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Santoro V, Hou MD, Premoli I, Belardinelli P, Biondi A, Carobin A, Puledda F, Michalopoulou PG, Richardson MP, Rocchi L, Shergill SS. Investigating cortical excitability and inhibition in patients with schizophrenia: A TMS-EEG study. Brain Res Bull 2024; 212:110972. [PMID: 38710310 DOI: 10.1016/j.brainresbull.2024.110972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/24/2024] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) combined with electromyography (EMG) has widely been used as a non-invasive brain stimulation tool to assess excitation/inhibition (E/I) balance. E/I imbalance is a putative mechanism underlying symptoms in patients with schizophrenia. Combined TMS-electroencephalography (TMS-EEG) provides a detailed examination of cortical excitability to assess the pathophysiology of schizophrenia. This study aimed to investigate differences in TMS-evoked potentials (TEPs), TMS-related spectral perturbations (TRSP) and intertrial coherence (ITC) between patients with schizophrenia and healthy controls. MATERIALS AND METHODS TMS was applied over the motor cortex during EEG recording. Differences in TEPs, TRSP and ITC between the patient and healthy subjects were analysed for all electrodes at each time point, by applying multiple independent sample t-tests with a cluster-based permutation analysis to correct for multiple comparisons. RESULTS Patients demonstrated significantly reduced amplitudes of early and late TEP components compared to healthy controls. Patients also showed a significant reduction of early delta (50-160 ms) and theta TRSP (30-250ms),followed by a reduction in alpha and beta suppression (220-560 ms; 190-420 ms). Patients showed a reduction of both early (50-110 ms) gamma increase and later (180-230 ms) gamma suppression. Finally, the ITC was significantly lower in patients in the alpha band, from 30 to 260 ms. CONCLUSION Our findings support the putative role of impaired GABA-receptor mediated inhibition in schizophrenia impacting excitatory neurotransmission. Further studies can usefully elucidate mechanisms underlying specific symptoms clusters using TMS-EEG biometrics.
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Affiliation(s)
- V Santoro
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom; Headache Group, Wolfson SPaRC, Institute of Psychiatry Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom.
| | - M D Hou
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - I Premoli
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - P Belardinelli
- Cimec, Center for Mind/Brain Sciences, University of Trento, Trento, Italy
| | - A Biondi
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - A Carobin
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - F Puledda
- Headache Group, Wolfson SPaRC, Institute of Psychiatry Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - P G Michalopoulou
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - M P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - L Rocchi
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - S S Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom; Kent and Medway Medical School, Canterbury CT2 7FS, United Kingdom; Kent and Medway NHS and Social Care Partnership Trust, Maidstone, ME7 4JL, United Kingdom
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Dima A, Abdelsamie A, Clark-Castillo R, Webb-Wilson H, Shergill SS, Stanton B, Gaughran F, Whiskey E, Nettis MA. Overcoming Obstacles to Clozapine Treatment: A Case of Clozapine Rechallenge in ECT-Resistant Schizophrenia With Catatonic Features. J Clin Psychopharmacol 2024; 44:182-185. [PMID: 38315142 DOI: 10.1097/jcp.0000000000001819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
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Tracy DK, Albertson DN, Cordoba EL, Shergill SS. Kaleidoscope. Br J Psychiatry 2023; 222:224-225. [PMID: 37066851 DOI: 10.1192/bjp.2023.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
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Tracy DK, Albertson DN, Lloyd L, Shergill SS. Kaleidoscope. Br J Psychiatry 2023; 222:182-183. [PMID: 36934767 DOI: 10.1192/bjp.2023.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
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Tracy DK, Albertson DN, Sri A, Shergill SS. Kaleidoscope. Br J Psychiatry 2023; 222:146-147. [PMID: 36786538 DOI: 10.1192/bjp.2023.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2023; 222:93-94. [PMID: 36715124 DOI: 10.1192/bjp.2022.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Mannan FA, Porffy LA, Joyce DW, Shergill SS, Celiktutan O. Automatic Detection of Cognitive Impairment with Virtual Reality. Sensors (Basel) 2023; 23:s23021026. [PMID: 36679823 PMCID: PMC9864638 DOI: 10.3390/s23021026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 05/14/2023]
Abstract
Cognitive impairment features in neuropsychiatric conditions and when undiagnosed can have a severe impact on the affected individual's safety and ability to perform daily tasks. Virtual Reality (VR) systems are increasingly being explored for the recognition, diagnosis and treatment of cognitive impairment. In this paper, we describe novel VR-derived measures of cognitive performance and show their correspondence with clinically-validated cognitive performance measures. We use an immersive VR environment called VStore where participants complete a simulated supermarket shopping task. People with psychosis (k=26) and non-patient controls (k=128) participated in the study, spanning ages 20-79 years. The individuals were split into two cohorts, a homogeneous non-patient cohort (k=99 non-patient participants) and a heterogeneous cohort (k=26 patients, k=29 non-patient participants). Participants' spatio-temporal behaviour in VStore is used to extract four features, namely, route optimality score, proportional distance score, execution error score, and hesitation score using the Traveling Salesman Problem and explore-exploit decision mathematics. These extracted features are mapped to seven validated cognitive performance scores, via linear regression models. The most statistically important feature is found to be the hesitation score. When combined with the remaining extracted features, the multiple linear regression model resulted in statistically significant results with R2 = 0.369, F-Stat = 7.158, p(F-Stat) = 0.000128.
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Affiliation(s)
- Farzana A. Mannan
- Department of Engineering, King’s College London, London WC2R 2LS, UK
- Correspondence: (F.A.M.); (O.C.)
| | - Lilla A. Porffy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Dan W. Joyce
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Sukhwinder S. Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- Kent and Medway Medical School, Canterbury CT2 7NZ, UK
| | - Oya Celiktutan
- Department of Engineering, King’s College London, London WC2R 2LS, UK
- Correspondence: (F.A.M.); (O.C.)
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2022; 221:771-772. [PMID: 36403631 DOI: 10.1192/bjp.2022.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2022; 221:651-652. [PMID: 36154941 DOI: 10.1192/bjp.2022.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2022. [PMID: 35988918 DOI: 10.1192/bjp.2022.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2022. [PMID: 35848385 DOI: 10.1192/bjp.2022.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2022. [PMID: 35718353 DOI: 10.1192/bjp.2022.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2022. [PMID: 35599581 DOI: 10.1192/bjp.2022.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Horne CM, Sahni A, Pang SW, Vanes LD, Szentgyorgyi T, Averbeck B, Moran RJ, Shergill SS. The role of cognitive control in the positive symptoms of psychosis. Neuroimage Clin 2022; 34:103004. [PMID: 35468567 PMCID: PMC9059151 DOI: 10.1016/j.nicl.2022.103004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/26/2022]
Abstract
Mechanisms underlying positive symptoms in psychosis are unclear. Differential fMRI activity present in left amygdala, pallidum and thalamus in high positive symptom patients compared to low. Lower activity in SMA/pre-SMA also present in high symptom patients. We suggest poor integration of social-emotional information with reward feedback. Results may be important for guiding treatment strategies to prevent chronic illness.
Background Positive symptoms of psychosis (e.g., hallucinations) often limit everyday functioning and can persist despite adequate antipsychotic treatment. We investigated whether poor cognitive control is a mechanism underlying these symptoms. Methods 97 patients with early psychosis (30 with high positive symptoms (HS) and 67 with low positive symptoms (LS)) and 40 healthy controls (HC) underwent fMRI whilst performing a reward learning task with two conditions; low cognitive demand (choosing between neutral faces) and high cognitive demand (choosing between angry and happy faces – shown to induce an emotional bias). Decision and feedback phases were examined. Results Both patient groups showed suboptimal learning behaviour compared to HC and altered activity within a core reward network including occipital/lingual gyrus (decision), rostral Anterior Cingulate Cortex, left pre-central gyrus and Supplementary Motor Cortex (feedback). In the low cognitive demand condition, HS group showed significantly reduced activity in Supplementary Motor Area (SMA)/pre-SMA during the decision phase whilst activity was increased in LS group compared to HC. Recruitment of this region suggests a top-down compensatory mechanism important for control of positive symptoms. With additional cognitive demand (emotional vs. neutral contrast), HS patients showed further alterations within a subcortical network (increased left amygdala activity during decisions and reduced left pallidum and thalamus activity during feedback) compared to LS patients. Conclusions The findings suggest a core reward system deficit may be present in both patient groups, but persistent positive symptoms are associated with a specific dysfunction within a network needed to integrate social-emotional information with reward feedback.
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Affiliation(s)
- Charlotte M Horne
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Angad Sahni
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Sze W Pang
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Lucy D Vanes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Timea Szentgyorgyi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Bruno Averbeck
- Laboratory of Neuropsychology, National Institute for Mental Health, Bethesda, BETHESDA, MD 20814, USA
| | - Rosalyn J Moran
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Sukhwinder S Shergill
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK; Kent and Medway Medical School, Cantebury Christ Church University and University of Kent, Kent CT2 7FS, UK
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Tracy DK, Hanson K, Underwood BR, Shergill SS. Why care about integrated care? Part 3. Weighing sunlight: delivering integration in practice and measuring success. BJPsych advances 2022. [DOI: 10.1192/bja.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
The first two articles in this series have shown the direction of travel for health and social care in England, and how the status quo in already stressed systems is not viable. It is difficult to disagree with the principles of ‘integrated care’, yet we currently lack evidenced models on which we might build. There is a need for experiential learning and sharing of experiences. This third article describes in more granularity the experiences, positive and negative, of an early-adopting integrating service in south-east London that incorporated aspects of the local authority and secondary care physical and mental health services. It provides structured guidance on which types of integration one might aim for, managing internal and external relationships, and discussion on evaluating progress.
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2022. [PMID: 35354507 DOI: 10.1192/bjp.2022.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2022; 220:167-168. [PMID: 35184765 DOI: 10.1192/bjp.2022.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Das S, Shergill SS. Prevalence of uncorrected refractive errors among adults attending at a tertiary care hospital – A retrospective study. Med J DY Patil Vidyapeeth 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_145_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2022; 220:47-48. [PMID: 35045902 DOI: 10.1192/bjp.2021.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2021; 219:701-702. [PMID: 35048867 DOI: 10.1192/bjp.2021.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2021; 219:624-625. [PMID: 35048826 DOI: 10.1192/bjp.2021.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2021; 219:573-574. [PMID: 35048883 DOI: 10.1192/bjp.2021.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2021; 219:527-528. [PMID: 35048865 DOI: 10.1192/bjp.2021.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Affiliation(s)
- Evangelos Papanastasiou
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,Therapeutic Area CNS, Retinopathies and Emerging Areas, Boehringer Ingelheim International GmbH, Ingelheim, Germany,Evangelos Papanastasiou, Cognition Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Sukhwinder S Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2021; 219:469-470. [PMID: 35048842 DOI: 10.1192/bjp.2021.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Whiskey E, Barnard A, Oloyede E, Dzahini O, Taylor DM, Shergill SS. An evaluation of the variation and underuse of clozapine in the United Kingdom. Acta Psychiatr Scand 2021; 143:339-347. [PMID: 33501659 DOI: 10.1111/acps.13280] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Clozapine is the only licensed treatment for treatment refractory schizophrenia. Despite this, it remains grossly underused relative to the prevalence of refractory schizophrenia. The extent of underuse and the degree of regional variation in prescribing in the United Kingdom is unknown. It is also unclear, how the UK compares with other European countries in rates of clozapine prescribing. METHODS We obtained data relating to all clozapine prescribing in the UK from the relevant clozapine registries. We examined regional variation in clozapine use across England, corrected for the known prevalence of severe mental illness (SMI). We also compared the UK rate of clozapine use per 100,000 population to that described in other European countries. FINDINGS There is substantial variation in clozapine prescribing across different regions of England and only about a third of potentially eligible patients were prescribed the drug in the UK. Clozapine prescribing rate in the UK was lower than in several European countries. INTERPRETATION There is clear regional inequity in access to the most effective treatment in refractory schizophrenia in England. Strategies to increase clozapine use, by overcoming both real and perceived barriers, are urgently necessary to reduce treatment inequity for patients with refractory schizophrenia.
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Affiliation(s)
- Eromona Whiskey
- Pharmacy Department, South London & Maudsley NHS Foundation Trust, London, UK.,Institute of Pharmaceutical Sciences, King's College, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, Kings College, London, UK
| | - Alex Barnard
- Clinical Research Network CRN, National Institute for Health Research NIHR, London, UK
| | - Ebenezer Oloyede
- Pharmacy Department, South London & Maudsley NHS Foundation Trust, London, UK.,Institute of Pharmaceutical Sciences, King's College, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, Kings College, London, UK
| | - Olubanke Dzahini
- Pharmacy Department, South London & Maudsley NHS Foundation Trust, London, UK.,Institute of Pharmaceutical Sciences, King's College, London, UK
| | - David M Taylor
- Pharmacy Department, South London & Maudsley NHS Foundation Trust, London, UK.,Institute of Pharmaceutical Sciences, King's College, London, UK
| | - Sukhwinder S Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, Kings College, London, UK
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2021; 218:235-236. [PMID: 36644828 DOI: 10.1192/bjp.2021.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Horne CM, Vanes LD, Verneuil T, Mouchlianitis E, Szentgyorgyi T, Averbeck B, Leech R, Moran RJ, Shergill SS. Cognitive control network connectivity differentially disrupted in treatment resistant schizophrenia. Neuroimage Clin 2021; 30:102631. [PMID: 33799270 PMCID: PMC8044714 DOI: 10.1016/j.nicl.2021.102631] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 11/04/2022]
Abstract
Mechanisms underlying treatment-resistant schizophrenia are unclear. Effective connectivity within cortico-striatal network differentially disrupted in resistant patients. Resistance associated with lack of top-down control and aberrant glutamate function. We suggest a subtype of schizophrenia with distinct neurobiological mechanism. Results are important for guiding treatment strategies and developing new drugs.
Antipsychotic treatment resistance affects a third of people with schizophrenia and the underlying mechanism remains unclear. We used an fMRI emotion-yoked reward learning task, allied to prefrontal cortical glutamate levels, to explain the role of cognitive control in differentiating treatment-resistant from responsive patients. We investigated how reward learning is disrupted at the network level in 21 medicated treatment-responsive and 20 medicated treatment-resistant patients with schizophrenia compared with 24 healthy controls (HC). Dynamic Causal Modelling assessed how effective connectivity between regions in a cortico-striatal-limbic network is disrupted in each patient group compared to HC. Connectivity was also examined with respect to symptoms, salience and anterior cingulate (ACC) glutamate levels measured from the same region of the ACC. We found that ACC connectivity differentiated these patient groups, with responsive patients exhibiting increased top-down connectivity from ACC to sensory regions and reduced ACC drive to the striatum, while resistant patients showed altered connectivity within the ACC itself. In these resistant patients, the ACC drive to striatum was positively correlated with their symptom severity. ACC glutamate levels were found to correlate with ACC control over sensory regions in responsive patients but not in resistant patients. We suggest a central non-dopaminergic impairment that impacts cognitive control networks in treatment-resistant schizophrenia. This impairment was associated with disrupted reward learning and could be underpinned by aberrant glutamate function. These findings should form the focus of future treatment strategies (e.g. glutamatergic targets and giving clozapine earlier) in resistant patients.
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Affiliation(s)
- Charlotte M Horne
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Lucy D Vanes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
| | - Tess Verneuil
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
| | - Elias Mouchlianitis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
| | - Timea Szentgyorgyi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
| | - Bruno Averbeck
- Laboratory of Neuropsychology, National Institute for Mental Health Bethesda, BETHESDA, MD 20814, USA
| | - Robert Leech
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
| | - Rosalyn J Moran
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
| | - Sukhwinder S Shergill
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
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Joyce DW, Averbeck BB, Frith CD, Shergill SS. Examining belief and confidence in schizophrenia - ADDENDUM. Psychol Med 2021; 51:704. [PMID: 31280731 DOI: 10.1017/s0033291719001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Krivoy A, Whiskey E, Webb-Wilson H, Joyce D, Tracy DK, Gaughran F, MacCabe JH, Shergill SS. Outcomes in treatment-resistant schizophrenia: symptoms, function and clozapine plasma concentrations. Ther Adv Psychopharmacol 2021; 11:20451253211037179. [PMID: 34676067 PMCID: PMC8524694 DOI: 10.1177/20451253211037179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/13/2021] [Accepted: 07/16/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clozapine is the only medication licenced for treating patients with treatment-refractory schizophrenia. However, there are no evidence-based guidelines as to the optimal plasma level of clozapine to aim for, and their association with clinical and functional outcome. OBJECTIVE We assessed the relationship between clinical and functional outcome measures and blood concentrations of clozapine among patients with treatment-refractory psychosis. METHODS Data were reviewed in 82 patients with treatment-refractory psychosis admitted to a specialised tertiary-level service and treated with clozapine. Analysis focussed on the relationship between clozapine and norclozapine plasma concentrations and the patient's clinical symptoms and functional status. RESULTS Clinical symptom improvement was positively correlated with norclozapine plasma concentrations and inversely correlated with clozapine to norclozapine plasma concentrations ratio. Clozapine concentrations showed a bimodal association with clinical improvement (peaks around 350 and 660 ng/ml). Clinical symptom improvement correlated with functional outcomes, although there was no significant correlation between the latter and clozapine or norclozapine plasma concentrations. CONCLUSION Clozapine treatment was associated with optimal clinical improvement at two different peak plasma concentrations around 350 and 650 ng/ml. Clinical improvement was associated with functional outcome; however, functionality was not directly associated with clozapine concentrations. A subset of patients may require higher clozapine plasma concentrations to achieve clinical improvement.
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Affiliation(s)
- Amir Krivoy
- Geha Mental Health Center, Petach-Tikva, Israel
| | - Eromona Whiskey
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Henrietta Webb-Wilson
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Dan Joyce
- National Institute of Health Research Oxford Health Biomedical Research Center and Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Derek K Tracy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fiona Gaughran
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - James H MacCabe
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sukhwinder S Shergill
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
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31
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Tracy DK, Joyce DW, Albertson DN, Shergill SS. Kaleidoscope. Br J Psychiatry 2020; 217:731-732. [PMID: 33250063 DOI: 10.1192/bjp.2020.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Frangou S, Kington J, Raymont V, Shergill SS. Examining ventral and dorsal prefrontal function in bipolar disorder: A functional magnetic resonance imaging study. Eur Psychiatry 2020; 23:300-8. [PMID: 17656073 DOI: 10.1016/j.eurpsy.2007.05.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 05/12/2007] [Accepted: 05/25/2007] [Indexed: 11/20/2022] Open
Abstract
AbstractSeveral lines of research suggest both dorsal and ventral prefrontal cortical dysfunction in bipolar disorder (BD). We used functional magnetic resonance imaging to compare patterns of brain activation in remitted BD patients and controls whilst performing tasks selected for their relative specificity in engaging either the dorsal (n-back sequential-letter working memory task) or ventral (gambling task) PFC. Seven BD patients were selected from participants of the Maudsley Bipolar Disorder Project on the basis of clinical remission, absence of cognitive deficits, and monotherapy with mood stabilisers. Subjects were individually matched by gender, age, and IQ to an equal number of healthy controls. In the n-back task, group differences were only present in response to increasing memory load. Patients did not show the predicted dynamic response in the dorsal PFC, but had increased activation in the parietal cortices. During the gambling task, controls showed significant activation in the ventral and dorsal PFC; this was attenuated in BD patients where increased activation was seen in lateral temporal and polar regions. Our findings suggest that there are trait abnormalities in dorsal and ventral PFC function in BD that may be more pronounced during tasks that rely on ventral–dorsal PFC interaction.
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Affiliation(s)
- Sophia Frangou
- Section of Neurobiology of Psychosis, Institute of Psychiatry, Kings College London, De Crespigny Park, London, UK.
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Papanastasiou E, Mouchlianitis E, Joyce DW, McGuire P, Boussebaa C, Banaschewski T, Bokde ALW, Büchel C, Quinlan E, Desrivières S, Flor H, Grigis A, Garavan H, Spechler P, Gowland P, Heinz A, Ittermann B, Martinot MLP, Artiges E, Nees F, Orfanos DP, Paus T, Poustka L, Millenet S, Fröhner JH, Smolka MN, Walter H, Whelan R, Schumann G, Shergill SS. Examination of the neural basis of psychotic-like experiences in adolescence during processing of emotional faces. Sci Rep 2020; 10:5164. [PMID: 32198484 PMCID: PMC7083946 DOI: 10.1038/s41598-020-62026-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 02/24/2020] [Indexed: 01/28/2023] Open
Abstract
Contemporary theories propose that dysregulation of emotional perception is involved in the aetiology of psychosis. 298 healthy adolescents were assessed at age 14- and 19-years using fMRI while performing a facial emotion task. Psychotic-like experiences (PLEs) were assessed with the CAPE-42 questionnaire at age 19. The high PLEs group at age 19 years exhibited an enhanced response in right insular cortex and decreased response in right prefrontal, right parahippocampal and left striatal regions; also, a gradient of decreasing response to emotional faces with age, from 14 to 19 years, in the right parahippocampal region and left insular cortical area. The right insula demonstrated an increasing response to emotional faces with increasing age in the low PLEs group, and a decreasing response over time in the high PLEs group. The change in parahippocampal/amygdala and insula responses during the perception of emotional faces in adolescents with high PLEs between the ages of 14 and 19 suggests a potential 'aberrant' neurodevelopmental trajectory for critical limbic areas. Our findings emphasize the role of the frontal and limbic areas in the aetiology of psychotic symptoms, in subjects without the illness phenotype and the confounds introduced by antipsychotic medication.
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Affiliation(s)
- Evangelos Papanastasiou
- Cognition Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom.
| | - Elias Mouchlianitis
- Cognition Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Dan W Joyce
- Cognition Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Celia Boussebaa
- Cognition Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Arun L W Bokde
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Erin Quinlan
- Centre for Population Neuroscience and Precision Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
- Medical Research Council, Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Sylvane Desrivières
- Centre for Population Neuroscience and Precision Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
- Medical Research Council, Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Antoine Grigis
- NeuroSpin, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Hugh Garavan
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
- Department of Psychology, University of Vermont, Burlington, Vermont, USA
| | - Philip Spechler
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
- Department of Psychology, University of Vermont, Burlington, Vermont, USA
| | - Penny Gowland
- Sir Peter Mansfield Imaging Centre School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | | | - Marie-Laure Paillère Martinot
- Institut National de la Santé et de la Recherche Médicale, Neuroimaging & Psychiatry, University Paris Sud - Paris-Saclay, University Paris Descartes, Paris, France
- Department of Adolescent Psychopathology and Medicine, Maison de Solenn, Cochin Hospital, Paris, France
| | - Eric Artiges
- Institut National de la Santé et de la Recherche Médicale, Neuroimaging & Psychiatry, DIGITEO Labs, University Paris Saclay, Gif-sur-Yvette, France
- Psychiatry Department, Orsay Hospital, Orsay, France
| | - Frauke Nees
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Tomáš Paus
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital and Departments of Psychology and Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany
- Clinic for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Sabina Millenet
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Juliane H Fröhner
- Department of Psychiatry and Neuroimaging Centre, Technische Universität Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry and Neuroimaging Centre, Technische Universität Dresden, Dresden, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Whelan
- School of Psychology and Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Gunter Schumann
- Centre for Population Neuroscience and Precision Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Sukhwinder S Shergill
- Cognition Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
- Centre for Population Neuroscience and Precision Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
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Tracy DK, Holloway F, Hanson K, James A, Strathdee G, Holmes D, Kalidindi S, Shergill SS. Why care about integrated care? Part I. Demographics, finances and workforce: immovable objects facing mental health services. BJPsych advances 2020. [DOI: 10.1192/bja.2019.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Demands on health and social care are growing in quantity and complexity, with resources and staffing not projected to match this. The landmark NHS Long Term Plan calls for services in England to be delivered differently through integrated care systems (ICSs) that will better join commissioners and providers, and health and social care. The scale of these changes is immense, and the detail can feel confusing. However, they are important and will affect all clinicians in the public service. This three-part series provides a primer on integrated care, explaining why it is happening, how services are changing and why clinicians should get involved. In this first article we focus on the changing demographics, and the workforce and financial resources required to address these.
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Tracy DK, Holloway F, Hanson K, Kanani N, Trainer M, Dimond I, James A, Kalidindi S, Shergill SS. Why care about integrated care? Part 2. Integrated care systems: an irresistible force changing mental health services. BJPsych advances 2020. [DOI: 10.1192/bja.2020.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Part 1 of this three-part series on integrated care discussed the drivers for change in healthcare delivery in England set out in the NHS Long Term Plan. This second part explores the evolution of mental health services within the wider National Health Service (NHS), and describes important relevant legislation and policy over the past decade, leading up to the 2019 Long Term Plan. We explain the implications of this, including the detail of emerging structures such as integrated care systems (ICSs) and primary care networks (PCNs), and conclude with challenges facing these novel systems. Part 3 will address the practical local implementation of integrated care.
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Porffy LA, Bell V, Coutrot A, Wigton R, D'Oliveira T, Mareschal I, Shergill SS. In the eye of the beholder? Oxytocin effects on eye movements in schizophrenia. Schizophr Res 2020; 216:279-287. [PMID: 31836261 DOI: 10.1016/j.schres.2019.11.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/30/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Individuals with schizophrenia have difficulty in extracting salient information from faces. Eye-tracking studies have reported that these individuals demonstrate reduced exploratory viewing behaviour (i.e. reduced number of fixations and shorter scan paths) compared to healthy controls. Oxytocin has previously been demonstrated to exert pro-social effects and modulate eye gaze during face exploration. In this study, we tested whether oxytocin has an effect on visual attention in patients with schizophrenia. METHODS Nineteen male participants with schizophrenia received intranasal oxytocin 40UI or placebo in a double-blind, placebo-controlled, crossover fashion during two visits separated by seven days. They engaged in a free-viewing eye-tracking task, exploring images of Caucasian men displaying angry, happy, and neutral emotional expressions; and control images of animate and inanimate stimuli. Eye-tracking parameters included: total number of fixations, mean duration of fixations, dispersion, and saccade amplitudes. RESULTS We found a main effect of treatment, whereby oxytocin increased the total number of fixations, dispersion, and saccade amplitudes, while decreasing the duration of fixations compared to placebo. This effect, however, was non-specific to facial stimuli. When restricting the analysis to facial images only, we found the same effect. In addition, oxytocin modulated fixation rates in the eye and nasion regions. DISCUSSION This is the first study to explore the effects of oxytocin on eye gaze in schizophrenia. Oxytocin had enhanced exploratory viewing behaviour in response to both facial and inanimate control stimuli. We suggest that the acute administration of intranasal oxytocin may have the potential to enhance visual attention in schizophrenia.
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Affiliation(s)
- Lilla A Porffy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Victoria Bell
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Antoine Coutrot
- Laboratoire des Sciences du Numérique de Nantes, CNRS, Université de Nantes, Nantes, France
| | - Rebekah Wigton
- Department of Neurology, Harvard Medical School, Boston, MA, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Teresa D'Oliveira
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Isabelle Mareschal
- Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University, London, UK
| | - Sukhwinder S Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Rigoli F, Martinelli C, Shergill SS. The role of expecting feedback during decision-making under risk. Neuroimage 2019; 202:116079. [PMID: 31400531 DOI: 10.1016/j.neuroimage.2019.116079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Received: 04/08/2019] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 11/19/2022] Open
Abstract
Sometimes choice is followed by outcome feedback and other times it is not. It remains unknown whether humans prefer gambling when they expect feedback to be revealed. Regarding this question, decision-making theories make alternative predictions. Some theories have proposed that choice is influenced by whether one expects to be disappointed in the future. Given that feedback is sometimes disappointing, these theories predict increased aversion towards gambling when feedback is expected compared to when feedback is not expected. The opposite effect is predicted by theories of curiosity, which postulate reduction of uncertainty as an important behavioural drive. Given that feedback reduces uncertainty, these theories predict that gambling will be favoured when feedback is expected. To examine whether expecting feedback influences gambling behaviour, we recorded functional neuroimaging data while participants performed a novel decision-making task requiring to chose between a sure option and a gamble. Crucially, participants expected to receive feedback in some trials but not in other trials. Consistent with theories of curiosity, we found that expecting feedback increased gambling propensity. At the neural level, at option presentation the increased value of gambling during feedback was reflected in activity in the ventral striatum. This suggests that, together with its established role in signalling reward, the ventral striatum also processes a form of epistemic value. Our study demonstrates that gambling becomes more attractive when feedback is expected and suggests that striatal activity could signal the value of feedback information.
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Affiliation(s)
- Francesco Rigoli
- City, University of London, Northampton Square, London, EC1V 0HB, UK; The Wellcome Trust Centre for Neuroimaging, UCL, 12 Queen Square, London, WC1N 3BG, UK.
| | - Cristina Martinelli
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park Road, London, SE5 8AF, UK; Kingston University, Penrhyn Road, Kingston Upon Thames, Surrey, KT1 2EE, UK
| | - Sukhwinder S Shergill
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park Road, London, SE5 8AF, UK
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White TP, Gilleen J, Shergill SS. Corrigendum: Dysregulated but not decreased salience network activity in schizophrenia. Front Hum Neurosci 2019; 13:346. [PMID: 31636555 PMCID: PMC6794493 DOI: 10.3389/fnhum.2019.00346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/19/2019] [Indexed: 11/19/2022] Open
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Krivoy A, Joyce D, Tracy D, Gaughran F, MacCabe J, Lally J, Whiskey E, Sarkar SN, Shergill SS. Real-World Outcomes in the Management of Refractory Psychosis. J Clin Psychiatry 2019; 80. [PMID: 31556974 DOI: 10.4088/jcp.18m12716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 05/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Clozapine is the only medication approved for those patients with schizophrenia who do not achieve a clinical response to standard antipsychotic treatment, yet it is still underused. Furthermore, in the case of a partial or minimal response to clozapine treatment, there is no clarity on the next pharmacologic intervention. METHODS The National Psychosis Service is a tertiary referral inpatient unit for individuals with refractory psychosis. Data from 2 pooled data sets (for a total of 325 medical records) were analyzed for treatment trajectories between admission and discharge (2001-2016). Effectiveness of pharmacologic treatment was determined using change in symptoms, assessed using the Operational Criteria (OPCRIT) system applied retrospectively to the medical records. Analysis was focused on identifying the optimal medication regimens impacting clinical status during the admission. RESULTS Less than a quarter of the patients were on clozapine treatment at the time of admission; this rate increased to 63.4% at the time of discharge. Initiating clozapine during admission (n = 136) was associated with a 47.9% reduction of symptoms as reflected by their OPCRIT score. In cases in which clozapine monotherapy did not achieve sufficient improvement in symptoms, the most effective clozapine augmentation strategy was adding amisulpride (n = 22, 60.8% reduction of symptoms), followed by adding a mood stabilizer (n = 36, 53.7% reduction). A less favorable option was addition of quetiapine (n = 15, 26.7% reduction). CONCLUSIONS Many people with longer-term and complex refractory illness do respond to clozapine treatment with suitable augmentation strategies when necessary. Furthermore, it is possible to advance clozapine prescribing in these complex patients when they are supported by a skilled and dedicated multidisciplinary team. The optimal therapeutic approach relies on confirmation of diagnosis and compliance and optimization of clozapine dose using therapeutic drug monitoring, followed by augmentation of clozapine with amisulpride or mood stabilizers. There is some preliminary evidence suggesting that augmentation strategies may impact differentially depending on the symptom profile.
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Affiliation(s)
- Amir Krivoy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, London SE5 8AF, UK. .,National Psychosis Service, South London, and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Dan Joyce
- Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Derek Tracy
- Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Oxleas NHS Foundation Trust, Green Parks House, Orpington, Kent, London, United Kingdom
| | - Fiona Gaughran
- National Psychosis Service, South London, and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - James MacCabe
- National Psychosis Service, South London, and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - John Lally
- Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.,Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland
| | - Eromona Whiskey
- National Psychosis Service, South London, and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - S Neil Sarkar
- Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Sukhwinder S Shergill
- National Psychosis Service, South London, and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Tibber MS, Anderson EJ, Bobin T, Antonova E, Seabright A, Wright B, Carlin P, Shergill SS, Dakin SC. Corrigendum: Visual surround suppression in schizophrenia. Front Psychol 2019; 10:1898. [PMID: 31485211 PMCID: PMC6715016 DOI: 10.3389/fpsyg.2019.01898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marc S Tibber
- Institute of Ophthalmology, University College London, London, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital, London, UK
| | - Elaine J Anderson
- Institute of Ophthalmology, University College London, London, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital, London, UK.,Institute of Cognitive Neuroscience, University College London, London, UK
| | - Tracy Bobin
- Institute of Psychiatry, King's College London, London, UK
| | - Elena Antonova
- Institute of Psychiatry, King's College London, London, UK
| | - Alice Seabright
- Department of Cognitive, Perceptual and Brain Sciences, University College London, London, UK
| | - Bernice Wright
- Department of Cognitive, Perceptual and Brain Sciences, University College London, London, UK
| | | | | | - Steven C Dakin
- Institute of Ophthalmology, University College London, London, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital, London, UK
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Sarkar SN, Tracy DK, Fernandez MJM, Nalesnik N, Dhillon G, Onwumere J, Prins AM, Schepman K, Collier T, White TP, Patel A, Gaughran F, Shergill SS. Unheard voices: outcomes of tertiary care for treatment-refractory psychosis - ADDENDUM. BJPsych Bull 2019; 43:194. [PMID: 31177995 PMCID: PMC6642999 DOI: 10.1192/bjb.2019.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Beck K, Lally J, Shergill SS, Bloomfield MAP, MacCabe JH, Gaughran F, Howes OD. Prevalence of serum N-methyl-d-aspartate receptor autoantibodies in refractory psychosis - ADDENDUM. Br J Psychiatry 2019; 215:507. [PMID: 31180301 PMCID: PMC8055578 DOI: 10.1192/bjp.2019.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cliff M, Joyce DW, Lamar M, Dannhauser T, Tracy DK, Shergill SS. Corrigendum to "Aging effects on functional auditory and visual processing using fMRI with variable sensory loading" [Cortex 49 (2013) 1304-1313]. Cortex 2019; 121:488. [PMID: 31253413 DOI: 10.1016/j.cortex.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Cliff
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK.
| | - Dan W Joyce
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
| | - Melissa Lamar
- MRC Centre for Neurodegeneration, Department of Psychology-Section of Brain Maturation, Institute of Psychiatry, King's College London, UK; University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA
| | - Thomas Dannhauser
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK; Department of Mental Health Sciences, Royal Free & University College Medical School, London, UK
| | - Derek K Tracy
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
| | - Sukhwinder S Shergill
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
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Robol V, Tibber MS, Anderson EJ, Bobin T, Carlin P, Shergill SS, Dakin SC. Correction: Reduced Crowding and Poor Contour Detection in Schizophrenia Are Consistent with Weak Surround Inhibition. PLoS One 2019; 14:e0218483. [PMID: 31194845 PMCID: PMC6564015 DOI: 10.1371/journal.pone.0218483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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O'Daly OG, Joyce D, Tracy DK, Azim A, Stephan KE, Murray RM, Shergill SS. Correction: Amphetamine Sensitization Alters Reward Processing in the Human Striatum and Amygdala. PLoS One 2019; 14:e0218478. [PMID: 31188887 PMCID: PMC6561577 DOI: 10.1371/journal.pone.0218478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Tracy DK, Shergill SS, David AS, Fonagy P, Zaman R, Downar J, Eliott E, Bhui K. Self-harm and suicidal acts: a suitable case for treatment of impulsivity-driven behaviour with repetitive transcranial magnetic stimulation (rTMS) - ADDENDUM. BJPsych Open 2019; 5:e52. [PMID: 31530295 PMCID: PMC6642984 DOI: 10.1192/bjo.2019.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Tracy DK, Hanson K, Brown T, James AJB, Paulsen H, Mulliez Z, Shergill SS. Integrated care in mental health: next steps after the NHS Long Term Plan. Br J Psychiatry 2019; 214:315-317. [PMID: 30832746 DOI: 10.1192/bjp.2019.46] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Health and social care face growing and conflicting pressures: mounting complex needs of an ageing population, restricted funding and a workforce recruitment and retention crisis. In response, in the UK the NHS Long Term Plan promises increased investment and an emphasis on better 'integrated' care. We describe key aspects of integration that need addressing.Declaration of interestD.K.T. and S.S.S. are on the editorial board of the British Journal of Psychiatry and executives of the Academic Faculty at the Royal College of Psychiatrists. A.J.B.J., H.P. and Z.M. have roles at the Royal College of Psychiatrists that include evaluation of integrated care systems. A.J.B.J. is married to Dr Sarah Wollaston, Member of Parliament for Totnes and Chair of the Health Select Committee.
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Affiliation(s)
- Derek K Tracy
- Consultant Psychiatrist and Clinical Director,Oxleas NHS Foundation Trust;Senior Lecturer,The Institute of Psychiatry,Psychology and Neuroscience,King's College London; and Honorary Senior Lecturer,Department of Psychiatry,University College London,UK
| | - Kara Hanson
- Professor of Health System Economics and Dean,Faculty of Public Health and Policy,the London School of Hygiene and Tropical Medicine,UK
| | - Tom Brown
- Service Director,Bexleycare,Oxleas NHS Foundation Trust;and the London Borough of Bexley,UK
| | - Adrian J B James
- Registrar,Royal College of Psychiatrists; andConsultant Forensic Psychiatrist,Devon Partnership NHS Trust,UK
| | - Holly Paulsen
- Deputy Head of Policy and Campaigns,Royal College of Psychiatrists,UK
| | - Zoé Mulliez
- Policy and Campaigns Manager,Royal College of Psychiatrists,UK
| | - Sukhwinder S Shergill
- Professor of Psychiatry and Systems Neuroscience,Institute of Psychiatry, Psychology and Neuroscience,King's College London; andHonorary Consultant,South London and Maudsley NHS Foundation Trust,UK
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49
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Tracy DK, Joyce DW, Sarkar SN, Fernandez MJM, Shergill SS. Correction to: Skating on thin ice: pragmatic prescribing for medication refractory schizophrenia. BMC Psychiatry 2019; 19:160. [PMID: 31132998 PMCID: PMC6537304 DOI: 10.1186/s12888-019-2155-y] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 11/17/2022] Open
Abstract
After publication of the original article [1], the authors have notified us that there was an oversight on acknowledging funding received for the study. They would like to mention that Professor Sukhi Shergill was funded by an ERC Consolidator Award.
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Affiliation(s)
- Derek K. Tracy
- 0000 0000 9895 6940grid.500707.5Oxleas NHS Foundation Trust, Green Parks House, Orpington, London, Kent BR6 8NY UK ,0000 0001 2322 6764grid.13097.3cCognition, Schizophrenia & Imaging Laboratory, Department of Psychosis Studies, The Institute of Psychiatry, King’s College London, London, UK
| | - Dan W. Joyce
- 0000 0001 2322 6764grid.13097.3cCognition, Schizophrenia & Imaging Laboratory, Department of Psychosis Studies, The Institute of Psychiatry, King’s College London, London, UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - S. Neil Sarkar
- 0000 0001 2322 6764grid.13097.3cCognition, Schizophrenia & Imaging Laboratory, Department of Psychosis Studies, The Institute of Psychiatry, King’s College London, London, UK ,grid.450578.bCentral and North West London NHS Foundation Trust, London, UK
| | - Maria-Jesus Mateos Fernandez
- 0000 0001 2322 6764grid.13097.3cCognition, Schizophrenia & Imaging Laboratory, Department of Psychosis Studies, The Institute of Psychiatry, King’s College London, London, UK
| | - Sukhwinder S. Shergill
- 0000 0001 2322 6764grid.13097.3cCognition, Schizophrenia & Imaging Laboratory, Department of Psychosis Studies, The Institute of Psychiatry, King’s College London, London, UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
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50
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Joyce DW, Shergill SS. Integration is not necessarily at odds with reductionism. Int J Soc Psychiatry 2018; 64:626-627. [PMID: 29638180 DOI: 10.1177/0020764018770476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dan W Joyce
- Cognition, Schizophrenia & Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sukhwinder S Shergill
- Cognition, Schizophrenia & Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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