental Health Center Public Psychiatry Division, Beth
Israel Deaconess Medical Center, Boston, MA, United States
| | - Marek Kubicki
- Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Psychiatry Neuroimaging Laboratory, Department of Psychiatry,
Brigham and Women’s Hospital, Boston, MA, United States,Department of Radiology, Brigham and Women’s Hospital,
Harvard Medical School, Boston, MA, United States,MGH/HST Athinoula A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Charlestown, MA, United States
| | - Paul G. Nestor
- Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Department of Psychiatry, Veterans Affairs Boston Healthcare System,
Brockton, MA, United States,Laboratory of Applied Neuropsychology, University of Massachusetts,
Boston, MA, United States
| | - Erin W. Dickie
- Kimel Family Translational Imaging Genetics Laboratory, Research
Imaging Centre, Campbell Family Mental Health Institute, Centre for Addiction and
Mental Health, Department of Psychiatry, Faculty of Medicine, University of Toronto,
Toronto, ON, Canada
| | - Evangelos Vassos
- Institute of Psychiatry, Psychology, and Neuroscience,
King’s College London, London, United Kingdom,National Institute for Health Research (NIHR) Mental Health
Biomedical Research Centre at South London and Maudsley NHS Foundation Trust,
London, United Kingdom
| | - Simone Ciufolini
- Institute of Psychiatry, Psychology, and Neuroscience,
King’s College London, London, United Kingdom,National Institute for Health Research (NIHR) Mental Health
Biomedical Research Centre at South London and Maudsley NHS Foundation Trust,
London, United Kingdom
| | - Tiago Reis Marques
- Institute of Psychiatry, Psychology, and Neuroscience,
King’s College London, London, United Kingdom,National Institute for Health Research (NIHR) Mental Health
Biomedical Research Centre at South London and Maudsley NHS Foundation Trust,
London, United Kingdom
| | - Nicolas A. Crossley
- Institute of Psychiatry, Psychology, and Neuroscience,
King’s College London, London, United Kingdom,National Institute for Health Research (NIHR) Mental Health
Biomedical Research Centre at South London and Maudsley NHS Foundation Trust,
London, United Kingdom
| | - Shaun M. Purcell
- Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Stanley Center for Psychiatric Research, Broad Institute of MIT and
Harvard, Cambridge, MA, United States,Department of Psychiatry, Brigham and Women’s Hospital,
Boston, MA, United States,Division of Psychiatric Genomics, Departments of Psychiatry and
Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York,
NY, United States
| | - Jordan W. Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic
Medicine, Massachusetts General Hospital, Boston, MA, United States,Department of Psychiatry, Massachusetts General Hospital, Boston,
MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Stanley Center for Psychiatric Research, Broad Institute of MIT and
Harvard, Cambridge, MA, United States
| | - Neeltje E. M. van Haren
- Brain Centre Rudolf Magnus, Department of Psychiatry, University
Medical Centre Utrecht, Utrecht, The Netherlands
| | - Timothea Toulopoulou
- Institute of Psychiatry, Psychology, and Neuroscience,
King’s College London, London, United Kingdom,Department of Psychology, Bilkent University, Bilkent, Ankara,
Turkey,Department of Psychology, The University of Hong Kong, Pokfulam,
Hong Kong, SAR, China
| | - Gary Donohoe
- Neuropsychiatric Genetics Research Group, Department of Psychiatry,
Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland; Trinity
College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland,Cognitive Genetics and Cognitive Therapy Group, Neuroimaging and
Cognitive Genomics (NICOG) Centre and NCBES Galway Neuroscience Centre, School of
Psychology and Discipline of Biochemistry, National University of Ireland, Galway,
Ireland
| | - Jill M. Goldstein
- Department of Psychiatry, Massachusetts General Hospital, Boston,
MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Department of Medicine, Division of Women’s Health, Brigham
and Women’s Hospital, Harvard Medical School, Boston, MA, United
States,Department of Psychiatry, Brigham and Women’s Hospital,
Boston, MA, United States
| | - Larry J. Seidman
- Department of Psychiatry, Massachusetts General Hospital, Boston,
MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Massachusetts Mental Health Center Public Psychiatry Division, Beth
Israel Deaconess Medical Center, Boston, MA, United States
| | - Robert W. McCarley
- Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Department of Psychiatry, Veterans Affairs Boston Healthcare System,
Brockton, MA, United States
| | - Tracey L. Petryshen
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic
Medicine, Massachusetts General Hospital, Boston, MA, United States,Department of Psychiatry, Massachusetts General Hospital, Boston,
MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United
States,Stanley Center for Psychiatric Research, Broad Institute of MIT and
Harvard, Cambridge, MA, United States
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Kendler KS, Ohlsson H, Keefe RSE, Sundquist K, Sundquist J. The joint impact of cognitive performance in adolescence and familial cognitive aptitude on risk for major psychiatric disorders: a delineation of four potential pathways to illness. Mol Psychiatry 2018; 23:1076-1083. [PMID: 28416810 PMCID: PMC5647225 DOI: 10.1038/mp.2017.78] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 08/22/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 12/24/2022]
Abstract
How do joint measures of premorbid cognitive ability and familial cognitive aptitude (FCA) reflect risk for a diversity of psychiatric and substance use disorders? To address this question, we examined, using Cox models, the predictive effects of school achievement (SA) measured at age 16 and FCA-assessed from SA in siblings and cousins, and educational attainment in parents-on risk for 12 major psychiatric syndromes in 1 140 608 Swedes born 1972-1990. Four developmental patterns emerged. In the first, risk was predicted jointly by low levels of SA and high levels of FCA-that is a level of SA lower than would be predicted from the FCA. This pattern was strongest in autism spectrum disorders and schizophrenia, and weakest in bipolar illness. In these disorders, a pathologic process seems to have caused cognitive functioning to fall substantially short of familial potential. In the second pattern, seen in the internalizing conditions of major depression and anxiety disorders, risk was associated with low SA but was unrelated to FCA. Externalizing disorders-drug abuse and alcohol use disorders-demonstrated the third pattern, in which risk was predicted jointly by low SA and low FCA. The fourth pattern, seen in eating disorders, was directly opposite of that observed in externalizing disorders with risk associated with high SA and high FCA. When measured together, adolescent cognitive ability and FCA identified four developmental patterns leading to diverse psychiatric disorders. The value of cognitive assessments in psychiatric research can be substantially increased by also evaluating familial cognitive potential.
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Affiliation(s)
- KS Kendler
- Department of Psychiatry, Department of Human and Molecular Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychiatry, Virginia Commonwealth University, Richmond VA, USA,Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - H Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - RSE Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - K Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - J Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
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42
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Keefe RSE, Nomikos G, Zhong W, Christensen MC, Jacobson W. A Subgroup Analysis of the Impact of Vortioxetine on Functional Capacity, as Measured by UPSA, in Patients with Major Depressive Disorder and Subjective Cognitive Dysfunction. Int J Neuropsychopharmacol 2018; 21:442-447. [PMID: 29546401 PMCID: PMC5932468 DOI: 10.1093/ijnp/pyy020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/15/2017] [Accepted: 03/09/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We evaluated vortioxetine's effects on functional capacity in demographic and clinical subgroups of patients with major depressive disorder. METHODS This was an exploratory analysis of the CONNECT study (NCT01564862) that evaluated changes in functional capacity using University of California San Diego Performance-based Skills Assessment data, categorized by sex, age, education, employment status, and baseline disease severity (Montgomery-Åsberg Depression Rating Scale, Clinical Global Impressions-Severity of Illness). RESULTS Greater changes in University of California San Diego Performance-based Skills Assessment composite scores were observed with vortioxetine vs placebo in specific subgroups: males (∆+3.2), females (∆+2.9), 45-54 or ≥55 years (∆+5.6, ∆+3.4), working (∆+2.8), high school or greater education (∆+2.7, ∆+2.8), disease severity (Montgomery-Åsberg Depression Rating Scale, <30, ∆+3.5; ≥30, ∆+2.5; Clinical Global Impressions-Severity of Illness ≤4, ∆+2.8; >4, ∆+3.0), major depressive episodes (≤2, >2 [∆+2.7,+3.3]), and episode duration (≤22, >22 weeks [∆+3.7,+2.4]). CONCLUSIONS Our findings support the need for additional studies to assess whether vortioxetine improves functional capacity within specific patient subgroups. CLINICAL TRIAL REGISTRY clinicaltrials.gov: NCT01564862.
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Affiliation(s)
- Richard S E Keefe
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina,Correspondence: Richard S. E. Keefe, PhD, Duke University Medical Center, Box 3270, Durham, NC 27710 ()
| | - George Nomikos
- Takeda Development Center Americas, Inc., Deerfield, Illinois
| | - Wei Zhong
- Takeda Development Center Americas, Inc., Deerfield, Illinois
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Xavier RM, Pan W, Dungan JR, Keefe RSE, Vorderstrasse A. Unraveling interrelationships among psychopathology symptoms, cognitive domains and insight dimensions in chronic schizophrenia. Schizophr Res 2018; 193:83-90. [PMID: 28693755 DOI: 10.1016/j.schres.2017.07.002] [Citation(s) in RCA: 11] [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] [Received: 03/28/2017] [Revised: 06/30/2017] [Accepted: 07/01/2017] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Insight in schizophrenia is long known to have a complex relationship with psychopathology symptoms and cognition. However, very few studies have examined models that explain these interrelationships. METHODS In a large sample derived from the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial (N=1391), we interrogated these interrelationships for potential causal pathways using structural equation modeling. Using the NIMH consensus model, latent variables were constructed for psychopathology symptom dimensions, including positive, negative, disorganized, excited and depressed from the Positive and Negative Syndrome Scale (PANSS) items. Neurocognitive variables were created from five predefined domains of working memory, verbal memory, reasoning, vigilance and processing speed. Illness insight and treatment insight were tested using latent variables constructed from the Illness and Treatment Attitude Questionnaire (ITAQ). RESULTS Disorganized symptoms had the strongest effect on insight. Illness insight mediated the relationship of positive, depressed, and disorganized symptoms with treatment insight. Neurocognition mediated the relationship between disorganized and treatment insight and depressed symptoms and treatment insight. There was no effect of negative symptoms on either illness insight or treatment insight. Taken together, our results indicate overlapping and unique relational paths for illness and treatment insight dimensions, which could suggest differences in causal mechanisms and potential interventions to improve insight.
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Affiliation(s)
- Rose Mary Xavier
- Duke University School of Nursing, 307 Trent Dr, Durham, NC 27710, United States.
| | - Wei Pan
- Duke University School of Nursing, 307 Trent Dr, Durham, NC 27710, United States.
| | - Jennifer R Dungan
- Duke University School of Nursing, 307 Trent Dr, Durham, NC 27710, United States.
| | - Richard S E Keefe
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, United States.
| | - Allison Vorderstrasse
- Duke University School of Nursing, 307 Trent Dr, Durham, NC 27710, United States; Duke Center for Applied Genomics & Precision Medicine, United States.
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Healey KM, Penn DL, Perkins D, Woods SW, Keefe RSE, Addington J. Latent Profile Analysis and Conversion to Psychosis: Characterizing Subgroups to Enhance Risk Prediction. Schizophr Bull 2018; 44:286-296. [PMID: 29036587 PMCID: PMC5815120 DOI: 10.1093/schbul/sbx080] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Groups at clinical high risk (CHR) of developing psychosis are heterogeneous, composed of individuals with different clusters of symptoms. It is likely that there exist subgroups, each associated with different symptom constellations and probabilities of conversion. METHOD Present study used latent profile analysis (LPA) to ascertain subgroups in a combined sample of CHR (n = 171) and help-seeking controls (HSCs; n = 100; PREDICT study). Indicators in the LPA model included baseline Scale of Prodromal Symptoms (SOPS), Calgary Depression Scale for Schizophrenia (CDSS), and neurocognitive performance as measured by multiple instruments, including category instances (CAT). Subgroups were further characterized using covariates measuring demographic and clinical features. RESULTS Three classes emerged: class 1 (mild, transition rate 5.6%), lowest SOPS and depression scores, intact neurocognitive performance; class 2 (paranoid-affective, transition rate 14.2%), highest suspiciousness, mild negative symptoms, moderate depression; and class 3 (negative-neurocognitive, transition rate 29.3%), highest negative symptoms, neurocognitive impairment, social cognitive impairment. Classes 2 and 3 evidenced poor social functioning. CONCLUSIONS Results support a subgroup approach to research, assessment, and treatment of help-seeking individuals. Class 3 may be an early risk stage of developing schizophrenia.
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Affiliation(s)
- Kristin M Healey
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC,To whom correspondence should be addressed; Department of Psychology, University of North Carolina at Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC 27599-3270, US; tel: 609-468-2857, fax: 919-962-2537, e-mail:
| | - David L Penn
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC,School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Diana Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT
| | - Richard S E Keefe
- Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - Jean Addington
- Department of Psychiatry, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
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Georgiades A, Davis VG, Atkins AS, Khan A, Walker TW, Loebel A, Haig G, Hilt DC, Dunayevich E, Umbricht D, Sand M, Keefe RSE. Psychometric characteristics of the MATRICS Consensus Cognitive Battery in a large pooled cohort of stable schizophrenia patients. Schizophr Res 2017; 190:172-179. [PMID: 28433500 DOI: 10.1016/j.schres.2017.03.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 12/22/2016] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
The MATRICS Consensus Cognitive Battery (MCCB) was developed to assess cognitive treatment effects in schizophrenia clinical trials, and is considered the FDA gold standard outcome measure for that purpose. The aim of the present study was to establish pre-treatment psychometric characteristics of the MCCB in a large pooled sample. The dataset included 2616 stable schizophrenia patients enrolled in 15 different clinical trials between 2007 and 2016 within the United States (94%) and Canada (6%). The MCCB was administered twice prior to the initiation of treatment in 1908 patients. Test-retest reliability and practice effects of the cognitive composite score, the neurocognitive composite score, which excludes the domain Social Cognition, and the subtests/domains were examined using Intra-Class Correlations (ICC) and Cohen's d. Simulated regression models explored which domains explained the greatest portion of variance in composite scores. Test-retest reliability was high (ICC=0.88) for both composite scores. Practice effects were small for the cognitive (d=0.15) and neurocognitive (d=0.17) composites. Simulated bootstrap regression analyses revealed that 3 of the 7 domains explained 86% of the variance for both composite scores. The domains that entered most frequently in the top 3 positions of the regression models were Speed of Processing, Working Memory, and Visual Learning. Findings provide definitive psychometric characteristics and a benchmark comparison for clinical trials using the MCCB. The test-retest reliability of the MCCB composite scores is considered excellent and the learning effects are small, fulfilling two of the key criteria for outcome measures in cognition clinical trials.
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Affiliation(s)
| | | | | | | | - Trina W Walker
- NeuroCog Trials, Durham, NC, USA; Duke University, Durham, NC, USA
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Khan A, Liharska L, Harvey PD, Atkins A, Ulshen D, Keefe RSE. Negative Symptom Dimensions of the Positive and Negative Syndrome Scale Across Geographical Regions: Implications for Social, Linguistic, and Cultural Consistency. Innov Clin Neurosci 2017; 14:30-40. [PMID: 29410935 PMCID: PMC5788249] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objective: Recognizing the discrete dimensions that underlie negative symptoms in schizophrenia and how these dimensions are understood across localities might result in better understanding and treatment of these symptoms. To this end, the objectives of this study were to 1) identify the Positive and Negative Syndrome Scale negative symptom dimensions of expressive deficits and experiential deficits and 2) analyze performance on these dimensions over 15 geographical regions to determine whether the items defining them manifest similar reliability across these regions. Design: Data were obtained for the baseline Positive and Negative Syndrome Scale visits of 6,889 subjects across 15 geographical regions. Using confirmatory factor analysis, we examined whether a two-factor negative symptom structure that is found in schizophrenia (experiential deficits and expressive deficits) would be replicated in our sample, and using differential item functioning, we tested the degree to which specific items from each negative symptom subfactor performed across geographical regions in comparison with the United States. Results: The two-factor negative symptom solution was replicated in this sample. Most geographical regions showed moderate-to-large differential item functioning for Positive and Negative Syndrome Scale expressive deficit items, especially N3 Poor Rapport, as compared with Positive and Negative Syndrome Scale experiential deficit items, showing that these items might be interpreted or scored differently in different regions. Across countries, except for India, the differential item functioning values did not favor raters in the United States. Conclusion: These results suggest that the Positive and Negative Syndrome Scale negative symptom factor can be better represented by a two-factor model than by a single-factor model. Additionally, the results show significant differences in responses to items representing the Positive and Negative Syndrome Scale expressive factors, but not the experiential factors, across regions. This could be due to a lack of equivalence between the original and translated versions, cultural differences with the interpretation of items, dissimilarities in rater training, or diversity in the understanding of scoring anchors. Knowing which items are challenging for raters across regions can help to guide Positive and Negative Syndrome Scale training and improve the results of international clinical trials aimed at negative symptoms.
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Affiliation(s)
- Anzalee Khan
- Dr. Khan is Senior Biostatistician at NeuroCog Trials and holds an appointment in the Psychopharmacology Research Program at the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York
- Ms. Liharska is a researcher at Columbia University Medical Center in New York, New York
- Dr. Harvey is Professor of Psychiatry and Behavioral Sciences at the University of Miami School of Medicine in Miami, Florida
- Dr. Atkins and Mr. Ulshen are employees of NeuroCog Trials
- Dr. Keefe is an employee of NeuroCog Trials and Professor of Psychiatry and Behavioral Sciences at Duke University Institute for Brain Sciences in Chapel Hill, North Carolina
| | - Lora Liharska
- Dr. Khan is Senior Biostatistician at NeuroCog Trials and holds an appointment in the Psychopharmacology Research Program at the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York
- Ms. Liharska is a researcher at Columbia University Medical Center in New York, New York
- Dr. Harvey is Professor of Psychiatry and Behavioral Sciences at the University of Miami School of Medicine in Miami, Florida
- Dr. Atkins and Mr. Ulshen are employees of NeuroCog Trials
- Dr. Keefe is an employee of NeuroCog Trials and Professor of Psychiatry and Behavioral Sciences at Duke University Institute for Brain Sciences in Chapel Hill, North Carolina
| | - Philip D Harvey
- Dr. Khan is Senior Biostatistician at NeuroCog Trials and holds an appointment in the Psychopharmacology Research Program at the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York
- Ms. Liharska is a researcher at Columbia University Medical Center in New York, New York
- Dr. Harvey is Professor of Psychiatry and Behavioral Sciences at the University of Miami School of Medicine in Miami, Florida
- Dr. Atkins and Mr. Ulshen are employees of NeuroCog Trials
- Dr. Keefe is an employee of NeuroCog Trials and Professor of Psychiatry and Behavioral Sciences at Duke University Institute for Brain Sciences in Chapel Hill, North Carolina
| | - Alexandra Atkins
- Dr. Khan is Senior Biostatistician at NeuroCog Trials and holds an appointment in the Psychopharmacology Research Program at the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York
- Ms. Liharska is a researcher at Columbia University Medical Center in New York, New York
- Dr. Harvey is Professor of Psychiatry and Behavioral Sciences at the University of Miami School of Medicine in Miami, Florida
- Dr. Atkins and Mr. Ulshen are employees of NeuroCog Trials
- Dr. Keefe is an employee of NeuroCog Trials and Professor of Psychiatry and Behavioral Sciences at Duke University Institute for Brain Sciences in Chapel Hill, North Carolina
| | - Daniel Ulshen
- Dr. Khan is Senior Biostatistician at NeuroCog Trials and holds an appointment in the Psychopharmacology Research Program at the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York
- Ms. Liharska is a researcher at Columbia University Medical Center in New York, New York
- Dr. Harvey is Professor of Psychiatry and Behavioral Sciences at the University of Miami School of Medicine in Miami, Florida
- Dr. Atkins and Mr. Ulshen are employees of NeuroCog Trials
- Dr. Keefe is an employee of NeuroCog Trials and Professor of Psychiatry and Behavioral Sciences at Duke University Institute for Brain Sciences in Chapel Hill, North Carolina
| | - Richard S E Keefe
- Dr. Khan is Senior Biostatistician at NeuroCog Trials and holds an appointment in the Psychopharmacology Research Program at the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York
- Ms. Liharska is a researcher at Columbia University Medical Center in New York, New York
- Dr. Harvey is Professor of Psychiatry and Behavioral Sciences at the University of Miami School of Medicine in Miami, Florida
- Dr. Atkins and Mr. Ulshen are employees of NeuroCog Trials
- Dr. Keefe is an employee of NeuroCog Trials and Professor of Psychiatry and Behavioral Sciences at Duke University Institute for Brain Sciences in Chapel Hill, North Carolina
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Harvey PD, Khan A, Keefe RSE. Using the Positive and Negative Syndrome Scale (PANSS) to Define Different Domains of Negative Symptoms: Prediction of Everyday Functioning by Impairments in Emotional Expression and Emotional Experience. Innov Clin Neurosci 2017; 14:18-22. [PMID: 29410933 PMCID: PMC5788247] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Background: Reduced emotional experience and expression are two domains of negative symptoms. The authors assessed these two domains of negative symptoms using previously developed Positive and Negative Syndrome Scale (PANSS) factors. Using an existing dataset, the authors predicted three different elements of everyday functioning (social, vocational, and everyday activities) with these two factors, as well as with performance on measures of functional capacity. Methods: A large (n=630) sample of people with schizophrenia was used as the data source of this study. Using regression analyses, the authors predicted the three different aspects of everyday functioning, first with just the two Positive and Negative Syndrome Scale factors and then with a global negative symptom factor. Finally, we added neurocognitive performance and functional capacity as predictors. Results: The Positive and Negative Syndrome Scale reduced emotional experience factor accounted for 21 percent of the variance in everyday social functioning, while reduced emotional expression accounted for no variance. The total Positive and Negative Syndrome Scale negative symptom factor accounted for less variance (19%) than the reduced experience factor alone. The Positive and Negative Syndrome Scale expression factor accounted for, at most, one percent of the variance in any of the functional outcomes, with or without the addition of other predictors. Implications: Reduced emotional experience measured with the Positive and Negative Syndrome Scale, often referred to as "avolition and anhedonia," specifically predicted impairments in social outcomes. Further, reduced experience predicted social impairments better than emotional expression or the total Positive and Negative Syndrome Scale negative symptom factor. In this cross-sectional study, reduced emotional experience was specifically related with social outcomes, accounting for essentially no variance in work or everyday activities, and being the sole meaningful predictor of impairment in social outcomes.
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Affiliation(s)
- Philip D Harvey
- Dr. Harvey is Professor of Psychiatry and Behavioral Sciences at University of Miami School of Medicine in Miami, Florida
- Dr. Khan is Senior Biostatistician at NeuroCog Trials and holds an appointment in the Psychopharmacology Research Program at the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York
- Dr. Keefe is an employee of NeuroCog Trials and Professor of Psychiatry and Behavioral Sciences at Duke University Institute for Brain Sciences in Chapel Hill, North Carolina
| | - Anzalee Khan
- Dr. Harvey is Professor of Psychiatry and Behavioral Sciences at University of Miami School of Medicine in Miami, Florida
- Dr. Khan is Senior Biostatistician at NeuroCog Trials and holds an appointment in the Psychopharmacology Research Program at the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York
- Dr. Keefe is an employee of NeuroCog Trials and Professor of Psychiatry and Behavioral Sciences at Duke University Institute for Brain Sciences in Chapel Hill, North Carolina
| | - Richard S E Keefe
- Dr. Harvey is Professor of Psychiatry and Behavioral Sciences at University of Miami School of Medicine in Miami, Florida
- Dr. Khan is Senior Biostatistician at NeuroCog Trials and holds an appointment in the Psychopharmacology Research Program at the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York
- Dr. Keefe is an employee of NeuroCog Trials and Professor of Psychiatry and Behavioral Sciences at Duke University Institute for Brain Sciences in Chapel Hill, North Carolina
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Wang C, Lee J, Ho NF, Lim JKW, Poh JS, Rekhi G, Krishnan R, Keefe RSE, Adcock RA, Wood SJ, Fornito A, Chee MWL, Zhou J. Large-Scale Network Topology Reveals Heterogeneity in Individuals With at Risk Mental State for Psychosis: Findings From the Longitudinal Youth-at-Risk Study. Cereb Cortex 2017; 28:4234-4243. [DOI: 10.1093/cercor/bhx278] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 10/04/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chenhao Wang
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorder Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - New Fei Ho
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorder Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Joseph K W Lim
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorder Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Joann S Poh
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorder Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Gurpreet Rekhi
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Ranga Krishnan
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorder Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - R Alison Adcock
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Center for Cognitive Neuroscience, Duke University, Durham, NC, USA
| | - Stephen J Wood
- School of Psychology, University of Birmingham, Edgbaston, UK
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Parkville VIC, Australia
| | - Alex Fornito
- Monash Clinical and Imaging Neuroscience, School of Psychology and Psychiatry & Monash Biomedical Imaging, Monash University, Clayton VIC, Australia
| | - Michael W L Chee
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorder Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Juan Zhou
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorder Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Clinical Imaging Research Centre, The Agency for Science, Technology and Research and National University of Singapore, Singapore, Singapore
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Lam M, Wang M, Huang W, Eng GK, Rapisarda A, Kraus M, Kang S, Keefe RSE, Lee J. Establishing the Brief Assessment of Cognition - Short form. J Psychiatr Res 2017; 93:1-11. [PMID: 28549241 DOI: 10.1016/j.jpsychires.2017.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 12/01/2016] [Revised: 04/30/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
The study aims to identify and validate a parsimonious subset of tests in the commonly used Brief Assessment of Cognition in Schizophrenia (BACS) that allows the evaluation of global cognitive ability. Several permutations of subtests from the BACS were examined to identify the best subset of tests to compose the short form measure. The Brief Assessment of Cognition-Short Form (BAC-SF) was evaluated for convergent validity in healthy and psychiatric samples (N = 3718). Verbal Memory, Digit Sequencing, and Symbol Coding subtests were found to best summarize the variance of composite scores in both Asian and US Norming samples (r = 0.91) indicating that BAC-SF is an appropriate approximation of cognitive deficits. Test re-test reliability of the BAC-SF was adequate (Intraclass Correlation Coefficient (ICC) = 0.73) and showed sufficient separation between healthy controls and schizophrenia (Average Predictive Accuracy = 79.9%; replication = 76.5%). Findings indicate that the BAC-SF an could be used as a cognitive screener for large-scale clinical and epidemiological studies. The short form does not replace the need for comprehensive neuropsychological batteries purposed for detailed neuropsychological and clinical investigation of cognitive function. Further replication of the construct might be necessary in other clinical populations.
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Affiliation(s)
- Max Lam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park 10 Buangkok View, 539747, Singapore.
| | - Mingyuan Wang
- Research Division, Institute of Mental Health, Buangkok Green Medical Park 10 Buangkok View, 539747, Singapore
| | - Wanping Huang
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Goi Khia Eng
- Nanyang Technological University, 50 Nanyang Avenue, 639798, Singapore
| | - Attilio Rapisarda
- Research Division, Institute of Mental Health, Buangkok Green Medical Park 10 Buangkok View, 539747, Singapore
| | - Michael Kraus
- Psychiatry and Behavioral Sciences, 8 Duke University Medical Center Greenspace, Durham, NC 27703, USA
| | - Sim Kang
- Research Division, Institute of Mental Health, Buangkok Green Medical Park 10 Buangkok View, 539747, Singapore; General Psychiatry, Institute of Mental Health, Buangkok Green Medical Park 10 Buangkok View, 539747, Singapore
| | - R S E Keefe
- Psychiatry and Behavioral Sciences, 8 Duke University Medical Center Greenspace, Durham, NC 27703, USA
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Buangkok Green Medical Park 10 Buangkok View, 539747, Singapore; General Psychiatry, Institute of Mental Health, Buangkok Green Medical Park 10 Buangkok View, 539747, Singapore
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Abstract
IMPORTANCE Patients' previous experience with performance-based cognitive tests in clinical trials for cognitive impairment associated with schizophrenia can create practice-related improvements. Placebo-controlled trials for cognitive impairment associated with schizophrenia are at risk for these practice effects, which can be difficult to distinguish from placebo effects. OBJECTIVES To conduct a systematic evaluation of the magnitude of practice effects on the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB) in cognitive impairment associated with schizophrenia and to examine which demographic, clinical, and cognitive characteristics were associated with improvement in placebo conditions. DESIGN, SETTING, AND PARTICIPANTS A blinded review was conducted of data from 813 patients with schizophrenia who were treated with placebo in 12 randomized placebo-controlled clinical trials conducted mostly in outpatient clinics in North America, Europe, Asia, and Latin America from February 22, 2007, to March 1, 2014. A total of 779 patients provided data for the primary outcome measure at baseline and at least 1 follow-up. Seven trials had prebaseline assessments wherein the patients knew that they were not receiving treatment, allowing a comparison of practice and placebo effects in the same patients. INTERVENTIONS Placebo compared with various experimental drug treatments. MAIN OUTCOMES AND MEASURES Composite score on the MCCB. RESULTS Of the 813 patients in the study (260 women and 553 men; mean [SD] age, 41.2 [11.5] years), the mean MCCB composite score at baseline was 22.8 points below the normative mean, and the mean (SEM) total change in the MCCB during receipt of placebo was 1.8 (0.2) T-score points (95% CI, 1.40-2.18), equivalent to a change of 0.18 SD. Practice effects in the 7 studies in which there was a prebaseline assessment were essentially identical to the postbaseline placebo changes. Baseline factors associated with greater improvements in the MCCB during receipt of placebo included more depression/anxiety (F1,438 = 5.41; P = .02), more motivation (F1,272 = 4.63; P = .03), and less improvement from screening to baseline (F1,421 = 59.32; P < .001). CONCLUSIONS AND RELEVANCE Placebo effects were minimal and associated with the number of postbaseline assessments and several patient characteristics. Given that the patients performed 2.28 SDs below normative standards on average at baseline, a mean placebo-associated improvement of less than 0.2 SD provides evidence that ceiling effects do not occur in these trials. These minimal changes in the MCCB could not be responsible for effective active treatments failing to separate from placebo.
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Affiliation(s)
- Richard S. E. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Duke University Medical Center, Durham, North Carolina,NeuroCog Trials, Durham, North Carolina
| | | | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, Florida
| | | | - George M. Haig
- Neuroscience Development, Abbvie, North Chicago, Illinois
| | - Owen Hagino
- Research and Development, Immunology and Inflammation, Sanofi, Bridgewater, New Jersey
| | - Stephen Marder
- Semel Institute for Neuroscience at the University of California, Los Angeles
| | - Dana C. Hilt
- Drug Development, FORUM Pharmaceuticals, Waltham, Massachusetts
| | - Daniel Umbricht
- Neuroscience, Ophthalmology, Rare Diseases, Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann–La Roche Ltd, Basel, Switzerland
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