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Haber SL, McMahon RP, Barajas J, Hayes AR, Hussein H. Effects of Moringa oleifera in patients with type 2 diabetes. Am J Health Syst Pharm 2020; 77:1834-1837. [DOI: 10.1093/ajhp/zxaa255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stacy L Haber
- Midwestern University College of Pharmacy-Glendale Glendale, AZ
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2
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Dwyer KR, Andrea AM, Savage CLG, Orth RD, Shan L, Strauss GP, Adams HA, Kelly DL, Weiner E, Gold JM, McMahon RP, Carpenter WT, Buchanan RW, Blanchard JJ. A Randomized Clinical Trial of Oxytocin or Galantamine in Schizophrenia: Assessing the Impact on Behavioral, Lexical, and Self-Report Indicators of Social Affiliation. ACTA ACUST UNITED AC 2020; 1:sgaa001. [PMID: 32803156 PMCID: PMC7418868 DOI: 10.1093/schizbullopen/sgaa001] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Prior studies examining the impact of oxytocin on negative symptoms in schizophrenia have yielded mixed results. The current study explored whether oxytocin can improve more proximal indicators of social affiliation as indicated by changes in behavior, language and subjective indices of social affiliation among individuals with schizophrenia spectrum disorders during a role-play designed to elicit affiliative responses. We tested the hypothesis that daily intranasal oxytocin administered for 6 weeks would improve social affiliation as manifested by increased social skill ratings, use of positive, affiliative, and social words, and subjective responses from a previously published randomized controlled trial. Forty outpatients with schizophrenia or schizoaffective disorder were randomized to the oxytocin, galantamine, or placebo group and completed affiliative role-plays and self-report questionnaires of affect, reactions to the affiliative confederate, and willingness to interact at baseline and post-treatment. Results demonstrated that oxytocin was not effective at improving behavioral or subjective indicators of social affiliation. This study adds to a growing literature that the prosocial effects of oxytocin in schizophrenia are limited or null.
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Affiliation(s)
- Kristen R Dwyer
- Department of Psychology, University of Maryland College Park, Biology/Psychology Building, College Park, MD
| | - Alexandra M Andrea
- Department of Psychology, University of Maryland College Park, Biology/Psychology Building, College Park, MD
| | - Christina L G Savage
- Department of Psychology, University of Maryland College Park, Biology/Psychology Building, College Park, MD
| | - Ryan D Orth
- Department of Psychology, University of Maryland College Park, Biology/Psychology Building, College Park, MD
| | - LeeAnn Shan
- Department of Psychology, University of Maryland, Baltimore, MD
| | | | - Heather A Adams
- Maryland Psychiatric Research Center and Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Deanna L Kelly
- Maryland Psychiatric Research Center and Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Elaine Weiner
- Maryland Psychiatric Research Center and Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - James M Gold
- Maryland Psychiatric Research Center and Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Robert P McMahon
- Maryland Psychiatric Research Center and Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - William T Carpenter
- Maryland Psychiatric Research Center and Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Robert W Buchanan
- Maryland Psychiatric Research Center and Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Jack J Blanchard
- Department of Psychology, University of Maryland College Park, Biology/Psychology Building, College Park, MD
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3
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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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Barber GS, Sturgeon C, Fasano A, Cascella NG, Eaton WW, McMahon RP, Kelly DL. Elevated zonulin, a measure of tight-junction permeability, may be implicated in schizophrenia. Schizophr Res 2019; 211:111-112. [PMID: 31307857 DOI: 10.1016/j.schres.2019.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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] [Received: 05/02/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Gregory S Barber
- University of Maryland Baltimore, School of Medicine, United States of America
| | - Craig Sturgeon
- Massachusetts General Hospital, Center for Celiac Research and Treatment, United States of America
| | - Alessio Fasano
- Massachusetts General Hospital, Center for Celiac Research and Treatment, United States of America
| | - Nicola G Cascella
- Johns Hopkins University, Department of Psychiatry, United States of America
| | - William W Eaton
- Johns Hopkins Hospital, Bloomberg School of Public Health, United States of America
| | - Robert P McMahon
- University of Maryland Baltimore, School of Medicine, United States of America
| | - Deanna L Kelly
- University of Maryland Baltimore, School of Medicine, United States of America.
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5
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Kelly DL, Demyanovich HK, Rodriguez KM, Ciháková D, Talor MV, McMahon RP, Richardson CM, Vyas G, Adams HA, August SM, Fasano A, Cascella NG, Feldman SM, Liu F, Sayer MA, Powell MM, Wehring HJ, Buchanan RW, Gold JM, Carpenter WT, Eaton WW. Randomized controlled trial of a gluten-free diet in patients with schizophrenia positive for antigliadin antibodies (AGA IgG): a pilot feasibility study. J Psychiatry Neurosci 2019; 44. [PMID: 30938127 PMCID: PMC6606425 DOI: 10.1503/jpn.180174] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Approximately one-third of people with schizophrenia have elevated levels of anti-gliadin antibodies of the immunoglobulin G type (AGA IgG) — a higher rate than seen in healthy controls. We performed the first double-blind clinical trial of gluten-free versus gluten-containing diets in a subset of patients with schizophrenia who were positive for AGA IgG. METHODS In this pilot feasibility study, 16 participants with schizophrenia or schizoaffective disorder who had elevated AGA IgG (≥ 20 U) but were negative for celiac disease were admitted to an inpatient unit for a 5-week trial. All participants received standardized gluten-free meals and were randomized in a double-blind fashion to receive a shake containing 10 g of gluten flour or 10 g of rice flour each day. Participants were rated for psychiatric, cognitive and gastrointestinal symptoms at baseline and endpoint. RESULTS Of the 16 participants, 14 completed the 5-week trial (2 discontinued early for administrative reasons). Compared with participants on the gluten-containing diet, participants on the gluten-free diet showed improvement on the Clinical Global Impressions scale (Cohen d = –0.75) and in negative symptoms (Cohen d = –0.53). We noted no improvement in positive or global cognitive symptoms, but did observe an improvement in attention favouring the gluten-free diet (Cohen d = 0.60). Robust improvements in gastrointestinal adverse effects occurred in the gluten-free group relative to the glutencontaining group. Adverse effects were similar between groups. LIMITATIONS This study was limited by its small sample size; larger studies are needed. CONCLUSION This feasibility study suggests that removal of gluten from the diet is associated with improvement in psychiatric and gastrointestinal symptoms in people with schizophrenia or schizoaffective disorder.
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Affiliation(s)
- Deanna L. Kelly
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Haley K. Demyanovich
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Katrina M. Rodriguez
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Daniela Ciháková
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Monica V. Talor
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Robert P. McMahon
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Charles M. Richardson
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Gopal Vyas
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Heather A. Adams
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Sharon M. August
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Alessio Fasano
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Nicola G. Cascella
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Stephanie M. Feldman
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Fang Liu
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - MacKenzie A. Sayer
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Megan M. Powell
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Heidi J. Wehring
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - Robert W. Buchanan
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - James M. Gold
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - William T. Carpenter
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
| | - William W. Eaton
- From the Maryland Psychiatric Research Center (MPRC), School of Medicine, University of Maryland, College Park, MD (Kelly, McMahon, August, Feldman, Liu, Powell, Wehring, Buchanan, Gold, Carpenter); the Department of Orthopedics, School of Medicine, University of Maryland, College Park, MD (Demyanovich); the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Rodriguez, Eaton); the Department of Pathology, Division of Immunology, Immune Disorders Laboratory, Johns Hopkins University, Baltimore, MD (Cˇiháková, Talor); the Spring Grove Hospital Center, Baltimore, MD (Richardson, Vyas, Adams); the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA (Fasano); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD (Cascella); the Department of Psychology, Kent State University, Kent, OH (Sayer)
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6
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Gold JM, Robinson B, Leonard CJ, Hahn B, Chen S, McMahon RP, Luck SJ. Selective Attention, Working Memory, and Executive Function as Potential Independent Sources of Cognitive Dysfunction in Schizophrenia. Schizophr Bull 2018; 44:1227-1234. [PMID: 29140504 PMCID: PMC6192492 DOI: 10.1093/schbul/sbx155] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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: 11/14/2022]
Abstract
People with schizophrenia demonstrate impairments in selective attention, working memory, and executive function. Given the overlap in these constructs, it is unclear if these represent distinct impairments or different manifestations of one higher-order impairment. To examine this question, we administered tasks from the basic cognitive neuroscience literature to measure visual selective attention, working memory capacity, and executive function in 126 people with schizophrenia and 122 healthy volunteers. Patients demonstrated deficits on all tasks with the exception of selective attention guided by strong bottom-up inputs. Although the measures of top-down control of selective attention, working memory, and executive function were all intercorrelated, several sources of evidence indicate that working memory and executive function are separate sources of variance. Specifically, both working memory and executive function independently contributed to the discrimination of group status and independently accounted for variance in overall general cognitive ability as assessed by the MATRICS battery. These two cognitive functions appear to be separable features of the cognitive impairments observed in schizophrenia.
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Affiliation(s)
- James M Gold
- Maryland Psychiatric Research Center, Deparment of Psychiatry, University of Maryland School of Medicine,To whom correspondence should be addressed; tel: 410-402-7871, fax: 410-402-7198, e-mail:
| | - Benjamin Robinson
- Maryland Psychiatric Research Center, Deparment of Psychiatry, University of Maryland School of Medicine
| | | | - Britta Hahn
- Maryland Psychiatric Research Center, Deparment of Psychiatry, University of Maryland School of Medicine
| | - Shuo Chen
- Maryland Psychiatric Research Center, Deparment of Psychiatry, University of Maryland School of Medicine
| | - Robert P McMahon
- Maryland Psychiatric Research Center, Deparment of Psychiatry, University of Maryland School of Medicine
| | - Steven J Luck
- Center for Mind and Brain and Department of Psychology, University of California, Davis
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7
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Kelly DL, Powell MM, Wehring HJ, Sayer MA, Kearns AM, Hackman AL, Buchanan RW, Nichols RB, Adams HA, Richardson CM, Vyas G, McMahon RP, Earl AK, Sullivan KM, Liu F, Luttrell SE, Dickerson FB, Feldman SM, Narang S, Koola MM, Buckley PF, RachBeisel JA, McEvoy JP. Adjunct Aripiprazole Reduces Prolactin and Prolactin-Related Adverse Effects in Premenopausal Women With Psychosis: Results From the DAAMSEL Clinical Trial. J Clin Psychopharmacol 2018; 38:317-326. [PMID: 29912799 PMCID: PMC6103648 DOI: 10.1097/jcp.0000000000000898] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE/BACKGROUND Prolactin-related adverse effects contribute to nonadherence and adverse health consequences, particularly in women with severe mental illness. Treating these adverse effects may improve treatment acceptability, adherence, and long-term outcomes. METHODS/PROCEDURES Premenopausal women with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder were recruited for a randomized, double-blind, placebo-controlled 16-week trial of adjunct aripiprazole (5-15 mg/d). Participants had elevated prolactin (>24 ng/mL) and were experiencing galactorrhea, amenorrhea, oligomenorrhea, or sexual dysfunction on a prolactin-elevating antipsychotic. Participants were evaluated biweekly for prolactin elevation and galactorrhea and completed a menstrual diary review. Psychiatric symptoms and adverse effects were closely monitored. FINDINGS/RESULTS Forty-six women were randomized (n = 25 aripiprazole, n = 21 placebo). Thirty-seven completed at least 8 weeks of the study (n = 20 [80%] aripiprazole and n = 17 [81%] placebo). Aripiprazole (mean dose, 11.7 ± 2.4 mg/d) was effective for lowering prolactin relative to placebo (P = 0.04). In addition, 45% (9/20) of the aripiprazole group had a normalized prolactin (<24 mg/mL) compared with 12% (2/17) of the placebo group (P = 0.028). Galactorrhea resolved in 77% (10/13) of the aripiprazole-treated participants compared with 33% (4/12) in the placebo group (P = 0.028). Normalization of sexual function (<16 on the Arizona Sexual Experience Scale) occurred in 50% on aripiprazole (7/14) versus 9% (1/11) on placebo (P = 0.030). No differences between groups in symptoms or adverse effects were noted. Overall, women rated a mean score of 4.6 ± 0.6 on a 5-point Likert scale for sexual function improvement, suggesting their particular satisfaction with improvement in this domain. IMPLICATIONS/CONCLUSIONS Building upon prior studies, this rigorous evaluation confirms the utility of adjunctive aripiprazole as a strategy for improving prolactin and managing prolactin-related adverse effects in premenopausal women with psychosis.
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Affiliation(s)
| | - Megan M Powell
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Heidi J Wehring
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - MacKenzie A Sayer
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Ann Marie Kearns
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Ann L Hackman
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Robert W Buchanan
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | | | - Heather A Adams
- Spring Grove Hospital Center and Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine
| | - Charles M Richardson
- Spring Grove Hospital Center and Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine
| | - Gopal Vyas
- Spring Grove Hospital Center and Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine
| | - Robert P McMahon
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | | | - Kelli M Sullivan
- Cystic Fibrosis/Pulmonary Research and Treatment Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Fang Liu
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Sarah E Luttrell
- Department of Pharmacy, University of Maryland Eastern Shore School of Pharmacy, Princess Anne, MD
| | | | - Stephanie M Feldman
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Supriya Narang
- Mosaic Community Services, Sheppard Pratt Health System, Baltimore, MD
| | - Maju M Koola
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Peter F Buckley
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Jill A RachBeisel
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Joseph P McEvoy
- Department of Psychiatry, Georgia Regents University, Augusta, GA
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8
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Glassman M, Wehring HJ, Pocivavsek A, Sullivan KM, Rowland LM, McMahon RP, Chiappelli J, Liu F, Kelly DL. Peripheral Cortisol and Inflammatory Response to a Psychosocial Stressor in People with Schizophrenia. ACTA ACUST UNITED AC 2018; 2. [PMID: 30801048 PMCID: PMC6384221 DOI: 10.21767/2471-8548.10008] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives There is growing evidence of both hypothalamic-pituitary-adrenal (HPA) axis and immune system dysfunction in schizophrenia. Additionally, accumulating evidence has linked dysfunction in the kynurenine pathway to schizophrenia as well as to stress and inflammation. The current pilot tested changes in immune, cortisol and kynurenine and kynurenic acid responses to a psychosocial stressor in people with schizophrenia and healthy controls. Methods Ten people with schizophrenia/schizoaffective disorder and 10 healthy controls were included. Participants completed the Trier Social Stress Test (TSST) and cortisol, cytokines (IL-6 & TNF-α), kynurenine and kynurenic acid were measured in the plasma at baseline 15, 30, 60 and 90 minutes following the TSST. Results Compared to baseline, at 30 minutes post TSST, mean cortisol levels had increased by 7.6 ng/ml (11%) in healthy controls but decreased by 16.3 ng/ml (25%) in schizophrenia (F=4.34, df=3,38.2, p=0.010). While people with schizophrenia had a lower TNF-α level at baseline (χ2 (1)=10.14, p=0.001), no decreases or increases occurred after the TSST in either group. Both groups had a similar increase in IL-6 at 15 minutes post TSST (F=4.17, df=3, 16.3, p=0.023) demonstrating an immune response to the stress in both groups. A trend towards increased kynurenine from baseline was found immediately after the TSST followed by a decrease at 60 minutes in healthy controls but no change was found in people with schizophrenia (F=2.46, df=3, 49.1, p=0.074). Conclusion People with schizophrenia showed a decrease in cortisol from baseline following the TSST as compared to an elevation from baseline seen in healthy controls, supporting HPA axis dysfunction in schizophrenia. An immediate inflammatory response with IL-6 was seen in both groups following the TSST. Larger studies should examine psychosocial stress response in schizophrenia and the relationship of immune function and kynurenine pathway.
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Affiliation(s)
- Matthew Glassman
- Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Heidi J Wehring
- Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Ana Pocivavsek
- Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Kelli M Sullivan
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laura M Rowland
- Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Robert P McMahon
- Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Joshua Chiappelli
- Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Fang Liu
- Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Deanna L Kelly
- Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
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9
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Abstract
Overweight and obesity in schizophrenia are prevalent, affecting half to three-quarters of people with schizophrenia. Hyperphagia and increased meal size have also been implicated as significant contributors to the weight gain problem. Oxytocin has shown to play a role in appetite control in humans and is considered an anorexigenic peptide. This two-day, within-subjects, challenge study involved the examination of satiety after administration of 24 IU oxytocin (intranasal) vs. placebo in participants with a DSM-IV diagnosis of schizophrenia (N = 16). Self reported satiety along with a preload-test meal paradigm were utilized as well as related laboratory measures (insulin, glucose, and leptin), and measures of taste and smell. There were no statistically significant differences between the groups on self-reported satiety or test meal consumption, insulin or glucose levels, or sensory measures. A significant treatment difference was found (F = 5.22, df = 1,97.6, p = 0.025), with a decrease in leptin in the oxytocin group post-administration, but no time effect (F = 1.67, df = 6,95.1, p = 0.180) or treatment by time interaction (F = 1.36. df = 3,4.16, p = 0.261). Despite the small sample and mostly negative findings, we encourage more work to use higher and repeated doses of oxytocin, and to further examine the effect of oxytocin on leptin in schizophrenia as this may be important for understanding both weight control and psychopathology.
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Affiliation(s)
- Kimberly R Warren
- Maryland Psychiatric Research Center, University of Maryland, School of Medicine, PO Box 21247, Baltimore, MD 21228, United States; Morgan State University, Department of Psychology, 1700 East Cold Spring Lane, Baltimore, MD 21215, United States
| | - Heidi J Wehring
- Maryland Psychiatric Research Center, University of Maryland, School of Medicine, PO Box 21247, Baltimore, MD 21228, United States
| | - Fang Liu
- Maryland Psychiatric Research Center, University of Maryland, School of Medicine, PO Box 21247, Baltimore, MD 21228, United States
| | - Robert P McMahon
- Maryland Psychiatric Research Center, University of Maryland, School of Medicine, PO Box 21247, Baltimore, MD 21228, United States
| | - Shuo Chen
- Maryland Psychiatric Research Center, University of Maryland, School of Medicine, PO Box 21247, Baltimore, MD 21228, United States
| | - Charlene Chester
- Morgan State University, Department of Psychology, 1700 East Cold Spring Lane, Baltimore, MD 21215, United States
| | - Deanna L Kelly
- Maryland Psychiatric Research Center, University of Maryland, School of Medicine, PO Box 21247, Baltimore, MD 21228, United States.
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10
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Cohen AS, Mitchell KR, Strauss GP, Blanchard JJ, Buchanan RW, Kelly DL, Gold J, McMahon RP, Adams HA, Carpenter WT. The effects of oxytocin and galantamine on objectively-defined vocal and facial expression: Data from the CIDAR study. Schizophr Res 2017; 188:141-143. [PMID: 28130004 PMCID: PMC5524598 DOI: 10.1016/j.schres.2017.01.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Received: 11/10/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Alex S. Cohen
- Louisiana State University, Department of Psychology
| | | | | | | | - Robert W. Buchanan
- University of Maryland School of Medicine, Maryland Psychiatric Research Center
| | - Deanna L. Kelly
- University of Maryland School of Medicine, Maryland Psychiatric Research Center
| | - James Gold
- University of Maryland School of Medicine, Maryland Psychiatric Research Center
| | - Robert P. McMahon
- University of Maryland School of Medicine, Maryland Psychiatric Research Center
| | - Heather A. Adams
- University of Maryland School of Medicine, Maryland Psychiatric Research Center
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11
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Xu P, Kelly DL, Kitchen C, Gildea JJ, Schiermeyer KA, Jose PA, Norman SM, McMahon RP, Wang Z, Felder R. Abstract P321: Clozapine-induced Hypertension: Role of the Dopamine Type 4 Receptor (D4R) in Human Renal Proximal Tubule Cells (RPTC). Hypertension 2017. [DOI: 10.1161/hyp.70.suppl_1.p321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clozapine (CLZ), a potent D
4
R antagonist that is an effective antipsychotic drug for the treatment of schizophrenia, is associated with hypertension. The hypertensive side effect of CLZ may be through inhibition of the D
4
R because germline deletion of D
4
R in mice causes hypertension. The hypertension caused by germline deletion of D
4
R may, in part, be due to increased renal expression of the angiotensin type 1 receptor (AT
1
R) and renal expression of sodium exchangers, transporters, and pumps, e.g., NHE3, NKCC2, NCC, and Na
+
K
+
/ATPase, α subunit. CLZ administered subcutaneously (20mg/kg/day/x3 days, n=5) in mice induced hypertension, shifted the pressure-natriuresis plot to the right, and increased the renal expressions of NCC and Na
+
K
+
/ATPase, α subunit, relative to vehicle-treated mice (n=5). Activation of D
4
R decreased AT
1
R expression and Na
+
K
+
/ATPase activity in rat renal proximal tubule cells (RPTCs). Therefore, we studied two groups: subjects 18 to 75 years old with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder treated with CLZ for >2 months (CLZ, N=32) and untreated healthy controls (
HC
, N=20) without psychiatric illness. There were no significant differences in blood pressure (BP) between the two groups since more than half of the CLZ participants received antihypertensive medication. We studied RPTCs cultured from the participant’s urine (CLZ, N=18;
HC,
N=9) and treated those cells with 100 nM CLZ. CLZ decreased D
4
R expression in both
HC
and CLZ groups (
HC
, VEH 1.04±0.17 vs CLZ 0.73±0.09, n=9, paired t-test, P<0.05; CLZ, VEH 1.02±0.09 vs CLZ 0.75±0.06, n=16, paired t-test, P<0.01). CLZ also increased reactive oxygen species (Rosstar550 assay) in the
HC
but not CLZ-treated group (
HC
, VEH 0.92±0.07 vs CLZ 1.02±0.09, n=8,
paired
t-test
, P<0.05; CLZ VEH 1.09±0.18 vs CLZ 1.07±0.18, n=14). The density of plasma membrane AT
1
R tended to be higher in CLZ-treated hypertensive (CLX HP) than the CLZ-treated normotensive participants (CLZ NP): (
HC
, 0.28±0.08 n=8; CLZ NP, 0.10±0.02 n=4; CLZ HP, 0.81±0.31 n=7). Thus, CLZ may induce hypertension through a D
4
R/AT
1
R-mediated mechanism similar to that reported in D
4
R knockout mice. Additional studies will determine if CLZ increases sodium transport in human RPTCs.
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Affiliation(s)
- Peng Xu
- The Univ of Virginia, Charlottesville, VA
| | | | | | | | | | | | | | | | - Z Wang
- George Washington Univ, Washington DC, DC
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12
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Shovestul BJ, Glassman M, Rowland LM, McMahon RP, Liu F, Kelly DL. Pilot study examining the relationship of childhood trauma, perceived stress, and medication use to serum kynurenic acid and kynurenine levels in schizophrenia. Schizophr Res 2017; 185:200-201. [PMID: 28082139 PMCID: PMC5833307 DOI: 10.1016/j.schres.2016.12.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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] [Received: 10/03/2016] [Revised: 12/21/2016] [Accepted: 12/23/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Bridget J. Shovestul
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228
| | - Matthew Glassman
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228
| | - Laura M. Rowland
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228
| | - Robert P. McMahon
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228
| | - Fang Liu
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228
| | - Deanna L. Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228
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13
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Abstract
OBJECTIVE Nicotine dependence is high in schizophrenia, and craving is known to impact relapse during quit attempts. METHODS We compared tobacco craving in smokers with schizophrenia treated with different antipsychotics. RESULTS Mean craving scores were lowest in participants receiving first-generation antipsychotics, although these differences were not statistically significant. Craving with clozapine was not lower than with other antipsychotics. CONCLUSIONS Further research is needed to determine whether differences in craving exist between antipsychotic classes.
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Affiliation(s)
- Heidi J Wehring
- a Maryland Psychiatric Research Center, University of Maryland School of Medicine , Baltimore , MD , USA
| | - Stephen J Heishman
- b National Institute of Health, National Institute on Drug Abuse, Intramural Research Program , Baltimore , MD , USA
| | - Robert P McMahon
- a Maryland Psychiatric Research Center, University of Maryland School of Medicine , Baltimore , MD , USA
| | - Fang Liu
- a Maryland Psychiatric Research Center, University of Maryland School of Medicine , Baltimore , MD , USA
| | - Stephanie Feldman
- a Maryland Psychiatric Research Center, University of Maryland School of Medicine , Baltimore , MD , USA
| | - Heather Raley
- a Maryland Psychiatric Research Center, University of Maryland School of Medicine , Baltimore , MD , USA
| | - Elaine Weiner
- a Maryland Psychiatric Research Center, University of Maryland School of Medicine , Baltimore , MD , USA
| | - Deanna L Kelly
- a Maryland Psychiatric Research Center, University of Maryland School of Medicine , Baltimore , MD , USA
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14
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Clark SM, Pocivavsek A, Nicholson JD, Notarangelo FM, Langenberg P, McMahon RP, Kleinman JE, Hyde TM, Stiller J, Postolache TT, Schwarcz R, Tonelli LH. Reduced kynurenine pathway metabolism and cytokine expression in the prefrontal cortex of depressed individuals. J Psychiatry Neurosci 2016; 41:386-394. [PMID: 27070351 PMCID: PMC5082509 DOI: 10.1503/jpn.150226] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Neuroinflammatory processes are increasingly believed to participate in the pathophysiology of a number of major psychiatric diseases, including depression. Immune activation stimulates the conversion of the amino acid tryptophan to kynurenine, leading to the formation of neuroactive metabolites, such as quinolinic acid and kynurenic acid. These compounds affect glutamatergic neurotransmission, which plays a prominent role in depressive pathology. Increased tryptophan degradation along the kynurenine pathway (KP) has been proposed to contribute to disease etiology. METHODS We used postmortem brain tissue from the ventrolateral prefrontal cortex (VLPFC) to assess tissue levels of tryptophan and KP metabolites, the expression of several KP enzymes and a series of cytokines as well as tissue pathology, including microglial activation. Tissue samples came from nonpsychiatric controls (n = 36) and individuals with depressive disorder not otherwise specified (DD-NOS, n = 45) who died of natural causes, homicide, accident, or suicide. RESULTS We found a reduction in the enzymatic conversion of tryptophan to kynurenine, determined using the kynurenine:tryptophan ratio, and reduced messenger RNA expression of the enzymes indoleamine-2,3-dioxygenase 1 and 2 and tryptophan-2,3-dioxygenase in depressed individuals irrespective of the cause of death. These findings correlated with reductions in the expression of several cytokines, including interferon-γ and tumour necrosis factor-α. Notably, quinolinic acid levels were also lower in depressed individuals than controls. LIMITATIONS Information on the use of antidepressants and other psychotropic medications was insufficient for statistical comparisons. CONCLUSION Contrary to expectations, the present results indicate that depression, in the absence of medical illness or an overt inflammatory process, is associated with compromised, rather than increased, KP metabolism in the VLPFC.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Leonardo H. Tonelli
- Correspondence to: L.H. Tonelli, Laboratory of Behavioral Neuroimmunology, Department of Psychiatry, University of Maryland School of Medicine, 655 W. Baltimore St. Baltimore MD, 21201, USA;
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15
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Richardson CM, Davis EA, Vyas GR, DiPaula BA, McMahon RP, Kelly DL. Evaluation of the Safety of Clozapine Use in Patients With Benign Neutropenia. J Clin Psychiatry 2016; 77:e1454-e1459. [PMID: 27736047 PMCID: PMC5470316 DOI: 10.4088/jcp.15m10315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 08/10/2015] [Accepted: 11/30/2015] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine if clozapine can be safely utilized in psychiatric patients with benign neutropenia. METHODS A single-center, retrospective chart review study of records from 2001 to 2014 was conducted in an inpatient psychiatric hospital. Patients included had benign neutropenia prior to receiving clozapine and received clozapine using modified monitoring guidelines. All available laboratory values for absolute neutrophil count (ANC) before initiation and during treatment were evaluated. The primary endpoint was difference in ANC after initiation of clozapine from before clozapine. RESULTS A total of 26 patients were reviewed. The mean age at clozapine initiation was 34 years. The majority were African-American (73% [n = 19]), with more men than women (73% [n = 19] vs 27% [n = 7]). The mean lowest ANC value was not significantly different after clozapine initiation compared to before (1.5× 10³ cells/mm³ and 1.4 × 10³ cells/mm³, respectively; P = .22). The overall mean ANC was significantly higher after initiation than before (2.63 × 10³ cells/mm³ and 2.13 × 10³ cells/mm³, respectively; P < .001). There were no cases of severe neutropenia (ANC < 0.5 × 10³ cells/mm³), and no patient was discontinued for falling below modified guideline limits. There were fewer occurrences of mild neutropenia (ANC < 2.0 × 10³ cells/mm³) after clozapine initiation than before (16.0% and 31.4%, respectively; P < .001). There were also fewer occurrences of moderate neutropenia (ANC < 1.5 × 10³ cells/mm³), with 2.1% after clozapine and 13.3% before (P < .001). CONCLUSIONS Twenty-six patients with benign neutropenia were safely treated with clozapine. Pre-clozapine neutropenia did not predict increased risk for severe neutropenia with clozapine. Patients had significantly fewer episodes of mild and moderate neutropenia after receiving clozapine compared to before.
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Affiliation(s)
| | | | - Gopal R. Vyas
- Maryland Psychiatric Research Center, University of Maryland School of Medicine and Spring Grove Hospital Center, Baltimore, Maryland
| | | | - Robert P. McMahon
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Deanna L. Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, Maryland
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16
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Koola MM, Kelly DL, McMahon RP, Boggs DL, Liu F, Gorelick DA. Psychoactive Substance Use by Adults With Schizophrenia Before and During Cannabis Withdrawal. Prim Care Companion CNS Disord 2016; 18. [PMID: 27835727 DOI: 10.4088/pcc.16l01959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Maju Mathew Koola
- Clinical Research Program, Sheppard Pratt Health System, Baltimore, Maryland, and Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Deanna L Kelly
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robert P McMahon
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Douglas L Boggs
- Veterans Affairs Connecticut Healthcare System, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Fang Liu
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David A Gorelick
- .,Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Hassan HE, Kelly D, Honick M, Shukla S, Ibrahim A, Gorelick DA, Glassman M, McMahon RP, Wehring HJ, Kearns AM, Feldman S, Yu M, Bauer K, Wang JB. Pharmacokinetics and Safety Assessment of l-Tetrahydropalmatine in Cocaine Users: A Randomized, Double-Blind, Placebo-Controlled Study. J Clin Pharmacol 2016; 57:151-160. [PMID: 27363313 DOI: 10.1002/jcph.789] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/13/2016] [Accepted: 06/28/2016] [Indexed: 11/07/2022]
Abstract
Cocaine use disorder (CUD) remains a significant public health challenge. l-Tetrahydropalmatine (l-THP), a well-tolerated and nonaddictive compound, shows promise for the management of CUD. Its pharmacologic profile includes blockade at dopamine and other monoamine receptors and attenuation of cocaine self-administration, reinstatement, and rewarding properties in rats. This study evaluated the safety of l-THP in human cocaine users and its influence on the safety and pharmacokinetics (PK) of cocaine. Twenty-four cocaine-using adult men were randomized to receive l-THP (30 mg twice a day orally) or placebo double-blind for 4 days, with an intranasal cocaine (40 mg) challenge on the fourth day. Safety and tolerability were evaluated using vital signs, ECG, clinical laboratory tests, and standardized self-report instruments. Peripheral venous blood was collected periodically and later assayed for l-THP and cocaine using highly sensitive and specific ultraperformance liquid chromatography-fluorescence detection (UPLC-FLD) methods. Twenty subjects completed the study, of whom 19 provided complete PK data. The short 3.5-day course of l-THP was safe and well tolerated and did not affect cocaine's PK or its acute cardiovascular effects. The cocaine AUC0→∞ was 211.5 and 261.4 h·ng/mL, and the Cmax was 83.3 and 104.5 ng/mL for the l-THP and placebo groups, respectively. In addition there were no significant differences in the number of side effects reported in each group (l-THP group 22 [48%], placebo group 24 [52%]) or vital signs including, heart rate, blood pressure, complete blood count, or ECG. These findings suggest that oral THP has promise for further development as a treatment for CUD.
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Affiliation(s)
- Hazem E Hassan
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, MD, USA.,Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Helwan University, Cairo, Egypt
| | - Deanna Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Moshe Honick
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - Sagar Shukla
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - Ahmed Ibrahim
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - David A Gorelick
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matthew Glassman
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert P McMahon
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Heidi J Wehring
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ann Marie Kearns
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephanie Feldman
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mingming Yu
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - Ken Bauer
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA
| | - Jia Bei Wang
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, MD, USA
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Koola MM, Raines JK, Hamilton RG, McMahon RP. Can anti-inflammatory medications improve symptoms and reduce mortality in schizophrenia? Curr Psychiatr 2016; 15:52-57. [PMID: 27274712 PMCID: PMC4891974] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Maju Mathew Koola
- Sheppard Pratt Health System, Baltimore, Maryland, Associate Professor, Department of Psychiatry and Behavioral Sciences, George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Jeffrey K Raines
- Emeritus Professor, Department of Surgery, University of Miami, Miami, Florida, Department of Surgery, Harvard Medical School, Cambridge, Massachusetts
| | - Robert G Hamilton
- Professor, Departments of Medicine and Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert P McMahon
- Professor of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
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19
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Lee MR, Wehring HJ, McMahon RP, Liu F, Linthicum J, Verbalis JG, Buchanan RW, Strauss GP, Rubin LH, Kelly DL. Relationship of plasma oxytocin levels to baseline symptoms and symptom changes during three weeks of daily oxytocin administration in people with schizophrenia. Schizophr Res 2016; 172:165-8. [PMID: 26879587 PMCID: PMC4821731 DOI: 10.1016/j.schres.2016.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/03/2016] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
Abstract
Several clinical studies have found an inverse relationship between clinical symptoms and peripheral oxytocin (OT) levels in people with schizophrenia. As oxytocin is a putative treatment for schizophrenia, the effect of repeated dosing of OT on OT levels, clinical symptoms and the relationship between the two is of interest. In a, randomized, double blind, parallel group 3 week study (N=28) with daily administration of intranasal OT (20 IU twice daily) or placebo (PBO), we examined the effect of OT administration on the correlation between the change in peripheral OT levels and change in clinical symptoms in patients with schizophrenia. At baseline, there were no significant treatment group differences in OT levels. There were no significant associations between baseline OT levels and any symptom measures. After 3 weeks of OT/PBO dosing, there was no significant difference in the magnitude of change in OT levels between the two treatment groups. Correlations between changes in peripheral OT levels and changes in the BPRS total and negative symptom scores were not different between treatment groups. Larger studies are needed to examine the effect of exogenous OT on peripheral OT levels and the relationship between the latter and clinical symptoms. Clinical Trials.gov=NCT00884897.
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Affiliation(s)
- Mary R. Lee
- National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Bethesda, MD,Corresponding author: , National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive, Bethesda, MD 20892-1108
| | - Heidi J. Wehring
- Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Robert P. McMahon
- Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Fang Liu
- Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Jared Linthicum
- Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Joseph G. Verbalis
- Georgetown-Howard Universities Center for Clinical and Translational Science, Georgetown University Medical Center
| | - Robert W. Buchanan
- Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Gregory P. Strauss
- Department of Psychology, State University of New York at Binghamton, Binghamton, NY
| | - Leah H. Rubin
- Women’s Mental Health Research Program, University of Illinois at Chicago
| | - Deanna L. Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine
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20
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Kelly DL, Rowland LM, Patchan KM, Sullivan K, Earl A, Raley H, Liu F, Feldman S, McMahon RP. Schizophrenia clinical symptom differences in women vs. men with and without a history of childhood physical abuse. Child Adolesc Psychiatry Ment Health 2016; 10:5. [PMID: 26941836 PMCID: PMC4776423 DOI: 10.1186/s13034-016-0092-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/09/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Childhood abuse has been implicated as an environmental factor that increases the risk for developing schizophrenia. A recent large population-based case-control study found that abuse may be a risk factor for schizophrenia in women, but not men. Given the sex differences in onset and clinical course of schizophrenia, we hypothesized that childhood abuse may cause phenotypic differences in the disorder between men and women. METHODS We examined the prevalence of childhood physical abuse in a cohort of men and women with schizophrenia and schizoaffective disorder. Specifically, we examined differences in positive, negative, cognitive and depressive symptoms in men and women who reported a history of childhood physical abuse. We recruited 100 subjects for a single visit and assessed a history of childhood physical abuse using the childhood trauma questionnaire (CTQ) and clinical symptoms and cognition using the brief psychiatric rating scale (BPRS), the calgary depression scale (CDS) and the repeatable battery of the assessment of neuropsychological status (RBANS) for cognition. RESULTS Ninety-two subjects completed the full CTQ with abuse classified as definitely present, definitely absent or borderline. Twelve subjects who reported borderline abuse scores were excluded. Of the 80 subjects whose data was analyzed, 10 of 24 (41.6 %) women and 11 of 56 (19.6 %) men reported a history of childhood physical abuse (χ(2) = 4.21, df = 1, p = 0.04). Women who reported such trauma had significantly more psychotic (sex by abuse interaction; F = 4.03, df = 1.76, p = 0.048) and depressive (F = 4.23, df = 1.76, p = 0.04) symptoms compared to women who did not have a trauma history and men, regardless of trauma history. There were no differences in negative or cognitive symptoms. CONCLUSIONS Women with schizophrenia and schizoaffective disorder may represent a distinct phenotype or subgroup with distinct etiologies and may require different, individually tailored treatments.
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Affiliation(s)
- Deanna L. Kelly
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Laura M. Rowland
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Kathleen M. Patchan
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Kelli Sullivan
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Amber Earl
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Heather Raley
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Fang Liu
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Stephanie Feldman
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Robert P. McMahon
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
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21
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Rowland LM, Krause BW, Wijtenburg SA, McMahon RP, Chiappelli J, Nugent KL, Nisonger SJ, Korenic SA, Kochunov P, Hong LE. Medial frontal GABA is lower in older schizophrenia: a MEGA-PRESS with macromolecule suppression study. Mol Psychiatry 2016; 21:198-204. [PMID: 25824298 PMCID: PMC4591074 DOI: 10.1038/mp.2015.34] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 02/17/2015] [Accepted: 02/24/2015] [Indexed: 01/09/2023]
Abstract
Gamma-butyric acid (GABA) dysfunction has been implicated in the pathophysiology of schizophrenia and its cognitive deficits. Proton magnetic resonance spectroscopy (MRS) was used to test the hypothesis that older participants with schizophrenia have lower anterior cingulate GABA levels compared with older control participants. One-hundred forty-five participants completed this study. For detection of GABA, spectra were acquired from the medial frontal/anterior cingulate cortex using a macromolecule-suppressed MEGA-PRESS sequence. Patients were evaluated for psychopathology and all participants completed neuropsychological tests of working memory, processing speed and functional capacity. GABA levels were significantly lower in the older participants with schizophrenia (n=31) compared with the older control (n=37) group (P=0.003) but not between the younger control (n=40) and schizophrenia (n=29) groups (P=0.994). Age strongly predicted GABA levels in the schizophrenia group accounting for 42% of the variance, but the effect of age was less in the control group accounting for 5.7% of the variance. GABA levels were specifically related to working memory but not processing speed performance, functional capacity, or positive or negative symptom severity. This is the largest MRS study of GABA in schizophrenia and the first to examine GABA without macromolecule contamination, a potentially significant issue in previous studies. GABA levels more rapidly declined with advancing age in the schizophrenia compared with the control group. Interventions targeted at halting the decline or increasing GABA levels may improve functional outcomes and quality of life as patients with schizophrenia age.
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Affiliation(s)
- Laura M Rowland
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine,Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine,Department of Psychology, University of Maryland Baltimore County,Corresponding Author. Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore, MD 21228, 410-402-6803,
| | - Benjamin W. Krause
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - S. Andrea Wijtenburg
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Robert P. McMahon
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Joshua Chiappelli
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Katie L. Nugent
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Sarah J. Nisonger
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Stephanie A. Korenic
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Peter Kochunov
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine,Department of Physics, University of Maryland Baltimore County
| | - L. Elliot Hong
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
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22
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Miller J, Wehring H, McMahon RP, DiPaula BA, Love RC, Morris AA, Raley H, Feldman S, Kelly DL. Urine testing for antipsychotics: a pilot trial for a method to determine detection levels. Hum Psychopharmacol 2015; 30:350-5. [PMID: 26010339 DOI: 10.1002/hup.2482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 09/30/2014] [Revised: 03/04/2015] [Accepted: 03/20/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of the present study was to demonstrate that the analytical assay of interest can detect antipsychotics in human urine specimens. METHOD Forty inpatients treated with haloperidol, quetiapine, risperidone, or olanzapine were recruited to participate in a one visit study. During the study visit, demographic and clinical information was collected as well as one urine sample that was forwarded to the Ameritox Laboratory and assayed for the presence of antipsychotic medications and/or metabolites. Urine samples were analyzed to determine detection sensitivity for four antipsychotic medications and their metabolites (risperidone, quetiapine, olanzapine, and/or haloperidol) using Ultra Performance Liquid Chromatography-Tandem Mass Spectrometry. RESULTS All urine samples produced positive results for the antipsychotic(s) the participants were known to be taking. Urine concentrations (level of quantification) for parent drugs ranged from <25-417 ng/mL for haloperidol, <25-4017 ng/mL for quetiapine, 0-997 ng/mL for risperidone, and 57-700 ng/mL for olanzapine. CONCLUSION The analytical assay produced by Ameritox, Ltd using Ultra Performance Liquid Chromatography-Tandem Mass Spectrometry can qualitatively detect antipsychotics in human urine specimens. The present study highlights the potential utility of the urine assay to help monitor adherence to antipsychotic medications.
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Affiliation(s)
- Jennifer Miller
- University of Maryland, School of Pharmacy, Baltimore, Maryland, USA.,Wilkes-Barre Veterans Affairs Medical Center (VAMC), Wilkes-Barre, Pennsylvania, USA
| | - Heidi Wehring
- University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Robert P McMahon
- University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Bethany A DiPaula
- University of Maryland, School of Pharmacy, Baltimore, Maryland, USA
| | - Raymond C Love
- University of Maryland, School of Pharmacy, Baltimore, Maryland, USA
| | | | - Heather Raley
- University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Stephanie Feldman
- University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Deanna L Kelly
- University of Maryland, School of Pharmacy, Baltimore, Maryland, USA.,University of Maryland, School of Medicine, Baltimore, Maryland, USA
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23
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Kelly DL, Ben-Yoav H, Payne GF, Winkler TE, Chocron SE, Kim E, Kitchen C, Stock V, Vyas G, Love RC, Wehring HJ, Sullivan KM, Feldman S, Liu F, McMahon RP, Ghodssi R. Blood Draw Barriers for Treatment with Clozapine and Development of a Point-of-Care Monitoring Device. ACTA ACUST UNITED AC 2015. [PMID: 26218235 DOI: 10.3371/csrp.kebe.070415] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND While clozapine (CLZ) is the most effective antipsychotic drug for schizophrenia treatment, it remains underused. In order to understand the barriers of frequent blood draws for white blood cell counts (WBCs) and clozapine levels, we developed a psychiatrist survey and began an integrative approach of designing a point-of-care device that could eventually have real-time monitoring with immediate results. METHODS We ascertained barriers related to CLZ management and the acceptance of possible solutions by sending an anonymous survey to physicians in psychiatric practice (n=860). In parallel, we tested CLZ sensing using a prototype point-of-care monitoring device. RESULTS 255 responses were included in the survey results. The two barriers receiving mean scores with the highest agreement as being a significant barrier were patient nonadherence to blood work and blood work's burden on the patient (out of 28). Among nine solutions, the ability to obtain lab results in the physician's office or pharmacy was top ranked (mean±sd Likert scale [4.0±1.0]). Physicians responded that a point-of-care device to measure blood levels and WBCs would improve care and increase CLZ use. Residents ranked point-of-care devices higher than older physicians (4.07±0.87 vs. 3.47±1.08, p<0.0001). Also, the prototype device was able to detect CLZ reliably in 1.6, 8.2, and 16.3 μg/mL buffered solutions. DISCUSSION Survey results demonstrate physicians' desire for point-of-care monitoring technology, particularly among younger prescribers. Prototype sensor results identify that CLZ can be detected and integrated for future device development. Future development will also include integration of WBCs for a complete detection device.
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Buchanan RW, Weiner E, Kelly DL, Gold JM, Keller WR, Waltz JA, McMahon RP, Gorelick DA. Rasagiline in the Treatment of the Persistent Negative Symptoms of Schizophrenia. Schizophr Bull 2015; 41:900-8. [PMID: 25368372 PMCID: PMC4466175 DOI: 10.1093/schbul/sbu151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 11/12/2022]
Abstract
OBJECTIVE The current study examined the efficacy and safety of rasagiline, a selective MAO-B inhibitor, for the treatment of persistent negative symptoms. METHODS Sixty people with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, schizophrenia or schizoaffective disorder, who met a priori criteria for persistent negative symptoms, were randomized to receive rasagiline, 1mg/d (n = 31) or placebo (n = 29) in a 12-week, double-blind, placebo-controlled clinical trial. The Scale for the Assessment of Negative Symptoms (SANS) total score was used to assess change in negative symptoms. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), N-Back test, a probabilistic learning task, and a delayed discounting task were used to assess cognition. RESULTS In a mixed model analysis of covariance (MM-ANCOVA), with time as a continuous variable, there was a significant treatment × time effect for SANS total score (F = 5.61(df = 1,40.3), P = .023). The treatment × time interaction effect was also significant for the SANS avolition subscale score (F(1,40.2) = 10.41, P = .002). In a post hoc MM-ANCOVA analyses, with time as a categorical variable, group differences were significant at week 12 for SANS total score (t(37.3) = 2.15; P = .04; d = -0.41) and SANS avolition subscale score (t(49.0) = 3.06; P = .004; d = -0.46). There was a significant difference in number of participants with a ≥20% reduction in SANS avolition score (χ(2)(1) = 10.94; P = .0009), but not in SANS total score (χ(2)(1) = 1.11; P = .29). There were no significant group differences on the RBANS, N-Back, probabilistic learning, or delayed discounting tasks. CONCLUSIONS Study results support future studies of the utility of rasagiline for the treatment of negative symptoms, including avolition (clinicaltrials.gov trial number: NCT00492336).
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Affiliation(s)
- Robert W. Buchanan
- *To whom correspondence should be addressed; Maryland Psychiatric Research Center, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228, US; tel: 410-402-7876, fax: 410-402-7198, e-mail:
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25
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Jarskog LF, Lowy MT, Grove RA, Keefe RSE, Horrigan JP, Ball MP, Breier A, Buchanan RW, Carter CS, Csernansky JG, Goff DC, Green MF, Kantrowitz JT, Keshavan MS, Laurelle M, Lieberman JA, Marder SR, Maruff P, McMahon RP, Seidman LJ, Peykamian MA. A Phase II study of a histamine H₃ receptor antagonist GSK239512 for cognitive impairment in stable schizophrenia subjects on antipsychotic therapy. Schizophr Res 2015; 164:136-42. [PMID: 25728831 DOI: 10.1016/j.schres.2015.01.041] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
Abstract
This Phase II exploratory study assessed GSK239512, a brain penetrant histamine H₃ receptor antagonist, versus placebo on cognitive impairment in 50 stable outpatients with schizophrenia. Subjects were randomized to placebo or GSK239512 for 7 weeks (4 weeks titration). GSK239512 was associated with a small positive effect size (ES) on the CogState Schizophrenia Battery (CSSB) Composite Score (ES=0.29, CI=-0.40, 0.99) relative to placebo (primary endpoint). GSK239512's ES on CSSB domains were generally positive or neutral except Processing Speed, which favored placebo (ES=-0.46). Effects on the MATRICS Consensus Cognitive Battery were mostly neutral or favored placebo. GSK239512 was generally well tolerated with an adverse event profile consistent with the known class pharmacology. There was no evidence of overall beneficial effects of GSK239512 for CIAS in this population.
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Affiliation(s)
- L Fredrik Jarskog
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Martin T Lowy
- GlaxoSmithKline Neurosciences Therapy Area Unit, RTP, NC, United States
| | - Richard A Grove
- GlaxoSmithKline Neurosciences Clinical Statistics, Stockley Park, UK.
| | | | - Joseph P Horrigan
- GlaxoSmithKline Neurosciences Therapy Area Unit, RTP, NC, United States
| | - M Patricia Ball
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Alan Breier
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | | | | | - Donald C Goff
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | | | | | | | | | - Jeffrey A Lieberman
- New York State Psychiatric Institute, New York , NY, United States; Columbia University, New York, NY, United States
| | | | | | - Robert P McMahon
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, United States
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26
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Fischer BA, McMahon RP, Kelly DL, Wehring HJ, Meyer WA, Feldman S, Carpenter WT, Gorelick DA. Risk-taking in schizophrenia and controls with and without cannabis dependence. Schizophr Res 2015; 161:471-7. [PMID: 25467541 PMCID: PMC4308438 DOI: 10.1016/j.schres.2014.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 11/05/2014] [Accepted: 11/09/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND Risk-based decision making is altered in people with schizophrenia and in people with cannabis use compared to healthy controls; the pattern of risk-assessment in people with co-occurring schizophrenia and cannabis dependence is poorly understood. This study examined measures of risk-taking and decision-making in people with and without schizophrenia and/or cannabis dependence. METHODS Participants with schizophrenia (n=24), cannabis dependence (n=23), schizophrenia and co-occurring cannabis dependence (n=18), and healthy controls (n=24) were recruited from the community via advertisements and completed a one-visit battery of symptom, risk-based decision making, gambling behavior, cognitive, and addiction assessments. This report presents self-assessments of self-mastery, optimism, impulsivity, and sensation seeking and a behavioral assessment of risk (Balloon Analog Risk Task [BART]). RESULTS On self-report measures, participants with schizophrenia and co-occurring cannabis dependence were intermediate between those with only cannabis dependence or only schizophrenia on ratings of self-mastery, sensation-seeking, and impulsivity. There were no group differences on ratings of optimism. Their behavior on the BART was most similar to participants with only cannabis dependence or healthy controls, rather than to participants with only schizophrenia. CONCLUSIONS People with schizophrenia and co-occurring cannabis dependence may represent a unique group in terms of risk-perception and risk-taking. This has implications for interventions designed to influence health behaviors such as motivational interviewing.
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Affiliation(s)
- Bernard A Fischer
- Veterans Affairs Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Baltimore, MD, USA; Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Robert P McMahon
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Deanna L Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Heidi J Wehring
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Walter A Meyer
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephanie Feldman
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William T Carpenter
- Veterans Affairs Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Baltimore, MD, USA; Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David A Gorelick
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
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Wonodi I, McMahon RP, Krishna N, Mitchell BD, Liu J, Glassman M, Hong LE, Gold JM. Influence of kynurenine 3-monooxygenase (KMO) gene polymorphism on cognitive function in schizophrenia. Schizophr Res 2014; 160:80-7. [PMID: 25464917 PMCID: PMC4516229 DOI: 10.1016/j.schres.2014.10.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/09/2014] [Accepted: 10/14/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cognitive deficits compromise quality of life and productivity for individuals with schizophrenia and have no effective treatments. Preclinical data point to the kynurenine pathway of tryptophan metabolism as a potential target for pro-cognitive drug development. We have previously demonstrated association of a kynurenine 3-monooxygenase (KMO) gene variant with reduced KMO gene expression in postmortem schizophrenia cortex, and neurocognitive endophenotypic deficits in a clinical sample. KMO encodes kynurenine 3-monooxygenase (KMO), the rate-limiting microglial enzyme of cortical kynurenine metabolism. Aberration of the KMO gene might be the proximal cause of impaired cortical kynurenine metabolism observed in schizophrenia. However, the relationship between KMO variation and cognitive function in schizophrenia is unknown. This study examined the effects of the KMO rs2275163C>T C (risk) allele on cognitive function in schizophrenia. METHODS We examined the association of KMO polymorphisms with general neuropsychological performance and P50 gating in a sample of 150 schizophrenia and 95 healthy controls. RESULTS Consistent with our original report, the KMO rs2275163C>T C (risk) allele was associated with deficits in general neuropsychological performance, and this effect was more marked in schizophrenia compared with controls. Additionally, the C (Arg452) allele of the missense rs1053230C>T variant (KMO Arg452Cys) showed a trend effect on cognitive function. Neither variant affected P50 gating. CONCLUSIONS These data suggest that KMO variation influences a range of cognitive domains known to predict functional outcome. Extensive molecular characterization of this gene would elucidate its role in cognitive function with implications for vertical integration with basic discovery.
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Affiliation(s)
- Ikwunga Wonodi
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Robert P. McMahon
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nithin Krishna
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Braxton D. Mitchell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Judy Liu
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matthew Glassman
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - L. Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James M. Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
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Jackson J, Eaton W, Cascella N, Fasano A, Santora D, Sullivan K, Feldman S, Raley H, McMahon RP, Carpenter WT, Demyanovich H, Kelly DL. Gluten sensitivity and relationship to psychiatric symptoms in people with schizophrenia. Schizophr Res 2014; 159:539-42. [PMID: 25311778 PMCID: PMC4476307 DOI: 10.1016/j.schres.2014.09.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 05/19/2014] [Revised: 09/09/2014] [Accepted: 09/11/2014] [Indexed: 12/20/2022]
Abstract
The relationship between gluten sensitivity and schizophrenia has been of increasing interest and novel mechanisms explaining this relationship continue to be described. Our study in 100 people with schizophrenia compared to 100 matched controls replicates a higher prevalence of gluten sensitivity and higher mean antigliadin IgG antibody levels schizophrenia (2.9 ± 7.7 vs. 1.3 ± 1.3, p = 0.046, controlled for age). Additionally, we examined symptoms within the schizophrenia group and found that while positive symptoms are significantly lower in people who have elevated antigliadin antibodies (AGA; 4.11 ± 1.36 vs. 6.39 ± 2.99, p = 0.020), no robust clinical profile differentiates between positive and negative antibody groups. Thus, identifying people in schizophrenia who may benefit from a gluten-free diet remains possible by blood test only.
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Affiliation(s)
- Jessica Jackson
- Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - William Eaton
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
| | - Nicola Cascella
- Neuropsychiatry Program Sheppard Pratt Hospital, 6501 North Charles Street, Baltimore, MD 21285, USA
| | - Alessio Fasano
- Massachusetts General Hospital for Children, 175 Cambridge Street, Boston, MA 02114, USA; Massachusetts General Hospital East, 16th Street, Charlestown, MA 02129, USA
| | - Debby Santora
- University of Maryland School of Medicine, 660 West Redwood Street, Baltimore, MD 21201, USA
| | - Kelli Sullivan
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center, 55 Wade Avenue, Catonsville, MD 21228, USA
| | - Stephanie Feldman
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center, 55 Wade Avenue, Catonsville, MD 21228, USA
| | - Heather Raley
- National Institute on Drug Abuse, 251 Bayview Blvd., Baltimore, MD 21223, USA
| | - Robert P McMahon
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center, 55 Wade Avenue, Catonsville, MD 21228, USA
| | - William T Carpenter
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center, 55 Wade Avenue, Catonsville, MD 21228, USA
| | - Haley Demyanovich
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center, 55 Wade Avenue, Catonsville, MD 21228, USA
| | - Deanna L Kelly
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center, 55 Wade Avenue, Catonsville, MD 21228, USA.
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29
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Gray BE, McMahon RP, Green MF, Seidman LJ, Mesholam-Gately RI, Kern RS, Nuechterlein KH, Keefe RS, Gold JM. Detecting reliable cognitive change in individual patients with the MATRICS Consensus Cognitive Battery. Schizophr Res 2014; 159:182-7. [PMID: 25156338 PMCID: PMC4469996 DOI: 10.1016/j.schres.2014.07.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Clinicians often need to evaluate the treatment response of an individual person and to know that observed change is true improvement or worsening beyond usual week-to-week changes. This paper gives clinicians tools to evaluate individual changes on the MATRICS Consensus Cognitive Battery (MCCB). We compare three different approaches: a descriptive analysis of MCCB test-retest performance with no intervention, a reliable change index (RCI) approach controlling for average practice effects, and a regression approach. METHOD Data were gathered as part of the MATRICS PASS study (Nuechterlein et al., 2008). A total of 159 people with schizophrenia completed the MCCB at baseline and 4weeks later. Data were analyzed using an RCI and a regression formula establishing confidence intervals. RESULTS The RCI and regression approaches agree within one point when baseline values are close to the sample mean. However, the regression approach offers more accurate limits for expected change at the tails of the distribution of baseline scores. CONCLUSIONS Although both approaches have their merits, the regression approach provides the most accurate measure of significant change across the full range of scores. As the RCI does not account for regression to the mean and has confidence limits that remain constant across baseline scores, the RCI approach effectively gives narrower confidence limits around an inaccurately predicted average change value. Further, despite the high test-retest reliability of the MCCB, a change in an individual's score must be relatively large to be confident that it is beyond normal month-to-month variation.
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Affiliation(s)
- Bradley E. Gray
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center. PO Box 21247, Baltimore, Maryland 21228, USA
| | - Robert P. McMahon
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center. PO Box 21247, Baltimore, Maryland 21228, USA
| | - Michael F. Green
- Semel Institute for Neuroscience and Human Behavior at UCLA, and VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Larry J. Seidman
- Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, and Harvard Medical School Department of Psychiatry, Boston, Massachusetts, 02115, USA
| | - Raquelle I. Mesholam-Gately
- Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, and Harvard Medical School Department of Psychiatry, Boston, Massachusetts, 02115, USA
| | - Robert S. Kern
- Semel Institute for Neuroscience and Human Behavior at UCLA, and VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Keith H. Nuechterlein
- Semel Institute for Neuroscience and Human Behavior at UCLA, and VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Richard S. Keefe
- Duke University School of Medicine, Department of Psychiatry, Translational Neuroscience. Durham, NC 27710, USA
| | - James M. Gold
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center. PO Box 21247, Baltimore, Maryland 21228, USA
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Kochunov P, Chiappelli J, Wright SN, Rowland LM, Patel B, Wijtenburg SA, Nugent K, McMahon RP, Carpenter WT, Muellerklein F, Sampath H, Hong LE. Multimodal white matter imaging to investigate reduced fractional anisotropy and its age-related decline in schizophrenia. Psychiatry Res 2014; 223:148-56. [PMID: 24909602 PMCID: PMC4100065 DOI: 10.1016/j.pscychresns.2014.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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: 01/03/2014] [Revised: 04/18/2014] [Accepted: 05/08/2014] [Indexed: 01/14/2023]
Abstract
We hypothesized that reduced fractional anisotropy (FA) of water diffusion and its elevated aging-related decline in schizophrenia patients may be caused by elevated hyperintensive white matter (HWM) lesions, by reduced permeability-diffusivity index (PDI), or both. We tested this hypothesis in 40/30 control/patient participants. FA values for the corpus callosum were calculated from high angular resolution diffusion tensor imaging (DTI). Whole-brain volume of HWM lesions was quantified by 3D-T2w-fluid-attenuated inversion recovery (FLAIR) imaging. PDI for corpus callosum was ascertained using multi b-value diffusion imaging (15 b-shells with 30 directions per shell). Patients had significantly lower corpus callosum FA values, and there was a significant age-by-diagnosis interaction. Patients also had significantly reduced PDI but no difference in HWM volume. PDI and HWM volume were significant predictors of FA and captured the diagnosis-related variance. Separately, PDI robustly explained FA variance in schizophrenia patients, but not in controls. Conversely, HWM volume made equally significant contributions to variability in FA in both groups. The diagnosis-by-age effect of FA was explained by a PDI-by-diagnosis interaction. Post hoc testing showed a similar trend for PDI of gray mater. Our study demonstrated that reduced FA and its accelerated decline with age in schizophrenia were explained by pathophysiology indexed by PDI, rather than HWM volume.
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Affiliation(s)
- Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA; Department of Physics, University of Maryland Baltimore County, Baltimore, MD 21250, USA.
| | - Joshua Chiappelli
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Susan N. Wright
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Laura M. Rowland
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Benish Patel
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - S. Andrea Wijtenburg
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Katie Nugent
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Robert P. McMahon
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - William T. Carpenter
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Florian Muellerklein
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Hemalatha Sampath
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - L. Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
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31
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Kiwanuka JN, Strauss GP, McMahon RP, Gold JM. Psychological predictors of functional outcome in people with schizophrenia. Schizophr Res 2014; 157:299-304. [PMID: 24878429 PMCID: PMC4120702 DOI: 10.1016/j.schres.2014.04.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 02/01/2014] [Revised: 04/24/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is increasing evidence that psychological factors (e.g., defeatist performance beliefs, trait negative affect) contribute to poor functional outcome in people with schizophrenia. In the current study, we evaluated whether multiple psychological factors predict poor functional outcome in individuals with schizophrenia, and whether associations between psychological variables and functional outcome persist even after accounting for neuropsychological impairment and negative symptoms. METHODS 100 patients meeting diagnostic criteria for schizophrenia or schizoaffective disorder and 78 demographically matched healthy control subjects completed self-report psychological measures, neuropsychological testing, and clinical rating scales. RESULTS Self-report scales assessing negative affectivity, defeatist performance beliefs, anhedonia, and behavioral inhibition were significantly correlated with functional outcome in people with schizophrenia. Neuropsychological impairment was associated with vocational outcome, whereas most of the self-report measures were related to social outcome. Defeatist performance attitudes were not correlated with neuropsychological performance. CONCLUSIONS Self-report measures predict variance in functional outcome beyond measures of clinical symptomatology and neuropsychological impairment. Findings indicate that psychological factors may be meaningful targets for psychosocial interventions aimed at improving functional outcome in schizophrenia.
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Affiliation(s)
- Jacqueline N. Kiwanuka
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore MD 21228,Correspondence author: Jacqueline Kiwanuka, Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore, Maryland 21228. (phone) 410-402-7145, (fax) 410-402-7198,
| | - Gregory P. Strauss
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore MD 21228
| | - Robert P. McMahon
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore MD 21228
| | - James M. Gold
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore MD 21228
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32
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Johnson MK, McMahon RP, Robinson BM, Harvey AN, Hahn B, Leonard CJ, Luck SJ, Gold JM. The relationship between working memory capacity and broad measures of cognitive ability in healthy adults and people with schizophrenia. Neuropsychology 2013; 27:220-9. [PMID: 23527650 DOI: 10.1037/a0032060] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Working memory (WM) capacity, typically measured with cognitively complex span tasks, is correlated with higher order cognitive abilities in healthy adults. The goals of this study were to determine whether a more focused measure of visual WM storage capacity would show similar higher order ability correlations in healthy adults and in people with schizophrenia (PSZ), thereby demonstrating the importance of simple storage capacity; determine whether the illness alters the pattern of correlations across cognitive domains; and evaluate whether between-groups differences in WM capacity could account for the generalized cognitive impairment in PSZ. METHOD Ninety-nine PSZ and 77 healthy controls (HCs) completed a visual WM change-localization task, the Wechsler Abbreviated Scale of Intelligence (WASI), and the MATRICS Consensus Cognitive Battery (MCCB). RESULTS PSZ performed more poorly than HCs on all cognitive measures. The between-groups effect size for WM capacity was large (d = 1.11). WM robustly correlated with WASI and MCCB performance, with no significant differences in the magnitude or pattern of correlations across groups. When the groups were pooled, WM capacity correlated at r = .68 with MCCB composite score and at r = .56 with WASI estimated Full Scale IQ. WM capacity accounted for approximately 40% of the between-groups variance across the WASI and MCCB. CONCLUSIONS A simple measure of WM storage capacity is robustly associated with the higher order cognitive abilities assessed by the WASI and MCCB in HCs and PSZ. WM capacity reduction may be a critical determinant of the general cognitive impairment in PSZ.
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Affiliation(s)
- Melissa K Johnson
- Baltimore VA Mental Health Care System, Mental Illness Research, Education & Clinical Center (VA Capital Health Care Network), Baltimore, Maryland, USA
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33
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Kelly DL, Wehring HJ, Earl AK, Sullivan KM, Dickerson FB, Feldman S, McMahon RP, Buchanan RW, Warfel D, Keller WR, Fischer BA, Shim JC. Treating symptomatic hyperprolactinemia in women with schizophrenia: presentation of the ongoing DAAMSEL clinical trial (Dopamine partial Agonist, Aripiprazole, for the Management of Symptomatic ELevated prolactin). BMC Psychiatry 2013; 13:214. [PMID: 23968123 PMCID: PMC3766216 DOI: 10.1186/1471-244x-13-214] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 08/07/2013] [Indexed: 01/01/2023] Open
Abstract
Prolactin elevations occur in people treated with antipsychotic medications and are often much higher in women than in men. Hyperprolactinemia is known to cause amenorrhea, oligomenorrhea, galactorrhea and gynecomastia in females and is also associated with sexual dysfunction and bone loss. These side effects increase risk of antipsychotic nonadherence and suicide and pose significant problems in the long term management of women with schizophrenia. In this manuscript, we review the literature on prolactin; its physiology, plasma levels, side effects and strategies for treatment. We also present the rationale and protocol for an ongoing clinical trial to treat symptomatic hyperprolactinemia in premenopausal women with schizophrenia. More attention and focus are needed to address these significant side effects and help the field better personalize the treatment of women with schizophrenia.
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Affiliation(s)
- Deanna L Kelly
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA.
| | - Heidi J Wehring
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Amber K Earl
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Kelli M Sullivan
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | | | - Stephanie Feldman
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Robert P McMahon
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Robert W Buchanan
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Dale Warfel
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - William R Keller
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Bernard A Fischer
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA,VA Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, Maryland, USA
| | - Joo-Cheol Shim
- Department of Psychiatry and Clinical Trial Center, Busan Paik Hospital, Inje University, Busan, South Korea
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Roth M, Hong LE, McMahon RP, Fuller RL. Comparison of the effectiveness of Conners' CPT and the CPT-identical pairs at distinguishing between smokers and nonsmokers with schizophrenia. Schizophr Res 2013; 148:29-33. [PMID: 23791390 PMCID: PMC3732498 DOI: 10.1016/j.schres.2013.06.012] [Citation(s) in RCA: 6] [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: 04/09/2013] [Revised: 05/24/2013] [Accepted: 06/02/2013] [Indexed: 12/31/2022]
Abstract
Sustained attention deficits and high rates of smoking are often observed in patients with schizophrenia. This has led to the hypothesis that patients may smoke as an attempt to ameliorate cognitive deficits related to abnormal nicotinic structure and function. Continuous performance tasks (CPT) are often used to index sustained attention deficits in patients with schizophrenia, however, there are important differences between tasks that may impact performance in smokers and nonsmokers with schizophrenia differently. The Conners' CPT (C-CPT) has a high signal-to-noise ratio and is commonly used to assess impulsivity. The CPT-Identical Pairs (CPT-IP) has a low signal-to-noise ratio and is commonly used to assess negative symptoms in patients with schizophrenia. We sought to determine whether there were differences of sustained attention between patient smokers vs. nonsmokers, and if one CPT would provide a better separation of sustained attention between groups. Results revealed that both instruments detect more impaired sustained attention deficits in patient smokers compared to nonsmokers. Patient smokers performed significantly worse on the majority of the CPT-IP composite scores compared to the C-CPT composite scores. These results do not support the self-medication theory, as patient smokers performed worse than patient nonsmokers. Researchers studying sustained attention in schizophrenia may wish to consider the CPT-IP over the C-CPT, as well as control for smoking status.
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Affiliation(s)
- Michelle Roth
- Department of Psychology, The Catholic University of America, 620 Michigan Avenue, NE, Washington, DC 20064 USA.
| | - L. Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, 21228 USA,
| | - Robert P. McMahon
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, PO Box 21247, Baltimore, Maryland, 21228 USA,
| | - Rebecca L. Fuller
- Department of Psychology, The Catholic University of America, 620 Michigan Avenue, NE, Washington, DC, 20064 USA,
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Gray BE, McMahon RP, Gold JM. General intellectual ability does not explain the general deficit in schizophrenia. Schizophr Res 2013; 147:315-9. [PMID: 23664590 PMCID: PMC3679318 DOI: 10.1016/j.schres.2013.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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] [Received: 03/07/2013] [Revised: 04/11/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
Abstract
Patients with schizophrenia demonstrate a generalized deficit across multiple cognitive domains. However, it is unknown whether this deficit is largely due to lower intelligence, or if there is an impact of schizophrenia which cannot be accounted for by measures of general intellectual ability (GIA). We created four IQ-matched strata of equal width between 89 healthy volunteers (HC) and 77 patients with schizophrenia (SZ) who had very similar IQ and reading scores within each stratum, then compared each stratum's performance on the MATRICS Consensus Cognitive Battery (MCCB). We hypothesized that any patient impairment on the MCCB after matching on IQ would be evidence that GIA does not fully explain the general deficit seen in schizophrenia. We found that patients showed evidence of greater neuropsychological impairment than what would be expected based solely on their IQ and reading ability scores. Further, this deficit was stronger in some cognitive domains than others, namely, processing speed and social cognition. These results suggest the presence of a distinction between GIA and generalized neuropsychological impairment that was consistent in magnitude across all patients, regardless of IQ.
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Affiliation(s)
- Bradley E. Gray
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center. PO Box 21247, Baltimore, Maryland 21228, USA
| | - Robert P. McMahon
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center. PO Box 21247, Baltimore, Maryland 21228, USA
| | - James M. Gold
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center. PO Box 21247, Baltimore, Maryland 21228, USA
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36
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Keller WR, Fischer BA, McMahon RP, Meyer W, Buchanan RW. Open-label salsalate for the treatment of pre-diabetes in people with schizophrenia. Schizophr Res 2013; 147:408-9. [PMID: 23680037 DOI: 10.1016/j.schres.2013.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 04/09/2013] [Accepted: 04/11/2013] [Indexed: 01/04/2023]
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Fischer BA, McMahon RP, Meyer WA, Slack DJ, Appelbaum PS, Carpenter WT. Participants with schizophrenia retain the information necessary for informed consent during clinical trials. J Clin Psychiatry 2013; 74:622-7. [PMID: 23842013 PMCID: PMC4482016 DOI: 10.4088/jcp.12m07997] [Citation(s) in RCA: 6] [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: 07/03/2012] [Accepted: 10/16/2012] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Cognitive impairment is a characteristic of schizophrenia. This impairment may affect the retention of information required for ongoing knowledgeable participation in clinical trials. This study monitored retention of study-related knowledge-including assessment of therapeutic misconception-in people with stable, DSM-IV schizophrenia during participation in placebo-controlled clinical trials of adjunctive agents. Stability was defined as being on an antipsychotic with no change in medication or dose over the previous 4 weeks. METHOD This longitudinal study assessed retention of clinical trial-related consent information. Individuals enrolling in 1 of 8 clinical trials were approached for participation. Participants came from research clinics and community mental health centers. At baseline, clinical trial consent forms were reviewed and study knowledge assessed. Participants were randomized to follow-up assessments at weeks 1, 4, and 8; weeks 4 and 8; or at week 8 only. Clinical trial consent forms were not rereviewed at any follow-up visit. RESULTS Fifty-nine participants were enrolled; analysis included 52 participants with at least 1 follow-up visit. Study knowledge did not decrease meaningfully in any group. Therapeutic misconception was not observed in participants during the study. The group assessed most frequently demonstrated significant improvement over baseline (t44 = 3.43, P = .001). Retention of study knowledge was not related to symptoms but had a weak correlation with cognitive capacity (R = 0.28, P = .07). Performance did not differ between participants from research clinics and those from community mental health centers. CONCLUSIONS Clinically stable people with schizophrenia enrolling in a placebo-controlled adjunctive medication study, once determined to have capacity to consent to a clinical trial, retained appropriate study knowledge for at least 8 weeks. In the absence of a specific reason to suspect a loss of decisional capacity, there appears to be no need to routinely reevaluate participants during this type of clinical trial.
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Affiliation(s)
- Bernard A. Fischer
- Veterans Affairs Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, Maryland, USA,Department of Psychiatry, Maryland Psychiatric Research Center, University Of Maryland School of Medicine, Baltimore, Maryland, USA,Corresponding Author Address: Bernard A. Fischer, M.D., Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore, MD 21228, , phone: 410.402.7113, fax: 410.402.7198
| | - Robert P. McMahon
- Department of Psychiatry, Maryland Psychiatric Research Center, University Of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Walter A. Meyer
- Department of Psychiatry, Maryland Psychiatric Research Center, University Of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Daniel J. Slack
- The Shriver Center, University of Maryland Baltimore County, Baltimore, Maryland, U.S.A
| | - Paul S. Appelbaum
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - William T. Carpenter
- Veterans Affairs Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, Maryland, USA,Department of Psychiatry, Maryland Psychiatric Research Center, University Of Maryland School of Medicine, Baltimore, Maryland, USA
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Lee MR, Wehring HJ, McMahon RP, Linthicum J, Cascella N, Liu F, Bellack A, Buchanan RW, Strauss GP, Contoreggi C, Kelly DL. Effects of adjunctive intranasal oxytocin on olfactory identification and clinical symptoms in schizophrenia: results from a randomized double blind placebo controlled pilot study. Schizophr Res 2013; 145:110-5. [PMID: 23415472 PMCID: PMC4125132 DOI: 10.1016/j.schres.2013.01.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [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: 10/24/2012] [Revised: 12/21/2012] [Accepted: 01/03/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Deficits in olfactory identification have been widely reported in patients with schizophrenia (SZ) and are associated with negative symptomatology. Adjunctive oxytocin delivered intranasally has been shown to improve some aspects of social cognition as well as positive and negative symptoms in patients with schizophrenia. Given the intranasal delivery route of oxytocin to olfactory pathways and that olfactory abnormalities are a potential endophenotype in SZ, we investigated the effect of intranasal oxytocin on olfactory identification as well as positive and negative symptoms in people with schizophrenia. METHODS Individuals with schizophrenia or schizoaffective disorder (n=28; 16 outpatients, 12 inpatients) were randomized to receive adjunctive intranasal oxytocin 20 IU BID or placebo for 3 weeks. RESULTS All 28 participants completed the clinical trial. Odor identification performance significantly improved on the University of Pennsylvania Smell Identification Test (UPSIT) total score and subscore for pleasant smells. UPSIT score (F=5.20, df=1,23, p=0.032) and subscore for pleasant smells (F=4.56, df=1,23, p=0.044), in patients treated with oxytocin were compared to placebo from baseline to endpoint. Global symptomatology as well as positive and negative symptoms were not improved by intranasal oxytocin. In fact, global symptoms, not positive or negative symptoms, improved in the placebo group. Secondary analysis shows that intranasal oxytocin improved negative symptoms in the small group of inpatients. Intranasal oxytocin was well tolerated during the three week trial. CONCLUSION Adjunctive intranasal oxytocin may improve olfactory identification, particularly in items of positive valence. Larger studies are needed to determine the effects of oxytocin on negative symptoms in SZ. (NCT00884897; http://www.clinicaltrials.gov).
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Affiliation(s)
- Mary R Lee
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD 21224, USA.
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Waltz JA, Kasanova Z, Ross TJ, Salmeron BJ, McMahon RP, Gold JM, Stein EA. The roles of reward, default, and executive control networks in set-shifting impairments in schizophrenia. PLoS One 2013; 8:e57257. [PMID: 23468948 PMCID: PMC3584128 DOI: 10.1371/journal.pone.0057257] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 01/21/2013] [Indexed: 11/19/2022] Open
Abstract
Patients with schizophrenia (SZ) show deficits on tasks of rapid reinforcement learning, like probabilistic reversal learning (PRL), but the neural bases for those impairments are not known. Recent evidence of relatively intact sensitivity to negative outcomes in the ventral striatum (VS) in many SZ patients suggests that PRL deficits may be largely attributable to processes downstream from feedback processing, involving both the activation of executive control task regions and deactivation of default mode network (DMN) components. We analyzed data from 29 chronic SZ patients and 21 matched normal controls (NCs) performing a PRL task in an MRI scanner. Subjects were presented with eight pairs of fractal stimuli, for 50 trials each. For each pair, subjects learned to choose the more frequently-rewarded (better) stimulus. Each time a criterion was reached, the better stimulus became the worse one, and the worse became the better. Responses to feedback events were assessed through whole-brain and regions-of-interest (ROI) analyses in DMN. We also assessed correlations between BOLD signal contrasts and clinical measures in SZs. Relative to NCs, SZ patients showed comparable deactivation of VS in response to negative feedback, but reduced deactivation of DMN components including medial prefrontal cortex (mPFC). The magnitudes of patients' punishment-evoked deactivations in VS and ventromedial PFC correlated significantly with clinical ratings for avolition/anhedonia. These findings suggest that schizophrenia is associated with a reduced ability to deactivate components of default mode networks, following the presentation of informative feedback and that motivational deficits in SZ relate closely to feedback-evoked activity in reward circuit components. These results also confirm a role for ventrolateral and dorsomedial PFC in the execution of response-set shifts.
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Affiliation(s)
- James A Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
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Boggs DL, Kelly DL, Liu F, Linthicum JA, Turner H, Schroeder JR, McMahon RP, Gorelick DA. Cannabis withdrawal in chronic cannabis users with schizophrenia. J Psychiatr Res 2013; 47:240-5. [PMID: 23146560 PMCID: PMC3591813 DOI: 10.1016/j.jpsychires.2012.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 04/18/2012] [Revised: 09/12/2012] [Accepted: 10/17/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chronic users of cannabis often report withdrawal symptoms after abstinence from use, but little is known about cannabis withdrawal in people with schizophrenia. METHODS Cannabis use patterns and withdrawal symptoms in adults with schizophrenia who had at least weekly cannabis use before attempting to quit without formal treatment were assessed with the Marijuana Quit Questionnaire (MJQQ), a 176-item, semi-structured questionnaire. RESULTS 120 participants, predominantly African-American (62.5%) and male (76.7%), met inclusion criteria. 20.1% reported that their first regular cannabis use (median age 15 years [range 8-48]) preceded their age at first psychotic symptoms (20 [4-50] years). Twenty (16.7%) participants met lifetime criteria for cannabis abuse; 98 (81.7%) met surrogate criteria for lifetime cannabis dependence. Withdrawal symptoms were reported by 113 (94.2%) participants, with 74.2% reporting ≥4 symptoms. The most frequently reported withdrawal symptoms were craving for cannabis (59.2%), feeling anxious (52.57%), feeling bored (47.5%), feeling sad or depressed (45.8%), feeling irritable or jumpy (45.0%), feeling restless (43.3%), and trouble failing asleep (33.3%). One hundred-and-four (92.0%) participants took some action to relieve at least one of their withdrawal symptoms during their index-quit attempt, including 26 (23.0%) participants who reported resuming cannabis use. CONCLUSION Cannabis withdrawal is a clinically significant feature of cannabis use among people with schizophrenia, may serve as a negative reinforcer for relapse, and deserves greater attention in treatment and research. Clinical Trials registration NCT00679016.
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Affiliation(s)
- Douglas L. Boggs
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Deanna L. Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Fang Liu
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jared A. Linthicum
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hailey Turner
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jennifer R. Schroeder
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Robert P. McMahon
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David A. Gorelick
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA,Corresponding author. Chemistry and Drug Metabolism Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Boulevard, suite 200, Baltimore, MD 21224 USA. Tel.: +1 443 740 2526; fax: +1 443 740 2823. (D.A. Gorelick)
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Gorelick DA, Goodwin RS, Schwilke E, Schwope DM, Darwin WD, Kelly DL, McMahon RP, Liu F, Ortemann-Renon C, Bonnet D, Huestis MA. Tolerance to effects of high-dose oral δ9-tetrahydrocannabinol and plasma cannabinoid concentrations in male daily cannabis smokers. J Anal Toxicol 2012; 37:11-6. [PMID: 23074216 DOI: 10.1093/jat/bks081] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Oral cannabinoids are taken for medicinal or recreational purposes, yet little is known about tolerance to their effects after high-dose extended exposure. The development of tolerance to effects of around-the-clock oral synthetic Δ9-tetrahydrocannabinol (THC) (20 mg every 3.5-6 h) was evaluated in 13 healthy male daily cannabis smokers residing on a secure research unit: 40 mg on Day 1; 100 mg on Days 2-4; 120 mg on Days 5-6. Systolic and diastolic blood pressure (BP), heart rate, and symptoms of subjective intoxication (100 mm visual-analogue scales, VAS) were assessed the morning of Day 1 (before any oral THC), and on Days 2, 4 and 6, every 30 min for 3 h after the first morning THC dose. Morning subjective intoxication ratings increased from Days 1 to 2, and then declined on Days 4 and 6. The morning THC dose increased intoxication ratings on Day 2, but had less effect on Days 4 and 6, a pattern consistent with tolerance. THC lowered BP and increased heart rate over the six days. Plasma THC and 11-OH-THC concentrations increased significantly over the first five days of dosing. Six days of around-the-clock, oral THC produced tolerance to subjective intoxication, but not to cardiovascular effects.
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Affiliation(s)
- David A Gorelick
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
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Mackowick KM, Heishman SJ, Wehring HJ, Liu F, McMahon RP, Kelly DL. Illicit drug use in heavy smokers with and without schizophrenia. Schizophr Res 2012; 139:194-200. [PMID: 22591779 PMCID: PMC3393777 DOI: 10.1016/j.schres.2012.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 01/31/2012] [Revised: 04/16/2012] [Accepted: 04/20/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The prevalence of cigarette smoking among people with schizophrenia is greater than that of the general population. Because smoking and use of other drugs covary, we examined illicit drug use in current smokers not trying to quit or reduce their tobacco use. We recruited outpatient participants who had a DSM-IV diagnosis of schizophrenia or schizoaffective disorder (schizophrenia, n=70) and a control group who had no Axis I psychiatric disorders (control, n=97). During a 2-3-hour session, participants completed demographic and research questionnaires, including the Drug Use Survey (DUS). RESULTS Participants with schizophrenia were older than controls (p<0.001) and smoked more cigarettes per day (p=0.01), but did not differ in degree of nicotine dependence. Ever using a drug was similar between the groups, except that significantly more participants with schizophrenia reported ever using hallucinogens (p<0.001) and inhalants (p=0.001). For alcohol, cocaine, and marijuana, fewer participants with schizophrenia were current users, but more participants with schizophrenia were past users (ps<0.0001). Heavy smokers from the general population continued to use illicit drugs throughout their lives, while schizophrenia participants had the highest period of illicit drug use in their 20s. CONCLUSIONS These data suggest that illicit drug use tends to be high in heavy cigarette smokers, regardless of a schizophrenia diagnosis. However, while illicit drug use is high across the lifespan of heavy smokers in the general population, heavy smokers with schizophrenia use illicit drugs mostly in the first decade of their illness.
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Affiliation(s)
- Kristen M Mackowick
- Nicotine Psychopharmacology Section, Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Boulevard, Baltimore, MD 21224, USA.
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Abrams MT, Myers CS, Feldman SM, Boddie-Willis C, Park J, McMahon RP, Kelly DL. Cervical cancer screening and acute care visits among Medicaid enrollees with mental and substance use disorders. Psychiatr Serv 2012; 63:815-22. [PMID: 22660581 PMCID: PMC3631005 DOI: 10.1176/appi.ps.201100301] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study compared rates of cervical cancer screening and acute care (primary or gynecological) visits among women with and without a diagnosis of psychosis, substance use disorder, bipolar disorder or mania, or depression. METHODS Using data about women (N=105,681) enrolled in Maryland's Medicaid program in fiscal year 2005, the authors constructed logistic models with cancer screening and acute care visits as dependent variables and serious mental illness flags as independent variables. Covariates were age, race, geography, Medicaid eligibility category, and sexually transmitted diseases. The logistic model of cervical cancer screening outcomes was repeated with acute care visits as a covariate. RESULTS Women with psychosis (N=4,747), bipolar disorder or mania (N=3,319), or depression (N=5,014) were significantly (p<.05) more likely than women in a control group without such disorders (N=85,375) to receive cancer screening (adjusted odds ratio (AOR) range=1.46-1.78) and to have associated acute care visits (AOR range=1.45-2.15). Compared with those in the control group, women with a substance use disorder, with (N=1,104) or without (N=6,122) psychosis, demonstrated reduced odds of cancer screening (AOR=.80) but similar odds of acute care visits (AOR=1.04). Acute care visits were strongly correlated with cancer screens. Genital cancer prevalence did not significantly differ among diagnostic groups. CONCLUSIONS In Maryland Medicaid, the odds of cancer screening and related acute care visits were greater for women with major mental disorders compared with women in the control group. For women with substance use disorders, however, screening was reduced and acute care visits were similar compared with women in the control group. Providers should encourage and support their patients with substance use disorders to increase use of preventive care services by primary care physicians and gynecologists.
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Affiliation(s)
- Michael T Abrams
- The Hilltop Institute, University of Maryland, Baltimore County, 1000 Hilltop Circle, Sondheim Bldg., Third Floor, Baltimore, MD 21250, USA.
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Wehring HJ, Liu F, McMahon RP, Mackowick KM, Love RC, Dixon L, Kelly DL. Clinical characteristics of heavy and non-heavy smokers with schizophrenia. Schizophr Res 2012; 138:285-9. [PMID: 22578720 PMCID: PMC4062915 DOI: 10.1016/j.schres.2012.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 03/16/2012] [Accepted: 03/21/2012] [Indexed: 01/09/2023]
Abstract
Up to 50-90% of persons with schizophrenia smoke cigarettes. Limited data and theories suggest persons with schizophrenia may smoke for different reasons than persons without schizophrenia, making smoking cessation interventions particularly challenging in this population. Although health consequences of smoking are widely known, less information is available regarding characteristics of different amounts of smoking exposure in this population. This study was performed to investigate differences between heavy (≥ 1 pack per day) and non-heavy (<1 pack per day) smoking in patients with schizophrenia. Data from 745 patients, mean age 41.3+/-12.6 years, were drawn from a population of smokers admitted to State of Maryland inpatient mental health facilities (1994-2000). Records were reviewed to obtain demographic information, diagnosis, medication, smoking and substance use. 43% of patients were characterized as heavy smokers. Heavy and non-heavy groups did not differ in age, GAF, weight, or BMI. No differences were found in race, gender or antipsychotic treatments. However, patients smoking ≥ 1 packs per day were more likely to use other substances such as alcohol (χ(2)=6.67, df=1, p=0.01), cocaine (χ(2)=6.66, df=1, p=0.01), and other substances (χ(2)=9.95, df=1, p=0.003) compared to non-heavy smokers. No differences in cannabis or heroin use were found by smoking category. Controlling for age, race, sex and BMI, heavy smokers had higher total cholesterol (190.7(51.6)mg/dL) compared to non-heavy smokers (178.2 (43.0)mg/dL, p=0.03), but no differences were found in glucose or blood pressure. Heavy smoking may be a particular health risk in schizophrenia and significant efforts for smoking cessation or reduction are needed.
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Affiliation(s)
- Heidi J. Wehring
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Fang Liu
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Robert P. McMahon
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Kristen M. Mackowick
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Raymond C. Love
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD
| | - Lisa Dixon
- Division of Services Research, University of Maryland School of Medicine, Baltimore, MD
| | - Deanna L. Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
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Kelly DL, Raley HG, Lo S, Wright K, Liu F, McMahon RP, Moolchan ET, Feldman S, Richardson CM, Wehring HJ, Heishman SJ. Perception of smoking risks and motivation to quit among nontreatment-seeking smokers with and without schizophrenia. Schizophr Bull 2012; 38:543-51. [PMID: 21041835 PMCID: PMC3330003 DOI: 10.1093/schbul/sbq124] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We examined perceived consequences/benefits of cigarette smoking and motivation for quitting in nontreatment-seeking smokers who had schizophrenia or schizoaffective disorder (N = 100) or had no Axis I psychiatric disorder (normals, N = 100). METHODS Participants completed questionnaires and provided a breath carbon monoxide (CO) sample 10-15 minutes after smoking 1 preferred-brand cigarette. Primary assessments included the Smoking Consequences Questionnaire-Adult, the Reasons for Quitting Scale, and the Stages of Change. RESULTS There were no differences between the schizophrenia and control group in mean age of smoking onset (16.2 ± 5.4 vs 15.6 ± 5.5 y, P = .44), number of cigarettes daily (17.9 ± 11.6 vs 17.0 ± 7.9, P = 0.51), or in breath CO (28.0 ± 14.5 vs 22.9 ± 8.0 ppm, P = .61). Compared with normals, people with schizophrenia report greater stimulation/state enhancement (P < .0001) and social facilitation (P < .004) from smoking. People with schizophrenia had less appreciation of health risks associated with smoking than normal controls (P < .0001) and were less motivated to quit smoking than normal controls (P = .002), even though they were as likely to be in the preparation stage of change. Immediate reinforcement (P = .04) and health concerns (P = .002) were rated lower as motivators for considering quitting smoking in schizophrenia than normals. People with schizophrenia reported greater motivation to stop smoking due to social pressure/rewards than normals (P = .047). CONCLUSIONS This study underscores the degree to which people with schizophrenia perceive the state-enhancing effects of smoking and their lower appreciation for health risks of smoking compared with normal controls.
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Affiliation(s)
- Deanna L. Kelly
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228,To whom correspondence should be addressed; tel: 410-402-6860, fax: 410-402-6038, e-mail:
| | - Heather G. Raley
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Suzanne Lo
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
| | - Katherine Wright
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Fang Liu
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Robert P. McMahon
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | | | - Stephanie Feldman
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Charles M. Richardson
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Heidi J. Wehring
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Stephen J. Heishman
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
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Fischer BA, Keller WR, Arango C, Pearlson G, McMahon RP, Meyer WA, Francis A, Kirkpatrick B, Carpenter WT, Buchanan RW. Cortical structural abnormalities in deficit versus nondeficit schizophrenia. Schizophr Res 2012; 136:51-4. [PMID: 22336954 PMCID: PMC3298625 DOI: 10.1016/j.schres.2012.01.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 01/23/2012] [Accepted: 01/25/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the structural integrity of the dorsolateral prefrontal-basal ganglia-thalamocortical circuit in people with the deficit form of schizophrenia. METHOD A three-dimensional structural MRI sequence was used to conduct morphometric assessments of cortical and subcortical regions in deficit and nondeficit outpatients with schizophrenia and healthy controls. RESULTS The superior prefrontal and superior and middle temporal gyral gray matter volumes were significantly smaller in the deficit versus the nondeficit group and normal control groups. There were no significant group differences in examined subcortical structures. CONCLUSION People with deficit schizophrenia are characterized by selective reductions in the prefrontal and temporal cortex.
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Affiliation(s)
- Bernard A. Fischer
- Veterans Affairs Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, Maryland, USA.,Maryland Psychiatric Research Center, University Of Maryland School of Medicine, Baltimore, Maryland, USA
| | - William R. Keller
- Maryland Psychiatric Research Center, University Of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Celso Arango
- Departmento de Psiquiatria, Hospital General Universitario Gregorio Marañón, CIBERSAM, Madrid, Spain
| | - Godfrey Pearlson
- Department of Psychiatry, Yale University, New Haven, Connecticut, USA
| | - Robert P. McMahon
- Maryland Psychiatric Research Center, University Of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Walter A. Meyer
- Maryland Psychiatric Research Center, University Of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alan Francis
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center-College of Medicine, Temple, Texas, USA
| | - William T. Carpenter
- Veterans Affairs Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, Maryland, USA.,Maryland Psychiatric Research Center, University Of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robert W. Buchanan
- Maryland Psychiatric Research Center, University Of Maryland School of Medicine, Baltimore, Maryland, USA.,Corresponding Author Address: Robert W. Buchanan, M.D., Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore, MD 21228, , phone: 410.402.7876, fax: 410.402.7198
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Javitt DC, Buchanan RW, Keefe RSE, Kern R, McMahon RP, Green MF, Lieberman J, Goff DC, Csernansky JG, McEvoy JP, Jarskog F, Seidman LJ, Gold JM, Kimhy D, Nolan KS, Barch DS, Ball MP, Robinson J, Marder SR. Effect of the neuroprotective peptide davunetide (AL-108) on cognition and functional capacity in schizophrenia. Schizophr Res 2012; 136:25-31. [PMID: 22169248 DOI: 10.1016/j.schres.2011.11.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [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: 08/15/2011] [Revised: 10/31/2011] [Accepted: 11/03/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cognitive dysfunction is a key predictor of functional disability in schizophrenia. Davunetide (AL-108, NAP) is an intranasally administered peptide currently being developed for treatment of Alzheimer's disease and related disorders. This study investigates effects of davunetide on cognition in schizophrenia. METHOD Sixty-three subjects with schizophrenia received davunetide at one of two different doses (5, 30 mg) or placebo for 12 weeks in a multicenter, double-blind, parallel-group randomized clinical trial. The MATRICS Consensus Cognitive Battery (MCCB) assessed cognitive effects. The UCSD Performance-based Skills Assessment (UPSA) and the Schizophrenia Cognition Rating Scale (SCoRS) assessed functional capacity. Subjects continued their current antipsychotic treatment during the trial. RESULTS There were no significant differences in MCCB change between davunetide and placebo over the three treatment arms (p=.45). Estimated effect-size (d) values were .34 and .21 favoring the 5 and 30 mg doses vs. placebo, respectively. For UPSA, there was a significant main effect of treatment across study arms (p=.048). Between-group effect size (d) values were.74 and .48, favoring the 5 and 30 mg doses, respectively. No significant effects were observed on the SCoRS or on symptom ratings. No significant side effects or adverse events were observed. CONCLUSION Davunetide was well tolerated. Effects of davunetide on MCCB-rated cognition were not significant relative to placebo. In contrast, a significant beneficial effect was detected for the UPSA. Based upon effect-size considerations, sample sizes of at least 45-50 subjects/group would be required to obtain significant effects on both MCCB and UPSA, providing guidance for continued clinical development in schizophrenia.
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Affiliation(s)
- Daniel C Javitt
- Nathan Kline Institute for Psychiatry Research, Orangeburg, NY, United States.
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Boggs DL, Kelly DL, McMahon RP, Gold JM, Gorelick DA, Linthicum J, Conley RR, Liu F, Waltz J, Huestis MA, Buchanan RW. Rimonabant for neurocognition in schizophrenia: a 16-week double blind randomized placebo controlled trial. Schizophr Res 2012; 134:207-10. [PMID: 22137462 PMCID: PMC3268840 DOI: 10.1016/j.schres.2011.11.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 11/07/2011] [Accepted: 11/09/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the effect of rimonabant on neurocognitive impairments in people with schizophrenia. METHODS Participants entered a 16-week double-blind, placebo-controlled, randomized clinical trial. A neurocognitive battery was administered at baseline and end of study. RESULTS In comparison to rimonabant (20mg/day), placebo-treated participants exhibited a significant improvement on the Repeatable Battery for the Assessment of Neuropsychological Status total score. In contrast, rimonabant was associated with significant improvement on a probabilistic learning task. There were no other significant treatment effects. CONCLUSIONS Rimonabant did not improve global cognitive functioning, but did improve a specific learning deficit based on response to positive feedback.
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Affiliation(s)
| | - Deanna L. Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert P. McMahon
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James M. Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David A. Gorelick
- Chemistry and Drug Metabolism Section, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD
| | - Jared Linthicum
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Fang Liu
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James Waltz
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marilyn A. Huestis
- Chemistry and Drug Metabolism Section, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD
| | - Robert W. Buchanan
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
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August SM, Kiwanuka JN, McMahon RP, Gold JM. The MATRICS Consensus Cognitive Battery (MCCB): clinical and cognitive correlates. Schizophr Res 2012; 134:76-82. [PMID: 22093182 PMCID: PMC3245793 DOI: 10.1016/j.schres.2011.10.015] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [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: 07/13/2011] [Revised: 10/21/2011] [Accepted: 10/25/2011] [Indexed: 10/15/2022]
Abstract
The purpose of this study was to examine the cognitive and clinical correlates of the MATRICS Consensus Cognitive Battery (MCCB) which was originally developed to be an endpoint for cognitive enhancement clinical trials. In a sample of 117 people with schizophrenia and 77 healthy control participants we found the following: a) the MCCB was highly sensitive to the type and level of impairment typically observed in schizophrenia, b) the MCCB composite score was highly correlated with WASI Estimated Full Scale IQ score, c) that the MCCB domain scores were generally moderately-highly intercorrelated, d) that MCCB performance was minimally related to clinical symptom type and severity, and e) the MCCB is sensitive to employment status with better performance in employed vs. unemployed patients. These data support the validity of the MCCB as a sensitive measure of cognitive impairment in schizophrenia and suggest that MCCB performance is relevant for functional outcome. The data also suggest that the MCCB domain scores may offer limited resolution on discrete cognitive functions.
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Affiliation(s)
| | | | | | - James M. Gold
- Correspondence concerning this article should be addressed to James M. Gold, Ph.D., . Phone: +1-410-402-7871. Fax: +1-410-402-7198. University of Maryland School of Medicine, Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore, MD, 21228 USA
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Weiner E, Ball MP, Buchholz AS, Gold JM, Evins AE, McMahon RP, Buchanan RW. Bupropion sustained release added to group support for smoking cessation in schizophrenia: a new randomized trial and a meta-analysis. J Clin Psychiatry 2012; 73:95-102. [PMID: 21535998 DOI: 10.4088/jcp.10m06143gre] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [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: 03/28/2010] [Accepted: 08/03/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To clarify the efficacy and tolerability of bupropion sustained release (SR) for the treatment of cigarette smoking in people with schizophrenia. METHOD The first study is a double-blind, placebo-controlled clinical trial with 32 outpatients from the Maryland Psychiatric Research Center. From May 2003 to July 2007, clinically stable people with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder who smoked at least 10 cigarettes per day and who were interested in quitting smoking or cutting down were recruited for participation. All participated in a 9-week support group and were randomly assigned to receive 12 weeks of bupropion SR or placebo. The primary outcome measure was 4 weeks' sustained abstinence over the last 4 study weeks. Secondary outcome measures included decrease in smoking behavior and change in symptoms, neuropsychological performance, and side effects. In the second study, we performed an electronic literature search of MEDLINE in September 2008. Articles in English published between 2003 and 2008 were searched for the terms schizophrenia, bupropion SR, and smoking. Bibliographies of studies identified through the MEDLINE search were also examined. Case reports, open-label studies, crossover studies, and studies using nonstandard dosing of bupropion SR were excluded. In this way, 4 studies similar in methodology to the currently presented clinical trial were identified and the individual data combined in a meta-analysis. A random effects meta-analysis using Comprehensive Meta-Analysis software was used to obtain a pooled estimate of the odds ratio for 4-week smoking abstinence between bupropion SR and placebo. RESULTS There were no significant results on the primary or secondary smoking measures for the clinical trial, although a numeric advantage favored the bupropion SR group. There were no significant findings for secondary symptom or side effect measures and no significant change in neuropsychological performance. For the meta-analysis totaling 226 subjects, there were significant findings in favor of bupropion SR. The pooled estimate of the odds ratio for 4-week abstinence was 2.7 (95% CI, 1.3 to 5.7; P = .009), and clinically significant greater smoking reduction in the bupropion SR group, with pooled difference estimates increasing over time between groups, became statistically significant by week 5 of study medication (P < .02). CONCLUSIONS New clinical trial data and a meta-analysis strongly support the tolerability and efficacy of bupropion SR for the treatment of cigarette smoking in people with schizophrenia TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00176449.
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Affiliation(s)
- Elaine Weiner
- The Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA.
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