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Tse W, Khandaker GM, Zhou H, Luo H, Yan WC, Siu MW, Poon LT, Lee EHM, Zhang Q, Upthegrove R, Osimo EF, Perry BI, Chan SKW. Assessing the generalisability of the psychosis metabolic risk calculator (PsyMetRiC) for young people with first-episode psychosis with validation in a Hong Kong Chinese Han population: a 4-year follow-up study. Lancet Reg Health West Pac 2024; 47:101089. [PMID: 38774423 PMCID: PMC11106539 DOI: 10.1016/j.lanwpc.2024.101089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/16/2024] [Accepted: 04/27/2024] [Indexed: 05/24/2024]
Abstract
Background Metabolic syndrome (MetS) is common following first-episode psychosis (FEP), contributing to substantial morbidity and mortality. The Psychosis Metabolic Risk Calculator (PsyMetRiC), a risk prediction algorithm for MetS following a FEP diagnosis, was developed in the United Kingdom and has been validated in other European populations. However, the predictive accuracy of PsyMetRiC in Chinese populations is unknown. Methods FEP patients aged 15-35 y, first presented to the Early Assessment Service for Young People with Early Psychosis (EASY) Programme in Hong Kong (HK) between 2012 and 2021 were included. A binary MetS outcome was determined based on the latest available follow-up clinical information between 1 and 12 years after baseline assessment. The PsyMetRiC Full and Partial algorithms were assessed for discrimination, calibration and clinical utility in the HK sample, and logistic calibration was conducted to account for population differences. Sensitivity analysis was performed in patients aged >35 years and using Chinese MetS criteria. Findings The main analysis included 416 FEP patients (mean age = 23.8 y, male sex = 40.4%, 22.4% MetS prevalence at follow-up). PsyMetRiC showed adequate discriminative performance (full-model C = 0.76, 95% C.I. = 0.69-0.81; partial-model: C = 0.73, 95% C.I. = 0.65-0.8). Systematic risk underestimation in both models was corrected using logistic calibration to refine PsyMetRiC for HK Chinese FEP population (PsyMetRiC-HK). PsyMetRiC-HK provided a greater net benefit than competing strategies. Results remained robust with a Chinese MetS definition, but worse for the older age group. Interpretation With good predictive performance for incident MetS, PsyMetRiC-HK presents a step forward for personalized preventative strategies of cardiometabolic morbidity and mortality in young Hong Kong Chinese FEP patients. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Affiliation(s)
- Wing Tse
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Huiquan Zhou
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hao Luo
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Wai Ching Yan
- Department of Psychiatry, Kowloon Hospital, Hong Kong Special Administrative Region, China
| | - Man Wah Siu
- Department of Psychiatry, Kowloon Hospital, Hong Kong Special Administrative Region, China
| | - Lap Tak Poon
- Department of Psychiatry, United Christian Hospital, Hong Kong Special Administrative Region, China
| | - Edwin Ho Ming Lee
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Qingpeng Zhang
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Emanuele F. Osimo
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, England
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, England
| | - Benjamin I. Perry
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, England
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, England
| | - Sherry Kit Wa Chan
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Morales-Muñoz I, Marwaha S, Upthegrove R, Cropley V. Role of Inflammation in Short Sleep Duration Across Childhood and Psychosis in Young Adulthood. JAMA Psychiatry 2024:2818230. [PMID: 38717746 PMCID: PMC11079792 DOI: 10.1001/jamapsychiatry.2024.0796] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/28/2024] [Indexed: 05/12/2024]
Abstract
Importance Short sleep duration over a prolonged period in childhood could have a detrimental impact on long-term mental health, including the development of psychosis. Further, potential underlying mechanisms of these associations remain unknown. Objective To examine the association between persistent shorter nighttime sleep duration throughout childhood with psychotic experiences (PEs) and/or psychotic disorder (PD) at age 24 years and whether inflammatory markers (C-reactive protein [CRP] and interleukin 6 [IL-6]) potentially mediate any association. Design, Setting, and Participants This cohort study used data from the Avon Longitudinal Study of Parents and Children. Data analysis was conducted from January 30 to August 1, 2023. Exposures Nighttime sleep duration was collected at 6, 18, and 30 months and at 3.5, 4 to 5, 5 to 6, and 6 to 7 years. Main Outcomes and Measures PEs and PD were assessed at age 24 years from the Psychosislike Symptoms Interview. CRP level at ages 9 and 15 years and IL-6 level at 9 years were used as mediators. Latent class growth analyses (LCGAs) were applied to detect trajectories of nighttime sleep duration, and logistic regressions were applied for the longitudinal associations between trajectories of nighttime sleep duration and psychotic outcomes at 24 years. Path analyses were applied to test CRP and IL-6 as potential mediators. Results Data were available on 12 394 children (6254 female [50.5%]) for the LCGA and on 3962 young adults (2429 female [61.3%]) for the logistic regression and path analyses. The LCGA identified a group of individuals with persistent shorter nighttime sleep duration across childhood. These individuals were more likely to develop PD (odds ratio [OR], 2.50; 95% CI, 1.51-4.15; P < .001) and PEs (OR, 3.64; 95% CI, 2.23-5.95; P < .001) at age 24 years. Increased levels of IL-6 at 9 years, but not CRP at 9 or 15 years, partially mediated the associations between persistent shorter sleep duration and PD (bias-corrected estimate = 0.003; 95% CI, 0.002-0.005; P = .007) and PEs (bias-corrected estimate = 0.002; 95% CI, 0-0.003; P = .03) in young adulthood. Conclusions and Relevance Findings of this cohort study highlight the necessity of addressing short sleep duration in children, as persistence of this sleep problem was associated with subsequent psychosis. This study also provides preliminary evidence for future targeted interventions in children addressing both sleep and inflammatory responses.
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Affiliation(s)
- Isabel Morales-Muñoz
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Specialist Mood Disorders Clinic, Zinnia Centre, Birmingham, United Kingdom
- The Barberry National Centre for Mental Health, Birmingham, United Kingdom
| | - Rachel Upthegrove
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Early Intervention Service, Birmingham Women’s and Children’s NHS Trust, Birmingham, United Kingdom
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
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Bonivento C, Kambeitz-Ilankovic L, Maggioni E, Borgwardt S, Lencer R, Meisenzahl E, Kambeitz J, Ruhrmann S, Salokangas RKR, Bertolino A, Stainton A, Wenzel J, Pantelis C, Wood SJ, Upthegrove R, Koutsouleris N, Brambilla P. Neurocognitive skills and vulnerability for psychosis in depression and across the psychotic spectrum: findings from the PRONIA Consortium - CORRIGENDUM. Br J Psychiatry 2024; 224:185. [PMID: 38497099 DOI: 10.1192/bjp.2024.43] [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: 03/19/2024]
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Wannan CMJ, Nelson B, Addington J, Allott K, Anticevic A, Arango C, Baker JT, Bearden CE, Billah T, Bouix S, Broome MR, Buccilli K, Cadenhead KS, Calkins ME, Cannon TD, Cecci G, Chen EYH, Cho KIK, Choi J, Clark SR, Coleman MJ, Conus P, Corcoran CM, Cornblatt BA, Diaz-Caneja CM, Dwyer D, Ebdrup BH, Ellman LM, Fusar-Poli P, Galindo L, Gaspar PA, Gerber C, Glenthøj LB, Glynn R, Harms MP, Horton LE, Kahn RS, Kambeitz J, Kambeitz-Ilankovic L, Kane JM, Kapur T, Keshavan MS, Kim SW, Koutsouleris N, Kubicki M, Kwon JS, Langbein K, Lewandowski KE, Light GA, Mamah D, Marcy PJ, Mathalon DH, McGorry PD, Mittal VA, Nordentoft M, Nunez A, Pasternak O, Pearlson GD, Perez J, Perkins DO, Powers AR, Roalf DR, Sabb FW, Schiffman J, Shah JL, Smesny S, Spark J, Stone WS, Strauss GP, Tamayo Z, Torous J, Upthegrove R, Vangel M, Verma S, Wang J, Rossum IWV, Wolf DH, Wolff P, Wood SJ, Yung AR, Agurto C, Alvarez-Jimenez M, Amminger P, Armando M, Asgari-Targhi A, Cahill J, Carrión RE, Castro E, Cetin-Karayumak S, Mallar Chakravarty M, Cho YT, Cotter D, D’Alfonso S, Ennis M, Fadnavis S, Fonteneau C, Gao C, Gupta T, Gur RE, Gur RC, Hamilton HK, Hoftman GD, Jacobs GR, Jarcho J, Ji JL, Kohler CG, Lalousis PA, Lavoie S, Lepage M, Liebenthal E, Mervis J, Murty V, Nicholas SC, Ning L, Penzel N, Poldrack R, Polosecki P, Pratt DN, Rabin R, Rahimi Eichi H, Rathi Y, Reichenberg A, Reinen J, Rogers J, Ruiz-Yu B, Scott I, Seitz-Holland J, Srihari VH, Srivastava A, Thompson A, Turetsky BI, Walsh BC, Whitford T, Wigman JTW, Yao B, Yuen HP, Ahmed U, Byun A(JS, Chung Y, Do K, Hendricks L, Huynh K, Jeffries C, Lane E, Langholm C, Lin E, Mantua V, Santorelli G, Ruparel K, Zoupou E, Adasme T, Addamo L, Adery L, Ali M, Auther A, Aversa S, Baek SH, Bates K, Bathery A, Bayer JMM, Beedham R, Bilgrami Z, Birch S, Bonoldi I, Borders O, Borgatti R, Brown L, Bruna A, Carrington H, Castillo-Passi RI, Chen J, Cheng N, Ching AE, Clifford C, Colton BL, Contreras P, Corral S, Damiani S, Done M, Estradé A, Etuka BA, Formica M, Furlan R, Geljic M, Germano C, Getachew R, Goncalves M, Haidar A, Hartmann J, Jo A, John O, Kerins S, Kerr M, Kesselring I, Kim H, Kim N, Kinney K, Krcmar M, Kotler E, Lafanechere M, Lee C, Llerena J, Markiewicz C, Matnejl P, Maturana A, Mavambu A, Mayol-Troncoso R, McDonnell A, McGowan A, McLaughlin D, McIlhenny R, McQueen B, Mebrahtu Y, Mensi M, Hui CLM, Suen YN, Wong SMY, Morrell N, Omar M, Partridge A, Phassouliotis C, Pichiecchio A, Politi P, Porter C, Provenzani U, Prunier N, Raj J, Ray S, Rayner V, Reyes M, Reynolds K, Rush S, Salinas C, Shetty J, Snowball C, Tod S, Turra-Fariña G, Valle D, Veale S, Whitson S, Wickham A, Youn S, Zamorano F, Zavaglia E, Zinberg J, Woods SW, Shenton ME. Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ): Rationale and Study Design of the Largest Global Prospective Cohort Study of Clinical High Risk for Psychosis. Schizophr Bull 2024; 50:496-512. [PMID: 38451304 PMCID: PMC11059785 DOI: 10.1093/schbul/sbae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
This article describes the rationale, aims, and methodology of the Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ). This is the largest international collaboration to date that will develop algorithms to predict trajectories and outcomes of individuals at clinical high risk (CHR) for psychosis and to advance the development and use of novel pharmacological interventions for CHR individuals. We present a description of the participating research networks and the data processing analysis and coordination center, their processes for data harmonization across 43 sites from 13 participating countries (recruitment across North America, Australia, Europe, Asia, and South America), data flow and quality assessment processes, data analyses, and the transfer of data to the National Institute of Mental Health (NIMH) Data Archive (NDA) for use by the research community. In an expected sample of approximately 2000 CHR individuals and 640 matched healthy controls, AMP SCZ will collect clinical, environmental, and cognitive data along with multimodal biomarkers, including neuroimaging, electrophysiology, fluid biospecimens, speech and facial expression samples, novel measures derived from digital health technologies including smartphone-based daily surveys, and passive sensing as well as actigraphy. The study will investigate a range of clinical outcomes over a 2-year period, including transition to psychosis, remission or persistence of CHR status, attenuated positive symptoms, persistent negative symptoms, mood and anxiety symptoms, and psychosocial functioning. The global reach of AMP SCZ and its harmonized innovative methods promise to catalyze the development of new treatments to address critical unmet clinical and public health needs in CHR individuals.
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Affiliation(s)
- Cassandra M J Wannan
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Barnaby Nelson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Kelly Allott
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Alan Anticevic
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, Instituto de Salud Carlos III, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Justin T Baker
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Boston, MA, USA
| | - Carrie E Bearden
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tashrif Billah
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sylvain Bouix
- Department of Software Engineering and Information Technology, École de technologie supérieure, Montréal, Canada
| | - Matthew R Broome
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
- Early Intervention for Psychosis Services, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Kate Buccilli
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | | | - Monica E Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | | | - Eric Yu Hai Chen
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Kang Ik K Cho
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jimmy Choi
- Olin Neuropsychiatry Research Center, Hartford Hospital, Hartford, CT, USA
| | - Scott R Clark
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
- Basil Hetzel Institute, Woodville, SA, Australia
| | - Michael J Coleman
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Philippe Conus
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP–Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Cheryl M Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Barbara A Cornblatt
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Covadonga M Diaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, Instituto de Salud Carlos III, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Dominic Dwyer
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Bjørn H Ebdrup
- Centre for Neuropsychiatric Schizophrenia Research, CNSR Mental Health Centre, Glostrup, Copenhagen, Denmark
| | - Lauren M Ellman
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, King’s College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Liliana Galindo
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Pablo A Gaspar
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
| | - Carla Gerber
- Behavioral Health Services, PeaceHealth Medical Group, Eugene, OR, USA
| | - Louise Birkedal Glenthøj
- Copenhagen Research Centre for Mental Health, Mental Health Copenhagen, University of Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Robert Glynn
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health and Harvard Medical School, Boston, MA, USA
| | - Michael P Harms
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Leslie E Horton
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - René S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph Kambeitz
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - John M Kane
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Tina Kapur
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Korea
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Marek Kubicki
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Kerstin Langbein
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Kathryn E Lewandowski
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Boston, MA, USA
| | - Gregory A Light
- Department of Psychiatry, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Health Care System, San Diego, CA, USA
| | - Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | | | - Daniel H Mathalon
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Mental Health Service 116D, Veterans Affairs San Francisco Health Care System, San Francisco, CA, USA
| | - Patrick D McGorry
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health, Mental Health Copenhagen, University of Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Angela Nunez
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Ofer Pasternak
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Godfrey D Pearlson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Olin Neuropsychiatry Research Center, Hartford Hospital, Hartford, CT, USA
| | - Jesus Perez
- CAMEO, Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Department of Medicine, Institute of Biomedical Research (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Albert R Powers
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - David R Roalf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fred W Sabb
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Jai L Shah
- PEPP-Montreal, Douglas Research Centre, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Stefan Smesny
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Jessica Spark
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - William S Stone
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | | | - Zailyn Tamayo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - John Torous
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Rachel Upthegrove
- Department of Software Engineering and Information Technology, École de technologie supérieure, Montréal, Canada
- Birmingham Womens and Childrens, NHS Foundation Trust, Birmingham, UK
| | - Mark Vangel
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Swapna Verma
- Department of Psychosis, Institute of Mental Health, Singapore
| | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Inge Winter-van Rossum
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Daniel H Wolf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Phillip Wolff
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Stephen J Wood
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
- School of Psychology, University of Birmingham, Edgbaston, UK
| | - Alison R Yung
- Institute of Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Carla Agurto
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Paul Amminger
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Marco Armando
- Youth Early Detection/Intervention in Psychosis Platform (Plateforme ERA), Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and The University of Lausanne, Lausanne, Switzerland
| | | | - John Cahill
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Ricardo E Carrión
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Eduardo Castro
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Suheyla Cetin-Karayumak
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Youngsun T Cho
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - David Cotter
- Department Psychiatry, Beaumont Hospital, Dublin 9, Ireland
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Simon D’Alfonso
- School of Computing and Information Systems, The University of Melbourne, Parkville, VIC, Australia
| | - Michaela Ennis
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Boston, MA, USA
| | - Shreyas Fadnavis
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Clara Fonteneau
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Caroline Gao
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Tina Gupta
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Holly K Hamilton
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Gil D Hoftman
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Grace R Jacobs
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Johanna Jarcho
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Jie Lisa Ji
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Christian G Kohler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paris Alexandros Lalousis
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Suzie Lavoie
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Martin Lepage
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Einat Liebenthal
- Program for Specialized Treatment Early in Psychosis (STEP), CMHC, New Haven, CT, USA
| | - Josh Mervis
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Vishnu Murty
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Spero C Nicholas
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | - Lipeng Ning
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Nora Penzel
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Russell Poldrack
- Department of Psychology, Stanford University, Stanford, CA, USA
| | | | - Danielle N Pratt
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Rachel Rabin
- PEPP-Montreal, Douglas Research Centre, Montreal, Quebec, Canada
| | | | - Yogesh Rathi
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Avraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jenna Reinen
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Jack Rogers
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Bernalyn Ruiz-Yu
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Isabelle Scott
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Johanna Seitz-Holland
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Vinod H Srihari
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), CMHC, New Haven, CT, USA
| | - Agrima Srivastava
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew Thompson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Bruce I Turetsky
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara C Walsh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Thomas Whitford
- Orygen, Parkville, VIC, Australia
- School of Psychology, University of New South Wales (UNSW), Kensington, NSW, Australia
| | - Johanna T W Wigman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center,Groningen, Netherlands
| | - Beier Yao
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Boston, MA, USA
| | - Hok Pan Yuen
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | | | - Andrew (Jin Soo) Byun
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Yoonho Chung
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Boston, MA, USA
| | - Kim Do
- Department of Psychiatry, Center for Psychiatric Neuroscience, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience King’s College London, London, UK
| | - Larry Hendricks
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Kevin Huynh
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Clark Jeffries
- Renaissance Computing Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Erlend Lane
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Carsten Langholm
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Eric Lin
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Boston, MA, USA
- Medical Informatics Fellowship, Veteran Affairs Boston Healthcare System, Boston, MA, USA
- Food and Drug Administration, Silver Spring, MD, USA
| | - Valentina Mantua
- Department of Psychiatry, Neurodevelopment & Psychosis Section, University of Pennsylvania, Philadelphia, PA, USA
| | - Gennarina Santorelli
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Kosha Ruparel
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Eirini Zoupou
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Tatiana Adasme
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
| | - Lauren Addamo
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Laura Adery
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Munaza Ali
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Andrea Auther
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Samantha Aversa
- PEPP-Montreal, Douglas Research Centre, Montreal, Quebec, Canada
| | - Seon-Hwa Baek
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Korea
| | - Kelly Bates
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Alyssa Bathery
- Department of Psychiatry, Neurodevelopment & Psychosis Section, University of Pennsylvania, Philadelphia, PA, USA
| | - Johanna M M Bayer
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Rebecca Beedham
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Zarina Bilgrami
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Sonia Birch
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Ilaria Bonoldi
- Department of Psychosis Studies, King’s College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Owen Borders
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Lisa Brown
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alejandro Bruna
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
| | - Holly Carrington
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Rolando I Castillo-Passi
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
- Department of Neurology and Psychiatry, Clínica Alemana—Universidad del Desarrollo, Santiago, Chile
| | - Justine Chen
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Nicholas Cheng
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Ann Ee Ching
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Chloe Clifford
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Beau-Luke Colton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Pamela Contreras
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
| | - Sebastián Corral
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Monica Done
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Andrés Estradé
- Early Psychosis Detection and Clinical Intervention (EPIC) Lab, Department of Psychosis Studies, King’s College London, London, UK
| | - Brandon Asika Etuka
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Melanie Formica
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Rachel Furlan
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Mia Geljic
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Carmela Germano
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Ruth Getachew
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | | | - Anastasia Haidar
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Jessica Hartmann
- Department of Public Mental Health, Central Institute of Mental Health, Heidelberg Univeristy, Mannheim, Germany
| | - Anna Jo
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Omar John
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Kerins
- Early Psychosis Detection and Clinical Intervention (EPIC) Lab, Department of Psychosis Studies, King’s College London, London, UK
| | - Melissa Kerr
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Irena Kesselring
- Department of Psychiatry, Neurodevelopment & Psychosis Section, University of Pennsylvania, Philadelphia, PA, USA
| | - Honey Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Nicholas Kim
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Kyle Kinney
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Marija Krcmar
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Elana Kotler
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Melanie Lafanechere
- School of Psychology, University of Birmingham, Edgbaston, UK
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Clarice Lee
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Joshua Llerena
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | | | | | | | - Aissata Mavambu
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
| | | | - Amelia McDonnell
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Alessia McGowan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Rebecca McIlhenny
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brittany McQueen
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Yohannes Mebrahtu
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Martina Mensi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | | | - Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | - Neal Morrell
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Mariam Omar
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Alice Partridge
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Christina Phassouliotis
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Christian Porter
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Umberto Provenzani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Nicholas Prunier
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Jasmine Raj
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Susan Ray
- Northwell Health, Glen Oaks, NY, USA
| | - Victoria Rayner
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Manuel Reyes
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
- Department of Neurology and Psychiatry, Clínica Alemana—Universidad del Desarrollo, Santiago, Chile
| | - Kate Reynolds
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Sage Rush
- Department of Psychiatry, Neurodevelopment & Psychosis Section, University of Pennsylvania, Philadelphia, PA, USA
| | - Cesar Salinas
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
| | - Jashmina Shetty
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Callum Snowball
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Sophie Tod
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | | | - Daniela Valle
- Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile
| | - Simone Veale
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Whitson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Alana Wickham
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Youn
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Francisco Zamorano
- Unidad de imágenes cuantitativas avanzadas, departamento de imágenes, clínica alemana, universidad del Desarrollo, Santiago, Chile
- Facultad de ciencias para el cuidado de la salud, Universidad San Sebastián, Campus Los Leones, Santiago, Chile
| | - Elissa Zavaglia
- PEPP-Montreal, Douglas Research Centre, Montreal, Quebec, Canada
| | - Jamie Zinberg
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Martha E Shenton
- Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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5
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Upthegrove R, Goldsmith DR. The psychoneuroimmunology of Psychosis: Peeking past the clouds of Heterogeneity: Editorial. Brain Behav Immun 2024; 119:709-712. [PMID: 38670242 DOI: 10.1016/j.bbi.2024.04.037] [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] [Received: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Affiliation(s)
- Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham UK; Birmingham Early Intervention Service, Birmingham Womens and Childrens NHS Foundation Trust.
| | - David R Goldsmith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, United States
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6
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Griffiths SL, Murray GK, Logeswaran Y, Ainsworth J, Allan SM, Campbell N, Drake RJ, Katshu MZUH, Machin M, Pope MA, Sullivan SA, Waring J, Bogatsu T, Kane J, Weetman T, Johnson S, Kirkbride JB, Upthegrove R. Implementing and Evaluating a National Integrated Digital Registry and Clinical Decision Support System in Early Intervention in Psychosis Services (Early Psychosis Informatics Into Care): Co-Designed Protocol. JMIR Res Protoc 2024; 13:e50177. [PMID: 38502175 PMCID: PMC10988369 DOI: 10.2196/50177] [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: 06/23/2023] [Revised: 01/21/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Early intervention in psychosis (EIP) services are nationally mandated in England to provide multidisciplinary care to people experiencing first-episode psychosis, which disproportionately affects deprived and ethnic minority youth. Quality of service provision varies by region, and people from historically underserved populations have unequal access. In other disease areas, including stroke and dementia, national digital registries coupled with clinical decision support systems (CDSSs) have revolutionized the delivery of equitable, evidence-based interventions to transform patient outcomes and reduce population-level disparities in care. Given psychosis is ranked the third most burdensome mental health condition by the World Health Organization, it is essential that we achieve the same parity of health improvements. OBJECTIVE This paper reports the protocol for the program development phase of this study, in which we aimed to co-design and produce an evidence-based, stakeholder-informed framework for the building, implementation, piloting, and evaluation of a national integrated digital registry and CDSS for psychosis, known as EPICare (Early Psychosis Informatics into Care). METHODS We conducted 3 concurrent work packages, with reciprocal knowledge exchange between each. In work package 1, using a participatory co-design framework, key stakeholders (clinicians, academics, policy makers, and patient and public contributors) engaged in 4 workshops to review, refine, and identify a core set of essential and desirable measures and features of the EPICare registry and CDSS. Using a modified Delphi approach, we then developed a consensus of data priorities. In work package 2, we collaborated with National Health Service (NHS) informatics teams to identify relevant data currently captured in electronic health records, understand data retrieval methods, and design the software architecture and data model to inform future implementation. In work package 3, observations of stakeholder workshops and individual interviews with representative stakeholders (n=10) were subject to interpretative qualitative analysis, guided by normalization process theory, to identify factors likely to influence the adoption and implementation of EPICare into routine practice. RESULTS Stage 1 of the EPICare study took place between December 2021 and September 2022. The next steps include stage 2 building, piloting, implementation, and evaluation of EPICare in 5 demonstrator NHS Trusts serving underserved and diverse populations with substantial need for EIP care in England. If successful, this will be followed by stage 3, in which we will seek NHS adoption of EPICare for rollout to all EIP services in England. CONCLUSIONS By establishing a multistakeholder network and engaging them in an iterative co-design process, we have identified essential and desirable elements of the EPICare registry and CDSS; proactively identified and minimized potential challenges and barriers to uptake and implementation; and addressed key questions related to informatics architecture, infrastructure, governance, and integration in diverse NHS Trusts, enabling us to proceed with the building, piloting, implementation, and evaluation of EPICare. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50177.
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Affiliation(s)
- Siân Lowri Griffiths
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- CAMEO, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Yanakan Logeswaran
- Division of Psychiatry, University College London, London, United Kingdom
| | - John Ainsworth
- The University of Manchester, Manchester, United Kingdom
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Sophie M Allan
- Department of Clinical Psychology and Psychotherapies, Medical School, University of East Anglia, Norwich, United Kingdom
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Niyah Campbell
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Richard J Drake
- The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Mohammad Zia Ul Haq Katshu
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Matthew Machin
- The University of Manchester, Manchester, United Kingdom
| | - Megan A Pope
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Sarah A Sullivan
- Centre for Academic Mental Health, University of Bristol, Bristol, United Kingdom
- Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
| | - Justin Waring
- School of Social Policy, University of Birmingham, Birmingham, United Kingdom
| | - Tumelo Bogatsu
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Julie Kane
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Tyler Weetman
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - James B Kirkbride
- Division of Psychiatry, University College London, London, United Kingdom
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
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7
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Koutsouleris N, Buciuman MO, Vetter CS, Weyer CFC, Zhutovsky P, Perdomo ST, Khuntia A, Milaneschi Y, Popovic D, Ruef A, Dwyer D, Chisholm K, Kambeitz L, Antonucci L, Ruhrmann S, Kambeitz J, Riecher-Rössler A, Upthegrove R, Salokangas R, Hietala J, Pantelis C, Lencer R, Meisenzahl E, Wood S, Brambilla P, Borgwardt S, Bertolino A, Falkai P. Distinct multimodal biological and functional profiles of symptom-based subgroups in recent-onset psychosis. Res Sq 2024:rs.3.rs-3949072. [PMID: 38559014 PMCID: PMC10980097 DOI: 10.21203/rs.3.rs-3949072/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Symptom heterogeneity characterizes psychotic disorders and hinders the delineation of underlying biomarkers. Here, we identify symptom-based subtypes of recent-onset psychosis (ROP) patients from the multi-center PRONIA (Personalized Prognostic Tools for Early Psychosis Management) database and explore their multimodal biological and functional signatures. We clustered N = 328 ROP patients based on their maximum factor scores in an exploratory factor analysis on the Positive and Negative Syndrome Scale items. We assessed inter-subgroup differences and compared to N = 464 healthy control (HC) individuals regarding gray matter volume (GMV), neurocognition, polygenic risk scores, and longitudinal functioning trajectories. Finally, we evaluated factor stability at 9- and 18-month follow-ups. A 4-factor solution optimally explained symptom heterogeneity, showing moderate longitudinal stability. The ROP-MOTCOG (Motor/Cognition) subgroup was characterized by GMV reductions within salience, control and default mode networks, predominantly throughout cingulate regions, relative to HC individuals, had the most impaired neurocognition and the highest genetic liability for schizophrenia. ROP-SOCWD (Social Withdrawal) patients showed GMV reductions within medial fronto-temporal regions of the control, default mode, and salience networks, and had the lowest social functioning across time points. ROP-POS (Positive) evidenced GMV decreases in salience, limbic and frontal regions of the control and default mode networks. The ROP-AFF (Affective) subgroup showed GMV reductions in the salience, limbic, and posterior default-mode and control networks, thalamus and cerebellum. GMV reductions in fronto-temporal regions of the salience and control networks were shared across subgroups. Our results highlight the existence of behavioral subgroups with distinct neurobiological and functional profiles in early psychosis, emphasizing the need for refined symptom-based diagnosis and prognosis frameworks.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Lana Kambeitz
- University of Cologne, Faculty of Medicine and University Hospital
| | - Linda Antonucci
- Faculty of Medicine and University Hospital, University of Cologne, Cologne
| | - Stephan Ruhrmann
- Faculty of Medicine and University Hospital, University of Cologne, Cologne
| | - Joseph Kambeitz
- Faculty of Medicine and University Hospital, University of Cologne, Cologne
| | | | | | | | | | | | | | | | | | | | | | - Alessandro Bertolino
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience and Sense Organs, Aldo Moro University, Bari
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8
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Hoheisel L, Kambeitz-Ilankovic L, Wenzel J, Haas SS, Antonucci LA, Ruef A, Penzel N, Schultze-Lutter F, Lichtenstein T, Rosen M, Dwyer DB, Salokangas RKR, Lencer R, Brambilla P, Borgwardt S, Wood SJ, Upthegrove R, Bertolino A, Ruhrmann S, Meisenzahl E, Koutsouleris N, Fink GR, Daun S, Kambeitz J. Alterations of Functional Connectivity Dynamics in Affective and Psychotic Disorders. Biol Psychiatry Cogn Neurosci Neuroimaging 2024:S2451-9022(24)00065-X. [PMID: 38461964 DOI: 10.1016/j.bpsc.2024.02.013] [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] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/23/2024] [Accepted: 02/15/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Psychosis and depression patients exhibit widespread neurobiological abnormalities. The analysis of dynamic functional connectivity (dFC), allows for the detection of changes in complex brain activity patterns, providing insights into common and unique processes underlying these disorders. METHODS In the present study, we report the analysis of dFC in a large patient sample including 127 clinical high-risk patients (CHR), 142 recent-onset psychosis (ROP) patients, 134 recent-onset depression (ROD) patients, and 256 healthy controls (HC). A sliding window-based technique was used to calculate the time-dependent FC in resting-state MRI data, followed by clustering to reveal recurrent FC states in each diagnostic group. RESULTS We identified five unique FC states, which could be identified in all groups with high consistency (rmean = 0.889, sd = 0.116). Analysis of dynamic parameters of these states showed a characteristic increase in the lifetime and frequency of a weakly-connected FC state in ROD patients (p < 0.0005) compared to most other groups, and a common increase in the lifetime of a FC state characterised by high sensorimotor and cingulo-opercular connectivities in all patient groups compared to the HC group (p < 0.0002). Canonical correlation analysis revealed a mode which exhibited significant correlations between dFC parameters and clinical variables (r = 0.617, p < 0.0029), which was associated with positive psychosis symptom severity and several dFC parameters. CONCLUSIONS Our findings indicate diagnosis-specific alterations of dFC and underline the potential of dynamic analysis to characterize disorders such as depression, psychosis and clinical risk states.
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Affiliation(s)
- Linnea Hoheisel
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich, Germany
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Linda A Antonucci
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich, Germany
| | - Nora Penzel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Düsseldorf, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Dominic B Dwyer
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | | | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurosciences and Mental Health, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stephan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Stephen J Wood
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom; Birmingham Early Interventions Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Düsseldorf, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich, Germany
| | - Gereon R Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Silvia Daun
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; Institute of Zoology, University of Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
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9
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Tinch-Taylor R, Pickles A, Stringer D, Csipke E, Cella M, McCrone P, Reeder C, Birchwood M, Fowler D, Greenwood K, Johnson S, Perez J, Ritunnano R, Thompson A, Upthegrove R, Wilson J, Kenny A, Isok I, Joyce EM, Wykes T. Understanding the Mechanisms of Cognitive Remediation on Recovery in People With Early Psychosis: A Mediation and Moderation Analysis. Schizophr Bull 2024:sbae021. [PMID: 38428943 DOI: 10.1093/schbul/sbae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
BACKGROUND To provide precision cognitive remediation therapy (CR) for schizophrenia, we need to understand whether the mechanism for improved functioning is via cognition improvements. This mechanism has not been rigorously tested for potential moderator effects. STUDY DESIGN We used data (n = 377) from a randomized controlled trial using CIRCuiTS, a therapist-supported CR, with participants from first-episode psychosis services. We applied structured equation modeling to test whether: (1) CR hours explain the goal attainment functional outcome (GAS) at posttreatment, (2) global cognitive improvement mediates GAS, and if (3) total symptoms moderate the CR hours to cognitive improvement pathway, and/or negative symptoms moderate the cognition to functioning pathway, testing moderator effects via the mediator or directly on CR hours to functioning path. STUDY RESULTS CR produced significant functioning benefit for each therapy hour (Coeff = 0.203, 95% CI 0.101-0.304, P < .001). The mediated path from CR hours to cognition and cognition to functioning was small and nonsignificant (Coeff = 0.014, 95% CI = -0.010, 0.037, P = .256). Total symptoms did not moderate the path to cognition (P = .211) or the direct path to outcome (P = .896). However, negative symptoms significantly moderated the effect of cognitive improvements on functioning (P = .015) with high negative symptoms reducing the functional gains of improved cognition. CONCLUSIONS Although cognitive improvements were correlated with functioning benefit, they did not fully explain the positive effect of increased therapy hours on functioning, suggesting additional CR factors also contribute to therapy benefit. Negative symptoms interfere with the translation of cognitive improvements into functional gains so need consideration.
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Affiliation(s)
- Rose Tinch-Taylor
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dominic Stringer
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emese Csipke
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matteo Cella
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Paul McCrone
- School of Health Sciences, University of Greenwich, London, UK
| | - Clare Reeder
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
| | | | - Sonia Johnson
- Faculty of Brain Sciences, University College London, London, UK
| | - Jesus Perez
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Rosa Ritunnano
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alex Kenny
- Patient Advisory Board, King's College London, London, UK
| | - Iris Isok
- Patient Advisory Board, King's College London, London, UK
| | - Eileen M Joyce
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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10
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Bhui K, Joseph D, Khan N, Morrey T, Mooney R, Zahid U, Mackay T, Larkin M, Keating F, McCrone P, Upthegrove R, Griffiths SL, Edge D, Coventry PA, Arday J, Hosang GM. Experience-based Investigation and Co-design of Psychosis Centred Integrated Care Services for Ethnically Diverse People with Multimorbidity (CoPICS): study protocol. BMJ Open 2024; 14:e084121. [PMID: 38418242 PMCID: PMC10910695 DOI: 10.1136/bmjopen-2024-084121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/25/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Ethnic minorities (also called racialised groups) are more likely to experience severe mental illness (SMI). People with SMI are more likely to experience multimorbidity (MM), making psychosis among racialised groups more likely to lead to MM, poor outcomes, disability and premature mortality. METHODS AND ANALYSIS This National Institute for Health and Care Research-funded study (151887) seeks to use innovative participatory methods including photovoice and biographical narrative interviews in urban and rural areas of England to assemble experience data. These data will be subjected to polytextual thematic analysis, and alongside pictures and captions, will inform an experienced-based co-design of interventions, the implementation of which will be evaluated. There will be an economic analysis and a process evaluation of the implementation. ETHICS AND DISSEMINATION This programme of work has received ethical (IRAS 322421; Newcastle North Tyneside Research Ethics Committee 23/NE/0143) and sponsor approval. The findings will be disseminated in galleries showing the creative work, as lay and academic summaries and infographics; as practice briefings for practitioners, commissioners and policy makers; peer-reviewed publications. TRIAL REGISTRATION NUMBER https://www.researchregistry.com/browse-the-registry%23home/registrationdetails/649c08111c037d0027b17d17/.
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Affiliation(s)
- Kamaldeep Bhui
- Psychiatry, University of Oxford, Oxford, UK
- Queen Mary University of London, London, UK
| | | | - Nimra Khan
- Psychiatry, University of Oxford, Oxford, UK
| | - Tara Morrey
- Psychiatry, University of Oxford, Oxford, UK
| | | | | | | | | | - Frank Keating
- Department of Social Work, Royal Holloway University of London, Egham, UK
| | | | - Rachel Upthegrove
- Department of Psychiatry, School of Psychology and College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Early Intervention Service, Forward Thinking Birmingham, Birmingham, UK
| | | | - Dawn Edge
- University of Manchester, Manchester, UK
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11
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Bhui K, O'Brien A, Upthegrove R, Tsai AC, Soomro M, Newton-Howes G, Broome MR, Forrester A, Casey P, Doherty AM, Lee W, Kaufman KR. Protecting and promoting editorial independence. Br J Psychiatry 2024:1-3. [PMID: 38356355 DOI: 10.1192/bjp.2024.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
We argue that editorial independence, through robust practice of publication ethics and research integrity, promotes good science and prevents bad science. We elucidate the concept of research integrity, and then discuss the dimensions of editorial independence. Best practice guidelines exist, but compliance with these guidelines varies. Therefore, we make recommendations for protecting and strengthening editorial independence.
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Affiliation(s)
- Kamaldeep Bhui
- Department of Psychiatry, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK; East London NHS Foundation Trust, UK; and World Psychiatric Association Collaborating Centre, Oxford, UK
| | - Aileen O'Brien
- Population Health Research Institute, St George's University of London, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, UK; Birmingham Early Intervention Services, UK; and Birmingham Women's and Children's NHS Foundation Trust, UK
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; and Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Matthew R Broome
- Institute for Mental Health, University of Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, UK; and Oxford Uehiro Centre for Practical Ethics, University of Oxford, UK
| | - Andrew Forrester
- Department of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Patricia Casey
- Hermitage Medical Clinic, Dublin, Ireland; and University College Dublin, Ireland
| | | | | | - Kenneth R Kaufman
- Departments of Psychiatry and Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; and Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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12
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Casetta C, Santosh P, Bayley R, Bisson J, Byford S, Dixon C, Drake RJ, Elvins R, Emsley R, Fung N, Hayes D, Howes O, James A, James K, Jones R, Killaspy H, Lennox B, Marchant L, McGuire P, Oloyede E, Rogdaki M, Upthegrove R, Walters J, Egerton A, MacCabe JH. CLEAR - clozapine in early psychosis: study protocol for a multi-centre, randomised controlled trial of clozapine vs other antipsychotics for young people with treatment resistant schizophrenia in real world settings. BMC Psychiatry 2024; 24:122. [PMID: 38355533 PMCID: PMC10865566 DOI: 10.1186/s12888-023-05397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/22/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Clozapine is an antipsychotic drug with unique efficacy, and it is the only recommended treatment for treatment-resistant schizophrenia (TRS: failure to respond to at least two different antipsychotics). However, clozapine is also associated with a range of adverse effects which restrict its use, including blood dyscrasias, for which haematological monitoring is required. As treatment resistance is recognised earlier in the illness, the question of whether clozapine should be prescribed in children and young people is increasingly important. However, most research to date has been in older, chronic patients, and evidence regarding the efficacy and safety of clozapine in people under age 25 is lacking. The CLEAR (CLozapine in EARly psychosis) trial will assess whether clozapine is more effective than treatment as usual (TAU), at the level of clinical symptoms, patient rated outcomes, quality of life and cost-effectiveness in people below 25 years of age. Additionally, a nested biomarker study will investigate the mechanisms of action of clozapine compared to TAU. METHODS AND DESIGN This is the protocol of a multi-centre, open label, blind-rated, randomised controlled effectiveness trial of clozapine vs TAU (any other oral antipsychotic monotherapy licenced in the British National Formulary) for 12 weeks in 260 children and young people with TRS (12-24 years old). AIM AND OBJECTIVES The primary outcome is the change in blind-rated Positive and Negative Syndrome Scale scores at 12 weeks from baseline. Secondary outcomes include blind-rated Clinical Global Impression, patient-rated outcomes, quality of life, adverse effects, and treatment adherence. Patients will be followed up for 12 months and will be invited to give consent for longer term follow-up using clinical records and potential re-contact for further research. For mechanism of action, change in brain magnetic resonance imaging (MRI) biomarkers and peripheral inflammatory markers will be measured over 12 weeks. DISCUSSION The CLEAR trial will contribute knowledge on clozapine effectiveness, safety and cost-effectiveness compared to standard antipsychotics in young people with TRS, and the results may guide future clinical treatment recommendation for early psychosis. TRIAL REGISTRATION ISRCTN Number: 37176025, IRAS Number: 1004947. TRIAL STATUS In set-up. Protocol version 4.0 01/08/23. Current up to date protocol available here: https://fundingawards.nihr.ac.uk/award/NIHR131175# /.
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Affiliation(s)
- C Casetta
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - P Santosh
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R Bayley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - S Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - C Dixon
- Wonford House Hospital, Devon Partnership NHS Trust, Exeter, UK
| | - R J Drake
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - R Elvins
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - R Emsley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - N Fung
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - D Hayes
- South London and Maudsley NHS Foundation Trust, London, UK
| | - O Howes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A James
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - K James
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - R Jones
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - H Killaspy
- Division of Psychiatry, University College London, London, UK
| | - B Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - L Marchant
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - P McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - E Oloyede
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - M Rogdaki
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Birmingham Early Intervention Service, Birmingham Womens and Childrens NHS Foundation Trust, Birmingham, UK
| | - J Walters
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - A Egerton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J H MacCabe
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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13
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Şahin D, Kambeitz-Ilankovic L, Wood S, Dwyer D, Upthegrove R, Salokangas R, Borgwardt S, Brambilla P, Meisenzahl E, Ruhrmann S, Schultze-Lutter F, Lencer R, Bertolino A, Pantelis C, Koutsouleris N, Kambeitz J. Algorithmic fairness in precision psychiatry: analysis of prediction models in individuals at clinical high risk for psychosis. Br J Psychiatry 2024; 224:55-65. [PMID: 37936347 DOI: 10.1192/bjp.2023.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Computational models offer promising potential for personalised treatment of psychiatric diseases. For their clinical deployment, fairness must be evaluated alongside accuracy. Fairness requires predictive models to not unfairly disadvantage specific demographic groups. Failure to assess model fairness prior to use risks perpetuating healthcare inequalities. Despite its importance, empirical investigation of fairness in predictive models for psychiatry remains scarce. AIMS To evaluate fairness in prediction models for development of psychosis and functional outcome. METHOD Using data from the PRONIA study, we examined fairness in 13 published models for prediction of transition to psychosis (n = 11) and functional outcome (n = 2) in people at clinical high risk for psychosis or with recent-onset depression. Using accuracy equality, predictive parity, false-positive error rate balance and false-negative error rate balance, we evaluated relevant fairness aspects for the demographic attributes 'gender' and 'educational attainment' and compared them with the fairness of clinicians' judgements. RESULTS Our findings indicate systematic bias towards assigning less favourable outcomes to individuals with lower educational attainment in both prediction models and clinicians' judgements, resulting in higher false-positive rates in 7 of 11 models for transition to psychosis. Interestingly, the bias patterns observed in algorithmic predictions were not significantly more pronounced than those in clinicians' predictions. CONCLUSIONS Educational bias was present in algorithmic and clinicians' predictions, assuming more favourable outcomes for individuals with higher educational level (years of education). This bias might lead to increased stigma and psychosocial burden in patients with lower educational attainment and suboptimal psychosis prevention in those with higher educational attainment.
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Affiliation(s)
- Derya Şahin
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; and Department of Psychology, Faculty of Psychology and Educational Sciences, Ludwig-Maximilian University, Munich, Germany
| | - Stephen Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia; and Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Dominic Dwyer
- Department of Psychology, Faculty of Psychology and Educational Sciences, Ludwig-Maximilian University, Munich, Germany; and Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, UK; and Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Stefan Borgwardt
- Department of Psychiatry (University Psychiatric Clinics, UPK), University of Basel, Basel, Switzerland; and Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia; and University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany; and Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
| | - Nikolaos Koutsouleris
- Department of Psychology, Faculty of Psychology and Educational Sciences, Ludwig-Maximilian University, Munich, Germany; Max-Planck Institute of Psychiatry, Munich, Germany; and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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14
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Wenzel J, Badde L, Haas SS, Bonivento C, Van Rheenen TE, Antonucci LA, Ruef A, Penzel N, Rosen M, Lichtenstein T, Lalousis PA, Paolini M, Stainton A, Dannlowski U, Romer G, Brambilla P, Wood SJ, Upthegrove R, Borgwardt S, Meisenzahl E, Salokangas RKR, Pantelis C, Lencer R, Bertolino A, Kambeitz J, Koutsouleris N, Dwyer DB, Kambeitz-Ilankovic L. Transdiagnostic subgroups of cognitive impairment in early affective and psychotic illness. Neuropsychopharmacology 2024; 49:573-583. [PMID: 37737273 PMCID: PMC10789737 DOI: 10.1038/s41386-023-01729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/03/2023] [Accepted: 08/26/2023] [Indexed: 09/23/2023]
Abstract
Cognitively impaired and spared patient subgroups were identified in psychosis and depression, and in clinical high-risk for psychosis (CHR). Studies suggest differences in underlying brain structural and functional characteristics. It is unclear whether cognitive subgroups are transdiagnostic phenomena in early stages of psychotic and affective disorder which can be validated on the neural level. Patients with recent-onset psychosis (ROP; N = 140; female = 54), recent-onset depression (ROD; N = 130; female = 73), CHR (N = 128; female = 61) and healthy controls (HC; N = 270; female = 165) were recruited through the multi-site study PRONIA. The transdiagnostic sample and individual study groups were clustered into subgroups based on their performance in eight cognitive domains and characterized by gray matter volume (sMRI) and resting-state functional connectivity (rsFC) using support vector machine (SVM) classification. We identified an impaired subgroup (NROP = 79, NROD = 30, NCHR = 37) showing cognitive impairment in executive functioning, working memory, processing speed and verbal learning (all p < 0.001). A spared subgroup (NROP = 61, NROD = 100, NCHR = 91) performed comparable to HC. Single-disease subgroups indicated that cognitive impairment is stronger pronounced in impaired ROP compared to impaired ROD and CHR. Subgroups in ROP and ROD showed specific symptom- and functioning-patterns. rsFC showed superior accuracy compared to sMRI in differentiating transdiagnostic subgroups from HC (BACimpaired = 58.5%; BACspared = 61.7%, both: p < 0.01). Cognitive findings were validated in the PRONIA replication sample (N = 409). Individual cognitive subgroups in ROP, ROD and CHR are more informative than transdiagnostic subgroups as they map onto individual cognitive impairment and specific functioning- and symptom-patterns which show limited overlap in sMRI and rsFC. CLINICAL TRIAL REGISTRY NAME: German Clinical Trials Register (DRKS). Clinical trial registry URL: https://www.drks.de/drks_web/ . Clinical trial registry number: DRKS00005042.
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Affiliation(s)
- Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
| | - Luzie Badde
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, NY, USA
| | | | - Tamsyn E Van Rheenen
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Melbourne, VIC, Australia
| | - Linda A Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
- Department of Translational Biomedicine and Neuroscience - University of Bari Aldo Moro, Bari, Italy
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Department of Translational Biomedicine and Neuroscience - University of Bari Aldo Moro, Bari, Italy
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Paris Alexandros Lalousis
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - Marco Paolini
- Department of Radiology, University Hospital, Ludwig-Maximilian University, Munich, Germany
| | - Alexandra Stainton
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Muenster, Münster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University of Münster, Münster, Germany
| | - Paolo Brambilla
- Department of Neuosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Mental Health, University of Milan, Milan, Italy
| | - Stephen J Wood
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Rachel Upthegrove
- School of Psychology, University of Birmingham, Birmingham, UK
- Institute of Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Stefan Borgwardt
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Western Health, Melbourne, VIC, Australia
| | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Muenster, Münster, Germany
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Alessandro Bertolino
- Department of Translational Biomedicine and Neuroscience - University of Bari Aldo Moro, Bari, Italy
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, UK
- Max Planck Institute for Psychiatry, Munich, Germany
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
- Orygen, Melbourne, VIC, Australia
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Munich, Germany
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15
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Walter N, Wenzel J, Haas SS, Squarcina L, Bonivento C, Ruef A, Dwyer D, Lichtenstein T, Bastrük Ö, Stainton A, Antonucci LA, Brambilla P, Wood SJ, Upthegrove R, Borgwardt S, Lencer R, Meisenzahl E, Salokangas RKR, Pantelis C, Bertolino A, Koutsouleris N, Kambeitz J, Kambeitz-Ilankovic L. A multivariate cognitive approach to predict social functioning in recent onset psychosis in response to computerized cognitive training. Prog Neuropsychopharmacol Biol Psychiatry 2024; 128:110864. [PMID: 37717645 DOI: 10.1016/j.pnpbp.2023.110864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/01/2023] [Accepted: 09/13/2023] [Indexed: 09/19/2023]
Abstract
Clinical and neuroimaging data has been increasingly used in recent years to disentangle heterogeneity of treatment response to cognitive training (CT) and predict which individuals may achieve the highest benefits. CT has small to medium effects on improving cognitive and social functioning in recent onset psychosis (ROP) patients, who show the most profound cognitive and social functioning deficits among psychiatric patients. We employed multivariate pattern analysis (MVPA) to investigate the potential of cognitive data to predict social functioning improvement in response to 10 h of CT in patients with ROP. A support vector machine (SVM) classifier was trained on the naturalistic data of the Personalized Prognostic Tools for Early Psychosis Management (PRONIA) study sample to predict functioning in an independent sample of 70 ROP patients using baseline cognitive data. PRONIA is a part of a FP7 EU grant program that involved 7 sites across 5 European countries, designed and conducted with the main aim of identifying (bio)markers associated with an enhanced risk of developing psychosis in order to improve early detection and prognosis. Social functioning was predicted with a balanced accuracy (BAC) of 66.4% (Sensitivity 78.8%; Specificity 54.1%; PPV 60.5%; NPV 74.1%; AUC 0.64; P = 0.01). The most frequently selected cognitive features (mean feature weights > ± 0.2) included the (1) correct number of symbol matchings within the Digit Symbol Substitution Test, (2) the number of distracting stimuli leading to an error within 300 and 200 trials in the Continuous Performance Test and (3) the dynamics of verbal fluency between 15 and 30 s within the Verbal Fluency Test, phonetic part. Next, the SVM classifier generated on the PRONIA sample was applied to the intervention sample, that obtained 54 ROP patients who were randomly assigned to a social cognitive training (SCT) or treatment as usual (TAU) group and dichotomized into good (GF-S ≥ 7) and poor (GF-S < 7) functioning patients based on their level of Global Functioning-Social (GF-S) score at follow-up (FU). By applying the initial PRONIA classifier, using out-of-sample cross-validation (OOCV) to the sample of ROP patients who have undergone the CT intervention, a BAC of 59.3% (Sensitivity 70.4%; Specificity 48.1%; PPV 57.6%; NPV 61.9%; AUC 0.63) was achieved at T0 and a BAC of 64.8% (Sensitivity 66.7%; Specificity 63.0%; PPV 64.3%; NPV 65.4%; AUC 0.66) at FU. After SCT intervention, a significant improvement in predicted social functioning values was observed in the SCT compared to TAU group (P ≤0.05; ES[Cohens' d] = 0.18). Due to a small sample size and modest variance of social functioning of the intervention sample it was not feasible to predict individual response to SCT in the current study. Our findings suggest that the use of baseline cognitive data could provide a robust individual estimate of future social functioning, while prediction of individual response to SCT using cognitive data that can be generated in the routine patient care remains to be addressed in large-scale cognitive training trials.
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Affiliation(s)
- Nina Walter
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America
| | | | | | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Orygen Youth Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Öznur Bastrük
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Alexandra Stainton
- Orygen Youth Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Linda A Antonucci
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Paolo Brambilla
- Department of Neuosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Mental Health, University of Milan, Milan, Italy
| | - Stephen J Wood
- Orygen Youth Health, Melbourne, Australia; School of Psychology, University of Birmingham, United Kingdom; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Rachel Upthegrove
- School of Psychology, University of Birmingham, United Kingdom; Institute of Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Stefan Borgwardt
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Germany
| | - Rebekka Lencer
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & NorthWestern Mental Health, Melbourne, Australia
| | - Alessandro Bertolino
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany; Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany; Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Munich, Germany.
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16
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Griffiths K, Mellado MR, Chung R, Lally J, McQueen G, Sendt KV, Gillespie A, Ibrahim M, Richter A, Shields A, Ponsford M, Jolles S, Hodsoll J, Pollak TA, Upthegrove R, Egerton A, MacCabe JH. Changes in immunoglobulin levels during clozapine treatment in schizophrenia. Brain Behav Immun 2024; 115:223-228. [PMID: 37832895 DOI: 10.1016/j.bbi.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/20/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND AND HYPOTHESIS Use of clozapine in treatment-resistant schizophrenia is often limited due to risk of adverse effects. Cross-sectional associations between clozapine treatment and low immunoglobulin levels have been reported, however prospective studies are required to establish temporal relationships. We tested the hypothesis that reductions in immunoglobulin levels would occur over the first 6 months following initiation of clozapine treatment. Relationships between immunoglobulin levels and symptom severity over the course of clozapine treatment were also explored. DESIGN This prospective observational study measured immunoglobulin (Ig) levels (A, M and G) in 56 patients with treatment-resistant schizophrenia at 6-, 12- and 24-weeks following initiation with clozapine. Clinical symptoms were also measured at 12 weeks using the positive and negative syndrome scale (PANSS). RESULTS IgA, IgG and IgM all decreased during clozapine treatment. For IgA and IgG the reduction was significant at 24 weeks (IgA: β = -32.66, 95% CI = -62.38, -2.93, p = 0.03; IgG: β = -63.96, 95% CI = -118.00, -9.31, p = 0.02). For IgM the reduction was significant at 12 and 24 weeks (12 weeks: β = -23.48, 95% CI = -39.56, -7.42, p = 0.004; 24 weeks: β = -33.12, 95 %CI = -50.30, -15.94, p = <0.001). Reductions in IgA and IgG during clozapine treatment were correlated with reductions in PANSS-total over 12 weeks (n = 32, IgA r = 0.59, p = 0.005; IgG r = 0.48, p = 0.03). CONCLUSIONS The observed reductions in immunoglobulin levels over six months of clozapine treatment add further evidence linking clozapine to secondary antibody deficiency. Associations between Ig reduction and symptom improvement may however indicate that immune mechanisms contribute to both desirable and undesirable effects of clozapine.
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Affiliation(s)
- Kira Griffiths
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK
| | - Maria Ruiz Mellado
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK
| | - Raymond Chung
- Department of Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK
| | - John Lally
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK; Department of Psychiatry, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland; Department of Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Grant McQueen
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK
| | - Kyra-Verena Sendt
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK
| | | | - Muhammad Ibrahim
- Department of Immunobiology, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Alex Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Adrian Shields
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Mark Ponsford
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK; Henry Wellcome Building, School of Medicine, Cardiff University, Cardiff, UK
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - John Hodsoll
- Department of Biostatistics and Health Informatics, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK
| | - Thomas A Pollak
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, UK; Early Intervention Service, Birmingham Womens and Childrens NHS Foundation Trust, UK
| | - Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK
| | - James H MacCabe
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK.
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17
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Murray AJ, Humpston CS, Wilson M, Rogers JC, Zia Ul Haq Katshu M, Liddle PF, Upthegrove R. Measurement of brain glutathione with magnetic Resonance spectroscopy in Schizophrenia-Spectrum disorders - A systematic review and Meta-Analysis. Brain Behav Immun 2024; 115:3-12. [PMID: 37769980 DOI: 10.1016/j.bbi.2023.09.017] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/14/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023] Open
Abstract
Oxidative stress may contribute to declining course and poor outcomes in psychosis. However, in vivo Magnetic Resonance Spectroscopy studies yield disparate results due to clinical stage, sample demographics, neuroanatomical focus, sample size, and acquisition method variations. We investigated glutathione in brain regions from participants with psychosis, and the relation of glutathione to clinical features and spectroscopy protocols. Meta-analysis comprised 21 studies. Glutathione levels did not differ between total psychosis patients (N = 639) and controls (N = 704) in the Medial Prefrontal region (k = 21, d = -0.09, CI = -0.28 to 0.10, p = 0.37). Patients with stable schizophrenia exhibited a small but significant glutathione reduction compared to controls (k = 14, d = -0.20, CI = -0.40 to -0.00, p = 0.05). Meta-regression showed older studies had greater glutathione reductions, possibly reflecting greater accuracy related to spectroscopy advancements in more recent studies. No significant effects of methodological variables, such as voxel size or echo time were found. Reduced glutathione in patients with stable established schizophrenia may provide novel targets for precision medicine. Standardizing MRS acquisition methods in future studies may help address discrepancies in glutathione levels.
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Affiliation(s)
- Alex J Murray
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, United Kingdom.
| | - Clara S Humpston
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Department of Psychology, University of York, York, United Kingdom
| | - Martin Wilson
- Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Jack C Rogers
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Mohammad Zia Ul Haq Katshu
- Institute of Mental Health, Division of Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom; Nottinghamshire Healthcare National Health Service Foundation Trust, Nottingham, United Kingdom
| | - Peter F Liddle
- Institute of Mental Health, Division of Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, United Kingdom; Early Intervention Service, Birmingham Women's and Children's National Health Service Foundation Trust, Birmingham, United Kingdom
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18
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Howe J, MacPhee M, Duddy C, Habib H, Wong G, Jacklin S, Oduola S, Upthegrove R, Carlish M, Allen K, Patterson E, Maidment I. A realist review of medication optimisation of community dwelling service users with serious mental illness. BMJ Qual Saf 2023:bmjqs-2023-016615. [PMID: 38071586 DOI: 10.1136/bmjqs-2023-016615] [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: 08/06/2023] [Accepted: 10/14/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Severe mental illness (SMI) incorporates schizophrenia, bipolar disorder, non-organic psychosis, personality disorder or any other severe and enduring mental health illness. Medication, particularly antipsychotics and mood stabilisers are the main treatment options. Medication optimisation is a hallmark of medication safety, characterised by the use of collaborative, person-centred approaches. There is very little published research describing medication optimisation with people living with SMI. OBJECTIVE Published literature and two stakeholder groups were employed to answer: What works for whom and in what circumstances to optimise medication use with people living with SMI in the community? METHODS A five-stage realist review was co-conducted with a lived experience group of individuals living with SMI and a practitioner group caring for individuals with SMI. An initial programme theory was developed. A formal literature search was conducted across eight bibliographic databases, and literature were screened for relevance to programme theory refinement. In total 60 papers contributed to the review. 42 papers were from the original database search with 18 papers identified from additional database searches and citation searches conducted based on stakeholder recommendations. RESULTS Our programme theory represents a continuum from a service user's initial diagnosis of SMI to therapeutic alliance development with practitioners, followed by mutual exchange of information, shared decision-making and medication optimisation. Accompanying the programme theory are 11 context-mechanism-outcome configurations that propose evidence-informed contextual factors and mechanisms that either facilitate or impede medication optimisation. Two mid-range theories highlighted in this review are supported decision-making and trust formation. CONCLUSIONS Supported decision-making and trust are foundational to overcoming stigma and establishing 'safety' and comfort between service users and practitioners. Avenues for future research include the influence of stigma and equity across cultural and ethnic groups with individuals with SMI; and use of trained supports, such as peer support workers. PROSPERO REGISTRATION NUMBER CRD42021280980.
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Affiliation(s)
- Jo Howe
- Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Maura MacPhee
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire Duddy
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hafsah Habib
- Pharmacy School, Aston University College of Health and Life Sciences, Birmingham, UK
| | - Geoff Wong
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Jacklin
- School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Sheri Oduola
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Max Carlish
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Katherine Allen
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Emma Patterson
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Ian Maidment
- Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
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19
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Buciuman MO, Oeztuerk OF, Popovic D, Enrico P, Ruef A, Bieler N, Sarisik E, Weiske J, Dong MS, Dwyer DB, Kambeitz-Ilankovic L, Haas SS, Stainton A, Ruhrmann S, Chisholm K, Kambeitz J, Riecher-Rössler A, Upthegrove R, Schultze-Lutter F, Salokangas RKR, Hietala J, Pantelis C, Lencer R, Meisenzahl E, Wood SJ, Brambilla P, Borgwardt S, Falkai P, Antonucci LA, Bertolino A, Liddle P, Koutsouleris N. Structural and Functional Brain Patterns Predict Formal Thought Disorder's Severity and Its Persistence in Recent-Onset Psychosis: Results From the PRONIA Study. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:1207-1217. [PMID: 37343661 DOI: 10.1016/j.bpsc.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Formal thought disorder (FThD) is a core feature of psychosis, and its severity and long-term persistence relates to poor clinical outcomes. However, advances in developing early recognition and management tools for FThD are hindered by a lack of insight into the brain-level predictors of FThD states and progression at the individual level. METHODS Two hundred thirty-three individuals with recent-onset psychosis were drawn from the multisite European Prognostic Tools for Early Psychosis Management study. Support vector machine classifiers were trained within a cross-validation framework to separate two FThD symptom-based subgroups (high vs. low FThD severity), using cross-sectional whole-brain multiband fractional amplitude of low frequency fluctuations, gray matter volume and white matter volume data. Moreover, we trained machine learning models on these neuroimaging readouts to predict the persistence of high FThD subgroup membership from baseline to 1-year follow-up. RESULTS Cross-sectionally, multivariate patterns of gray matter volume within the salience, dorsal attention, visual, and ventral attention networks separated the FThD severity subgroups (balanced accuracy [BAC] = 60.8%). Longitudinally, distributed activations/deactivations within all fractional amplitude of low frequency fluctuation sub-bands (BACslow-5 = 73.2%, BACslow-4 = 72.9%, BACslow-3 = 68.0%), gray matter volume patterns overlapping with the cross-sectional ones (BAC = 62.7%), and smaller frontal white matter volume (BAC = 73.1%) predicted the persistence of high FThD severity from baseline to follow-up, with a combined multimodal balanced accuracy of BAC = 77%. CONCLUSIONS We report the first evidence of brain structural and functional patterns predictive of FThD severity and persistence in early psychosis. These findings open up avenues for the development of neuroimaging-based diagnostic, prognostic, and treatment options for the early recognition and management of FThD and associated poor outcomes.
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Affiliation(s)
- Madalina-Octavia Buciuman
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany
| | - Oemer Faruk Oeztuerk
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany
| | - David Popovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany
| | - Paolo Enrico
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Nadia Bieler
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Elif Sarisik
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany
| | - Johanna Weiske
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Mark Sen Dong
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexandra Stainton
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | | | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | | | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-Universität, Düsseldorf, Germany; Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Carlton South, Melbourne, Victoria, Australia; NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Stephen J Wood
- Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia; School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lüebeck, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany
| | - Linda A Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy; Department of Translational Biomedicine and Neuroscience (DiBraiN) - University of Bari "Aldo Moro," Bari, Italy
| | - Peter Liddle
- Division of Mental Health and Clinical Neuroscience, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
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Thomas M, Rakesh D, Whittle S, Sheridan M, Upthegrove R, Cropley V. The neural, stress hormone and inflammatory correlates of childhood deprivation and threat in psychosis: A systematic review. Psychoneuroendocrinology 2023; 157:106371. [PMID: 37651860 DOI: 10.1016/j.psyneuen.2023.106371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
Childhood adversity increases the risk of developing psychosis, but the biological mechanisms involved are unknown. Disaggregating early adverse experiences into core dimensions of deprivation and threat may help to elucidate these mechanisms. We therefore systematically searched the literature investigating associations between deprivation and threat, and neural, immune and stress hormone systems in individuals on the psychosis spectrum. Our search yielded 74 articles, from which we extracted and synthesized relevant findings. While study designs were heterogeneous and findings inconsistent, some trends emerged. In psychosis, deprivation tended to correlate with lower global cortical volume, and some evidence supported threat-related variation in prefrontal cortex morphology. Greater threat exposure was also associated with higher C-reactive protein, and higher and lower cortisol measures. When examined, associations in controls were less evident. Overall, findings indicate that deprivation and threat may associate with partially distinct biological mechanisms in the psychosis spectrum, and that associations may be stronger than in controls. Dimensional approaches may help disentangle the biological correlates of childhood adversity in psychosis, but more studies are needed.
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Affiliation(s)
- Megan Thomas
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia.
| | - Divyangana Rakesh
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia; Neuroimaging Department, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, United Kingdom
| | - Sarah Whittle
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia
| | - Margaret Sheridan
- Department of Psychology & Neuroscience, University of North Carolina, United States
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, United Kingdom; Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, United Kingdom
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia
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Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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Palmer ER, Griffiths SL, Watkins B, Weetman T, Ottridge R, Patel S, Woolley R, Tearne S, Au P, Taylor E, Sadiq Z, Al-Janabi H, Major B, Marriott C, Husain N, Katshu MZUH, Giacco D, Barnes NM, Walters JTR, Barnes TRE, Birchwood M, Drake R, Upthegrove R. Antidepressants for the prevention of depression following first-episode psychosis (ADEPP): study protocol for a multi-centre, double-blind, randomised controlled trial. Trials 2023; 24:646. [PMID: 37803384 PMCID: PMC10557320 DOI: 10.1186/s13063-023-07499-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/06/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Depressive episodes are common after first-episode psychosis (FEP), affecting more than 40% of people, adding to individual burden, poor outcomes, and healthcare costs. If the risks of developing depression were lower, this could have a beneficial effect on morbidity and mortality, as well as improving outcomes. Sertraline is a selective serotonin reuptake inhibitor and a common first-line medication for the treatment of depression in adults. It has been shown to be safe when co-prescribed with antipsychotic medication, and there is evidence that it is an effective treatment for depression in established schizophrenia. We present a protocol for a multi-centre, double-blind, randomised, placebo-controlled clinical trial called ADEPP that aims to investigate the efficacy and cost-effectiveness of sertraline in preventing depression after FEP. METHODS The recruitment target is 452 participants between the ages of 18 and 65 years who are within 12 months of treatment initiation for FEP. Having provided informed consent, participants will be randomised to receive either 50 mg of sertraline daily or matched placebo for 6 months, in addition to treatment as usual. The primary outcome measure will be a comparison of the number of new cases of depression between the treatment and placebo arms over the 6-month intervention phase. Secondary outcomes include suicidal behaviour, anxiety, rates of relapse, functional outcome, quality of life, and resource use. DISCUSSION The ADEPP trial will test whether the addition of sertraline following FEP is a clinically useful, acceptable, and cost-effective way of improving outcomes following FEP. TRIAL REGISTRATION ISRCTN12682719 registration date 24/11/2020.
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Affiliation(s)
- Edward R Palmer
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
- Early Intervention Service, Birmingham Women's and Children's NHS Trust, Birmingham, UK
| | - Siân Lowri Griffiths
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Ben Watkins
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Tyler Weetman
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- Early Intervention Service, Birmingham Women's and Children's NHS Trust, Birmingham, UK
| | - Ryan Ottridge
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Smitaa Patel
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Sarah Tearne
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Pui Au
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Eleanor Taylor
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Zara Sadiq
- Early Intervention Service, Birmingham Women's and Children's NHS Trust, Birmingham, UK
| | - Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Barnaby Major
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, UK
| | - Charlotte Marriott
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, UK
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Mersey Care NHS Foundation Trust, Merseyside, UK
| | - Mohammad Zia Ul Haq Katshu
- Institute of Mental Health, Division of Mental Health and Neurosciences University of Nottingham, Nottingham, UK
- Nottinghamshire Healthcare National Health Service Foundation Trust, Nottingham, UK
| | - Domenico Giacco
- Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Nicholas M Barnes
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - James T R Walters
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales, UK
| | | | - Max Birchwood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, UK
| | - Richard Drake
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Rachel Upthegrove
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK.
- Early Intervention Service, Birmingham Women's and Children's NHS Trust, Birmingham, UK.
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23
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Jones R, Morales-Munoz I, Shields A, Blackman G, Legge SE, Pritchard M, Kornblum D, MacCabe JH, Upthegrove R. Early neutrophil trajectory following clozapine may predict clozapine response - Results from an observational study using electronic health records. Brain Behav Immun 2023; 113:267-274. [PMID: 37494985 DOI: 10.1016/j.bbi.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/11/2023] [Accepted: 07/22/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Clozapine has unique effectiveness in treatment-resistant schizophrenia and is known to cause immunological side-effects. A transient spike in neutrophils commonly occurs in the first weeks of clozapine therapy. There is contradictory evidence in the literature as to whether neutrophil changes with clozapine are linked to treatment response. AIMS The current study aims to further examine the neutrophil changes in response to clozapine and explore any association between neutrophil trajectory and treatment response. METHODS A retrospective cohort study of patients undergoing their first treatment with clozapine and continuing for at least 2 years identified 425 patients (69% male/31% female). Neutrophil counts at baseline, 3 weeks and 1 month were obtained predominantly by linkage with data from the clozapine monitoring service. Clinical Global Impression- Severity (CGI-S) was rated from case notes at the time of clozapine initiation and at 2 years. Latent class growth analysis (LCGA) was performed to define distinct trajectories of neutrophil changes during the first month of treatment. Logistic regression was then conducted to investigate for association between the trajectory of neutrophil count changes in month 1 and clinical response at 2 years as well as between baseline neutrophil count and response. RESULTS Of the original cohort, 397 (93%) patients had useable neutrophil data during the first 6 weeks of clozapine treatment. LCGA revealed significant differences in neutrophil trajectories with a three-class model being the most parsimonious. The classes had similar trajectory profiles but differed primarily on overall neutrophil count: with low, high-normal and high neutrophil classes, comprising 52%, 40% and 8% of the sample respectively. Membership of the high-normal group was associated with significantly increased odds of a positive response to clozapine, as compared to the low neutrophil group [Odds ratio (OR) = 2.10, p-value = 0.002; 95% confidence interval (95% CI) = 1.31-3.36]. Baseline neutrophil count was a predictor of response to clozapine at 2 years, with counts of ≥5 × 109/l significantly associated with positive response (OR = 1.60, p-value = 0.03; 95% CI = 1.03-2.49). CONCLUSIONS Our data are consistent with the hypothesis that patients with low-level inflammation, reflected in a high-normal neutrophil count, are more likely to respond to clozapine, raising the possibility that clozapine exerts its superior efficacy via immune mechanisms.
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Affiliation(s)
- Rowena Jones
- Institute for Mental Health, School of Psychology, University of Birmingham, UK; Birmingham and Solihull Mental Health Foundation Trust, UK.
| | | | - Adrian Shields
- Clinical Immunology Service, University of Birmingham, UK
| | - Graham Blackman
- Department of Psychiatry, University of Oxford, Warneford Hospital, OX3 7JX, UK; Department of Psychosis Studies, King's College London, and South London and Maudsley NHS Foundation Trust, UK
| | - Sophie E Legge
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Daisy Kornblum
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - James H MacCabe
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK; Department of Psychosis Studies, King's College London, and South London and Maudsley NHS Foundation Trust, UK
| | - Rachel Upthegrove
- Institute for Mental Health, School of Psychology, University of Birmingham, UK; Early Intervention Service, Birmingham Women's and Children's NHS Trust, UK
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24
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Alexandros Lalousis P, Schmaal L, Wood SJ, L E P Reniers R, Cropley VL, Watson A, Pantelis C, Suckling J, Barnes NM, Pariante C, Jones PB, Joyce E, Barnes TRE, Lawrie SM, Husain N, Dazzan P, Deakin B, Shannon Weickert C, Upthegrove R. Inflammatory subgroups of schizophrenia and their association with brain structure: A semi-supervised machine learning examination of heterogeneity. Brain Behav Immun 2023; 113:166-175. [PMID: 37423513 DOI: 10.1016/j.bbi.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/15/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE Immune system dysfunction is hypothesised to contribute to structural brain changes through aberrant synaptic pruning in schizophrenia. However, evidence is mixed and there is a lack of evidence of inflammation and its effect on grey matter volume (GMV) in patients. We hypothesised that inflammatory subgroups can be identified and that the subgroups will show distinct neuroanatomical and neurocognitive profiles. METHODS The total sample consisted of 1067 participants (chronic patients with schizophrenia n = 467 and healthy controls (HCs) n = 600) from the Australia Schizophrenia Research Bank (ASRB) dataset, together with 218 recent-onset patients with schizophrenia from the external Benefit of Minocycline on Negative Symptoms of Psychosis: Extent and Mechanism (BeneMin) dataset. HYDRA (HeterogeneitY through DiscRiminant Analysis) was used to separate schizophrenia from HC and define disease-related subgroups based on inflammatory markers. Voxel-based morphometry and inferential statistics were used to explore GMV alterations and neurocognitive deficits in these subgroups. RESULTS An optimal clustering solution revealed five main schizophrenia groups separable from HC: Low Inflammation, Elevated CRP, Elevated IL-6/IL-8, Elevated IFN-γ, and Elevated IL-10 with an adjusted Rand index of 0.573. When compared with the healthy controls, the IL-6/IL-8 cluster showed the most widespread, including the anterior cingulate, GMV reduction. The IFN-γ inflammation cluster showed the least GMV reduction and impairment of cognitive performance. The CRP and the Low Inflammation clusters dominated in the younger external dataset. CONCLUSIONS Inflammation in schizophrenia may not be merely a case of low vs high, but rather there are pluripotent, heterogeneous mechanisms at play which could be reliably identified based on accessible, peripheral measures. This could inform the successful development of targeted interventions.
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Affiliation(s)
- Paris Alexandros Lalousis
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
| | - Lianne Schmaal
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Stephen J Wood
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Renate L E P Reniers
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom; Institute of Clinical Sciences, University of Birmingham, United Kingdom
| | - Vanessa L Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Andrew Watson
- The Department of Clinical and Motor Neuroscience, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia; NorthWestern Mental Health, Western Hospital Sunshine, St. Albans, Vicroria, Australia
| | - John Suckling
- Brain Mapping Unit, Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, United Kingdom; Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Nicholas M Barnes
- Institute for Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Carmine Pariante
- Stress, Psychiatry and Immunology Lab & Perinatal Psychiatry, The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom
| | - Peter B Jones
- Brain Mapping Unit, Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, United Kingdom; Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Eileen Joyce
- The Department of Clinical and Motor Neuroscience, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Thomas R E Barnes
- Division of Psychiatry, Imperial College London, London United Kingdom
| | - Stephen M Lawrie
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester & Mersey Care NHS Foundation Trust
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Bill Deakin
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Cynthia Shannon Weickert
- Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, NY, USA; Schizophrenia Research Laboratory, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom; Birmingham Early Interventions Service, Birmingham Women's and Children's NHS Foundation Trust, United Kingdom
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Stainton A, Chisholm K, Griffiths SL, Kambeitz-Ilankovic L, Wenzel J, Bonivento C, Brambilla P, Iqbal M, Lichtenstein TK, Rosen M, Antonucci LA, Maggioni E, Kambeitz J, Borgwardt S, Riecher-Rössler A, Andreou C, Schmidt A, Schultze-Lutter F, Meisenzahl E, Ruhrmann S, Salokangas RKR, Pantelis C, Lencer R, Romer G, Bertolino A, Upthegrove R, Koutsouleris N, Allott K, Wood SJ. Prevalence of cognitive impairments and strengths in the early course of psychosis and depression. Psychol Med 2023; 53:5945-5957. [PMID: 37409883 PMCID: PMC10520593 DOI: 10.1017/s0033291723001770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/12/2023] [Accepted: 06/01/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Studies investigating cognitive impairments in psychosis and depression have typically compared the average performance of the clinical group against healthy controls (HC), and do not report on the actual prevalence of cognitive impairments or strengths within these clinical groups. This information is essential so that clinical services can provide adequate resources to supporting cognitive functioning. Thus, we investigated this prevalence in individuals in the early course of psychosis or depression. METHODS A comprehensive cognitive test battery comprising 12 tests was completed by 1286 individuals aged 15-41 (mean age 25.07, s.d. 5.88) from the PRONIA study at baseline: HC (N = 454), clinical high risk for psychosis (CHR; N = 270), recent-onset depression (ROD; N = 267), and recent-onset psychosis (ROP; N = 295). Z-scores were calculated to estimate the prevalence of moderate or severe deficits or strengths (>2 s.d. or 1-2 s.d. below or above HC, respectively) for each cognitive test. RESULTS Impairment in at least two cognitive tests was as follows: ROP (88.3% moderately, 45.1% severely impaired), CHR (71.2% moderately, 22.4% severely impaired), ROD (61.6% moderately, 16.2% severely impaired). Across clinical groups, impairments were most prevalent in tests of working memory, processing speed, and verbal learning. Above average performance (>1 s.d.) in at least two tests was present for 40.5% ROD, 36.1% CHR, 16.1% ROP, and was >2 SDs in 1.8% ROD, 1.4% CHR, and 0% ROP. CONCLUSIONS These findings suggest that interventions should be tailored to the individual, with working memory, processing speed, and verbal learning likely to be important transdiagnostic targets.
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Affiliation(s)
- Alexandra Stainton
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Siân Lowri Griffiths
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Munich, Germany
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | | | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Mariam Iqbal
- Department of Psychology, Woodbourne Priory Hospital, Birmingham, UK
| | - Theresa K. Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Linda A. Antonucci
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari “Aldo Moro”, Bari, Italy
| | - Eleonora Maggioni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | | | - Christina Andreou
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - André Schmidt
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, VIC, Australia
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Georg Romer
- Department of Child Adolescent Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Alessandro Bertolino
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari “Aldo Moro”, Bari, Italy
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
- Birmingham Early Intervention Service, Birmingham Women's and Children NHS Foundation Trust, Birmingham, UK
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Max-Planck Institute of Psychiatry, Munich, Germany
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kelly Allott
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen J. Wood
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Psychology, University of Birmingham, Edgbaston, UK
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26
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Bonivento C, Kambeitz-Ilankovic L, Maggioni E, Borgwardt S, Lencer R, Meisenzahl E, Kambeitz J, Ruhrmann S, Salokangas RKR, Bertolino A, Stainton A, Wenzel J, Pantelis C, Wood SJ, Upthegrove R, Koutsouleris N, Brambilla P. Neurocognitive skills and vulnerability for psychosis in depression and across the psychotic spectrum: findings from the PRONIA Consortium. Br J Psychiatry 2023; 223:485-492. [PMID: 37846967 DOI: 10.1192/bjp.2023.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
BACKGROUND Neurocognitive deficits are a core feature of psychosis and depression. Despite commonalities in cognitive alterations, it remains unclear if and how the cognitive deficits in patients at clinical high risk for psychosis (CHR) and those with recent-onset psychosis (ROP) are distinct from those seen in recent-onset depression (ROD). AIMS This study was carried out within the European project 'Personalized Prognostic Tools for Early Psychosis Management', and aimed to characterise the cognitive profiles of patients with psychosis or depression. METHOD We examined cognitive profiles for patients with ROP (n = 105), patients with ROD (n = 123), patients at CHR (n = 116) and healthy controls (n = 372) across seven sites in five European countries. Confirmatory factor analysis identified four cognitive factors independent of gender, education and site: speed of processing, attention and working memory, verbal learning and spatial learning. RESULTS Patients with ROP performed worse than healthy controls in all four domains (P < 0.001), whereas performance of patients with ROD was not affected (P > 0.05). Patients at CHR performed worse than healthy controls in speed of processing (P = 0.001) and spatial learning (P = 0.003), but better than patients with ROP across all cognitive domains (all P ≤ 0.01). CHR and ROD groups did not significantly differ in any cognitive domain. These findings were independent of comorbid depressive symptoms, substance consumption and illness duration. CONCLUSIONS These results show that neurocognitive abilities are affected in CHR and ROP, whereas ROD seems spared. Although our findings may support the notion that those at CHR have a specific vulnerability to psychosis, future studies investigating broader transdiagnostic risk cohorts in longitudinal designs are needed.
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Affiliation(s)
| | - Lana Kambeitz-Ilankovic
- Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany; and Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Germany
| | - Eleonora Maggioni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy
| | - Stefan Borgwardt
- Translational Psychiatry Unit, Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - Rebekka Lencer
- Institute for Translational Psychiatry, Münster University, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Germany
| | - Joseph Kambeitz
- Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany; and Cognitive Neuroscience (INM-3), Institute of Neuroscience and Medicine, Research Center Jülich, Germany
| | - Stephan Ruhrmann
- Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
| | | | - Alessandro Bertolino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Italy
| | - Alexandra Stainton
- Orygen, Melbourne, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
| | - Julian Wenzel
- Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Australia
| | - Stephen J Wood
- Orygen, Melbourne, Australia; School of Psychology, University of Birmingham, UK; and Centre for Youth Mental Health, University of Melbourne, Australia
| | - Rachel Upthegrove
- School of Psychology, University of Birmingham, UK; Institute for Mental Health, University of Birmingham, UK; and Centre for Human Brain Health, University of Birmingham, UK
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Germany; Max Planck Institute for Psychiatry, Germany; and Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; and Department of Pathophysiology and Transplantation, University of Milan, Italy
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27
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Evans J, Tinch-Taylor R, Csipke E, Cella M, Pickles A, McCrone P, Stringer D, Oliver A, Reeder C, Birchwood M, Fowler D, Greenwood K, Johnson S, Perez J, Ritunnano R, Thompson A, Upthegrove R, Wilson J, Kenny A, Isok I, Joyce EM, Wykes T. Satisfaction with cognitive remediation therapy: its effects on implementation and outcomes using the cognitive remediation satisfaction scale. Schizophrenia (Heidelb) 2023; 9:67. [PMID: 37777545 PMCID: PMC10542804 DOI: 10.1038/s41537-023-00390-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/17/2023] [Indexed: 10/02/2023]
Abstract
Cognitive Remediation (CR) improves cognition and functioning but is implemented in a variety of ways (independent, group and one-to-one). There is no information on whether service users find these implementation methods acceptable or if their satisfaction influences CR outcomes. We used mixed participatory methods, including focus groups, to co-develop a CR satisfaction scale. This was refined using three psychometric criteria (Cronbach's alpha, item discrimination, test-retest agreement) to select items. Factor analysis explored potential substructures. The refined measure was used in structural equation joint modelling to evaluate whether satisfaction with CR is affected by implementation method and treatment engagement or influences recovery outcome, using data from a randomised controlled trial. Four themes (therapy hours, therapist, treatment effects, computer use) generated a 31-item Cognitive Remediation Satisfaction scale (CRS) that reduced to 18 Likert items, 2 binary and 2 open-ended questions following psychometric assessment. CRS had good internal consistency (Alpha = 0.814), test-retest reliability (r= 0.763), and concurrent validity using the Working Alliance Inventory (r = 0.56). A 2-factor solution divided items into therapy engagement and therapy effects. Satisfaction was not related to implementation method but was significantly associated with CR engagement. Therapy hours were significantly associated with recovery, but there was no direct effect of satisfaction on outcome. Although satisfaction is important to therapy engagement, it has no direct effect on outcome. CR therapy hours directly affect outcome irrespective of which implementation model is used, so measuring satisfaction early might help to identify those who are likely to disengage. The study has mixed methods design.
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Affiliation(s)
- Joanne Evans
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rose Tinch-Taylor
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emese Csipke
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matteo Cella
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul McCrone
- School of Health Sciences, University of Greenwich, London, UK
| | - Dominic Stringer
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Abigail Oliver
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Clare Reeder
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
| | | | - Sonia Johnson
- Faculty of Brain Sciences, University College London, London, UK
| | - Jesus Perez
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Rosa Ritunnano
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alex Kenny
- Patient Advisory Board, King's College London, London, UK
| | - Iris Isok
- Patient Advisory Board, King's College London, London, UK
| | - Eileen M Joyce
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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28
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Herniman SE, Wood SJ, Khandaker G, Dazzan P, Pariante CM, Barnes NM, Krynicki CR, Nikkheslat N, Vincent RC, Roberts A, Giordano A, Watson A, Suckling J, Barnes TRE, Husain N, Jones PB, Joyce E, Lawrie SM, Lewis S, Deakin B, Upthegrove R. Network analysis of inflammation and symptoms in recent onset schizophrenia and the influence of minocycline during a clinical trial. Transl Psychiatry 2023; 13:297. [PMID: 37723153 PMCID: PMC10507090 DOI: 10.1038/s41398-023-02570-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/30/2023] [Accepted: 07/24/2023] [Indexed: 09/20/2023] Open
Abstract
Attempts to delineate an immune subtype of schizophrenia have not yet led to the clear identification of potential treatment targets. An unbiased informatic approach at the level of individual immune cytokines and symptoms may reveal organisational structures underlying heterogeneity in schizophrenia, and potential for future therapies. The aim was to determine the network and relative influence of pro- and anti-inflammatory cytokines on depressive, positive, and negative symptoms. We further aimed to determine the effect of exposure to minocycline or placebo for 6 months on cytokine-symptom network connectivity and structure. Network analysis was applied to baseline and 6-month data from the large multi-center BeneMin trial of minocycline (N = 207) in schizophrenia. Pro-inflammatory cytokines IL-6, TNF-α, and IFN-γ had the greatest influence in the inflammatory network and were associated with depressive symptoms and suspiciousness at baseline. At 6 months, the placebo group network connectivity was 57% stronger than the minocycline group, due to significantly greater influence of TNF-α, early wakening, and pathological guilt. IL-6 and its downstream impact on TNF-α, and IFN-γ, could offer novel targets for treatment if offered at the relevant phenotypic profile including those with depression. Future targeted experimental studies of immune-based therapies are now needed.
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Affiliation(s)
- Sarah E Herniman
- Orygen, Melbourne, Australia.
- Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia.
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | - Stephen J Wood
- Orygen, Melbourne, Australia
- Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Golam Khandaker
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Carmine M Pariante
- Stress, Psychiatry and Immunology Lab & Perinatal Psychiatry, The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Nicholas M Barnes
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Carl R Krynicki
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Naghmeh Nikkheslat
- Stress, Psychiatry and Immunology Lab & Perinatal Psychiatry, The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Rachel C Vincent
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alex Roberts
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Annalisa Giordano
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Andrew Watson
- The Department of Clinical and Motor Neurosciences, UCL Institute of Neurology, London, UK
| | - John Suckling
- Brain Mapping Unit, Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Nusrat Husain
- Lancashire & South Cumbria NHS Foundation Trust, London, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Peter B Jones
- Brain Mapping Unit, Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Eileen Joyce
- The Department of Clinical and Motor Neurosciences, UCL Institute of Neurology, London, UK
| | - Stephen M Lawrie
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Shôn Lewis
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Bill Deakin
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Early Interventions Service, Birmingham Womens and Children's NHS Foundation Trust, Birmingham, UK
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
- Early Interventions Service, Birmingham Womens and Children's NHS Foundation Trust, Birmingham, UK
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Jauhar S, Arnone D, Baldwin DS, Bloomfield M, Browning M, Cleare AJ, Corlett P, Deakin JFW, Erritzoe D, Fu C, Fusar-Poli P, Goodwin GM, Hayes J, Howard R, Howes OD, Juruena MF, Lam RW, Lawrie SM, McAllister-Williams H, Marwaha S, Matuskey D, McCutcheon RA, Nutt DJ, Pariante C, Pillinger T, Radhakrishnan R, Rucker J, Selvaraj S, Stokes P, Upthegrove R, Yalin N, Yatham L, Young AH, Zahn R, Cowen PJ. A leaky umbrella has little value: evidence clearly indicates the serotonin system is implicated in depression. Mol Psychiatry 2023; 28:3149-3152. [PMID: 37322065 PMCID: PMC10618084 DOI: 10.1038/s41380-023-02095-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/17/2023] [Accepted: 04/21/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Sameer Jauhar
- Centre for Affective Disorders, Psychological Medicine, IoPPN, King's College, London, UK.
| | - Danilo Arnone
- Department of Psychiatry and Behavioural Science, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Michael Bloomfield
- Mental Health Neuroscience, Division of Psychiatry, University College, London, UK
| | - Michael Browning
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Oxford Health NHS Trust, Oxford, United Kingdom
| | - Anthony J Cleare
- Centre for Affective Disorders, Psychological Medicine, IoPPN, King's College, London, UK
| | - Phillip Corlett
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
| | | | - David Erritzoe
- Division of Brain Sciences, Dept of Medicine, Imperial College, London, UK
| | - Cynthia Fu
- Department of Psychological Sciences, School of Psychology, University of East London, London, UK
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, IoPPN, King's College, London, UK
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Oxford Health NHS Trust, Oxford, United Kingdom
| | - Joseph Hayes
- Mental Health Neuroscience, Division of Psychiatry, University College, London, UK
| | - Robert Howard
- Mental Health Neuroscience, Division of Psychiatry, University College, London, UK
| | - Oliver D Howes
- Department of Psychosis Studies, IoPPN, King's College, London, UK
- H Lundbeck A/s, Iveco House, Watford, WD17 1ET, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, Du Cane Road, London, UK
| | - Mario F Juruena
- Centre for Affective Disorders, Psychological Medicine, IoPPN, King's College, London, UK
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Hamish McAllister-Williams
- Faculty of Medical Sciences, University of Newcastle, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - David Matuskey
- Departments of Radiology and Biomedical Sciences, Psychiatry, and Neurology, Yale University, New Haven, CT, USA
| | - Robert A McCutcheon
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Oxford Health NHS Trust, Oxford, United Kingdom
| | - David J Nutt
- Division of Brain Sciences, Dept of Medicine, Imperial College, London, UK
| | - Carmine Pariante
- Centre for Affective Disorders, Psychological Medicine, IoPPN, King's College, London, UK
| | - Toby Pillinger
- Department of Psychosis Studies, IoPPN, King's College, London, UK
| | | | - James Rucker
- Centre for Affective Disorders, Psychological Medicine, IoPPN, King's College, London, UK
| | - Sudhakar Selvaraj
- Louis Faillace Department of Psychiatry and Behavioral Science, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
- Intra-Cellular Therapies, Inc, New York, NY, 10016, USA
| | - Paul Stokes
- Centre for Affective Disorders, Psychological Medicine, IoPPN, King's College, London, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Nefize Yalin
- Centre for Affective Disorders, Psychological Medicine, IoPPN, King's College, London, UK
| | - Lakshmi Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Allan H Young
- Centre for Affective Disorders, Psychological Medicine, IoPPN, King's College, London, UK
| | - Roland Zahn
- Centre for Affective Disorders, Psychological Medicine, IoPPN, King's College, London, UK
| | - Philip J Cowen
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Oxford Health NHS Trust, Oxford, United Kingdom
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Theisen C, Rosen M, Meisenzahl E, Koutsouleris N, Lichtenstein T, Ruhrmann S, Kambeitz J, Kambeitz-Ilankovic L, Riecher-Rössler A, Chisholm K, Upthegrove R, Antonucci LA, Bertolino A, Pigoni A, Salokangas RKR, Pantelis C, Wood SJ, Lencer R, Falkai P, Hietala J, Brambilla P, Schmidt A, Andreou C, Borgwardt S, Osman N, Schultze-Lutter F. The heterogeneity of attenuated and brief limited psychotic symptoms: association of contents with age, sex, country, religion, comorbidities, and functioning. Front Psychiatry 2023; 14:1209485. [PMID: 37484669 PMCID: PMC10361815 DOI: 10.3389/fpsyt.2023.1209485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction The Attenuated Psychosis Symptoms (APS) syndrome mostly represents the ultra-high-risk state of psychosis but, as does the Brief Intermittent Psychotic Symptoms (BIPS) syndrome, shows a large variance in conversion rates. This may be due to the heterogeneity of APS/BIPS that may be related to the effects of culture, sex, age, and other psychiatric morbidities. Thus, we investigated the different thematic contents of APS and their association with sex, age, country, religion, comorbidity, and functioning to gain a better understanding of the psychosis-risk syndrome. Method A sample of 232 clinical high-risk subjects according to the ultra-high risk and basic symptom criteria was recruited as part of a European study conducted in Germany, Italy, Switzerland, and Finland. Case vignettes, originally used for supervision of inclusion criteria, were investigated for APS/BIPS contents, which were compared for sex, age, country, religion, functioning, and comorbidities using chi-squared tests and regression analyses. Result We extracted 109 different contents, mainly of APS (96.8%): 63 delusional, 29 hallucinatory, and 17 speech-disorganized contents. Only 20 contents (18.3%) were present in at least 5% of the sample, with paranoid and referential ideas being the most frequent. Thirty-one (28.5%) contents, in particular, bizarre ideas and perceptual abnormalities, demonstrated an association with age, country, comorbidity, or functioning, with regression models of country and obsessive-compulsive disorders explaining most of the variance: 55.8 and 38.3%, respectively. Contents did not differ between religious groups. Conclusion Psychosis-risk patients report a wide range of different contents of APS/BIPS, underlining the psychopathological heterogeneity of this group but also revealing a potential core set of contents. Compared to earlier reports on North-American samples, our maximum prevalence rates of contents were considerably lower; this likely being related to a stricter rating of APS/BIPS and cultural influences, in particular, higher schizotypy reported in North-America. The various associations of some APS/BIPS contents with country, age, comorbidities, and functioning might moderate their clinical severity and, consequently, the related risk for psychosis and/or persistent functional disability.
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Affiliation(s)
- Christian Theisen
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Max-Planck-Institute of Psychiatry, Munich, Germany
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Research Center Jülich, Institute for Cognitive Neuroscience (INM-3), Jülich, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Department of Psychology, Aston University, Birmingham, United Kingdom
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Linda A. Antonucci
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen J. Wood
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Orygen, The National Centre of Excellence for Youth Mental Health, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Max-Planck-Institute of Psychiatry, Munich, Germany
| | - Jarmo Hietala
- Department of Psychiatry, Medical Faculty, University of Turku, Turku, Finland
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Mental Health, University of Milan, Milan, Italy
| | - André Schmidt
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Christina Andreou
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Naweed Osman
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Marwaha S, Young AH, Suppes T, Upthegrove R. Treatments for major depression - Authors' reply. Lancet 2023; 401:2111-2112. [PMID: 37355290 DOI: 10.1016/s0140-6736(23)00952-2] [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] [Received: 02/20/2023] [Accepted: 05/04/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, UK; Birmingham and Solihull Mental Health NHS Trust, Birmingham, UK
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Trisha Suppes
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, UK; Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, UK.
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Morales‐Muñoz I, Upthegrove R, Lawrence K, Thayakaran R, Kooij S, Gregory AM, Marwaha S. The role of inflammation in the prospective associations between early childhood sleep problems and ADHD at 10 years: findings from a UK birth cohort study. J Child Psychol Psychiatry 2023; 64:930-940. [PMID: 36597271 PMCID: PMC10952536 DOI: 10.1111/jcpp.13755] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Several underlying mechanisms potentially account for the link between sleep and attention deficit and hyperactivity disorder (ADHD), including inflammation. However, studies so far have been cross sectional. We investigate (a) the association between early childhood sleep and probable ADHD diagnosis in childhood and (b) whether childhood circulating inflammatory markers mediate these prospective associations. METHODS Data from the Avon Longitudinal Study of Parents and Children were available for 7,658 10-year-old children. Parent-reported sleep duration, night awakening frequency and regular sleep routines were collected at 3.5 years. The Development and Wellbeing Assessment was administered to capture children with clinically relevant ADHD symptoms, or probable ADHD diagnosis. Blood samples were collected at 9 years, from which two inflammatory markers were obtained [interleukin-6 (IL-6) and C-reactive protein (CRP)]. Logistic regression analyses were applied to investigate the associations between sleep variables at 3.5 years and probable ADHD diagnosis at 10 years. Further, path analysis was applied to examine the potential mediating role of inflammation at 9 years (as measured by CRP and IL-6) in the associations between early sleep and ADHD at 10 years. RESULTS Less regular sleep routines (OR = 0.51, 95% CI = 0.28-0.93, p = .029), shorter nighttime sleep (OR = 0.70, 95% CI = 0.56-0.89, p = .004) and higher night awakening frequency (OR = 1.27, 95% CI = 1.06-1.52, p = .009) at 3.5 years were associated with higher odds of ADHD at 10 years. Further, IL-6 at 9 years, but not CRP, mediated the association between irregular sleep routines and ADHD (bias-corrected estimate, -0.002; p = .005) and between night awakening and ADHD (bias-corrected estimate, 0.002; p = .003). CONCLUSIONS Several sleep problems in early childhood constitute a risk factor for probable ADHD diagnosis at 10 years. Further, these associations are partially mediated by IL-6 at 9 years. These results open a new research vista to the pathophysiology of ADHD and highlight sleep and inflammation as potential preventative targets for ADHD.
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Affiliation(s)
| | - Rachel Upthegrove
- Institute for Mental HealthUniversity of BirminghamBirminghamUK
- Early Intervention Service, Birmingham Women's and Children's NHS TrustBirminghamUK
| | - Kate Lawrence
- Department of PsychologySt Mary's University Twickenham LondonLondonUK
| | - Rasiah Thayakaran
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Sandra Kooij
- Department of Psychiatry, Amsterdam Public Health Research InstituteVU University Medical CenterAmsterdamThe Netherlands
- PsyQ, Expertise Center Adult ADHDThe HagueThe Netherlands
| | - Alice M Gregory
- Department of Psychology, GoldsmithsUniversity of LondonLondonUK
| | - Steven Marwaha
- Institute for Mental HealthUniversity of BirminghamBirminghamUK
- Specialist Mood Disorders ClinicZinnia CentreBirminghamUK
- The Barberry National Centre for Mental HealthBirminghamUK
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Altaweel N, Upthegrove R, Surtees A, Durdurak B, Marwaha S. Personality traits as risk factors for relapse or recurrence in major depression: a systematic review. Front Psychiatry 2023; 14:1176355. [PMID: 37215669 PMCID: PMC10196019 DOI: 10.3389/fpsyt.2023.1176355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/05/2023] [Indexed: 05/24/2023] Open
Abstract
Background Major depressive disorder (MDD) is highly recurrent. Identifying risk factors for relapse in depression is essential to improve prevention plans and therapeutic outcomes. Personality traits and personality disorders are widely considered to impact outcomes in MDD. We aimed to evaluate the role of personality aspects in the risk of relapse and recurrence in MDD. Method A PROSPERO-registered systematic review was conducted using Medline, Embase, PsycINFO, Web of Science and CINAHL as data sources, together with hand searching of four journals over the five years till 2022. There was independent abstract selection, quality assessment and data extraction from each study. Results Twenty two studies me t eligibility criteria involving 12,393 participants. Neurotic personality features are significantly associated with the risk of relapse and recurrence of depression, though the data is not uniform. There is some, though limited, evidence that borderline, obsessive-compulsive and dependent personality traits or disorders increase the risk for relapse in depression. Limitations The small number, in addition to the methodological heterogeneity of the included studies, did not allow further analysis, such as meta-analysis. Conclusion People with high neuroticism and dependent personality traits, borderline personality disorder or obsessive-compulsive personality disorder, compared to those without, may be at a higher risk of experiencing relapse or recurrence of MDD. Specific and targeted interventions may potentially reduce relapse and recurrence rates in these groups and could improve outcomes. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=235919, identifier: CRD42021235919.
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Affiliation(s)
- Nada Altaweel
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Department of Psychology, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Rachel Upthegrove
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Birmingham Woman's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Surtees
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Birmingham Woman's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Buse Durdurak
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Steven Marwaha
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Birmingham Woman's and Children's NHS Foundation Trust, Birmingham, United Kingdom
- Specialist Mood Disorders Clinic, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
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Morales-Muñoz I, Mallikarjun PK, Chandan JS, Thayakaran R, Upthegrove R, Marwaha S. Impact of anxiety and depression across childhood and adolescence on adverse outcomes in young adulthood: a UK birth cohort study. Br J Psychiatry 2023; 222:212-220. [PMID: 36919351 PMCID: PMC10895507 DOI: 10.1192/bjp.2023.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Little is still known about the long-term impact of childhood and adolescent persistent depression and anxiety in adulthood. AIMS To investigate the impact of persistent anxiety, depression, and comorbid anxiety and depression across childhood and adolescence on the development of multiple adverse outcomes in young adulthood. METHOD This study used data from 8122 participants in the Avon Longitudinal Study of Parents and Children cohort. The Development and Well-Being Assessment (DAWBA) examined child anxiety and depression symptomatology. The DAWBA generalised anxiety and mood subscales at 8, 10 and 13 years were selected, and a measure of comorbid anxiety and depression symptoms was created at each time point. Further, several mental and physical health, substance misuse and education/employment problems were assessed at 24 years. Latent class growth analyses were used to detect trajectories of anxiety, depression and comorbid anxiety and depression; and logistic regression to examine how persistent anxiety, depression or both were associated with adverse outcomes at 24 years. RESULTS All three classes with persistent anxiety, depression or both were significantly associated with presenting with any mental health problems and any education/employment problem. Persistent high levels of depression and high levels of comorbid anxiety and depression, but not persistent high anxiety, were significantly associated with any physical health problem. High levels of comorbid anxiety and depression was the only DAWBA domain significantly associated with substance misuse; and overall, this was the domain that exerted the greatest negative impact, as it presented the highest odd ratio values. CONCLUSIONS Children and adolescents with comorbid anxiety and depression are at the highest risk for having more adverse outcomes at 24 years.
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Affiliation(s)
| | - Pavan K Mallikarjun
- Early Intervention Service, Birmingham Women's and Children's NHS Trust, Birmingham, UK
| | - Joht S Chandan
- Institute of Applied Health Research, University of Birmingham, UK
| | | | - Rachel Upthegrove
- Institute for Mental Health, School of Psychology, University of Birmingham, UK and Early Intervention Service, Birmingham Women's and Children's NHS Trust, Birmingham, UK
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, UK; Early Intervention Service, Birmingham Women's and Children's NHS Trust, Birmingham, UK; Specialist Mood Disorders Clinic, Zinnia Centre, Birmingham, UK; and The Barberry National Centre for Mental Health, Birmingham, UK
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35
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Watson AJ, Giordano A, Suckling J, Barnes TRE, Husain N, Jones PB, Krynicki CR, Lawrie SM, Lewis S, Nikkheslat N, Pariante CM, Upthegrove R, Deakin B, Dazzan P, Joyce EM. Cognitive function in early-phase schizophrenia-spectrum disorder: IQ subtypes, brain volume and immune markers. Psychol Med 2023; 53:2842-2851. [PMID: 35177144 PMCID: PMC10244009 DOI: 10.1017/s0033291721004815] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Evidence suggests that cognitive subtypes exist in schizophrenia that may reflect different neurobiological trajectories. We aimed to identify whether IQ-derived cognitive subtypes are present in early-phase schizophrenia-spectrum disorder and examine their relationship with brain structure and markers of neuroinflammation. METHOD 161 patients with recent-onset schizophrenia spectrum disorder (<5 years) were recruited. Estimated premorbid and current IQ were calculated using the Wechsler Test of Adult Reading and a 4-subtest WAIS-III. Cognitive subtypes were identified with k-means clustering. Freesurfer was used to analyse 3.0 T MRI. Blood samples were analysed for hs-CRP, IL-1RA, IL-6 and TNF-α. RESULTS Three subtypes were identified indicating preserved (PIQ), deteriorated (DIQ) and compromised (CIQ) IQ. Absolute total brain volume was significantly smaller in CIQ compared to PIQ and DIQ, and intracranial volume was smaller in CIQ than PIQ (F(2, 124) = 6.407, p = 0.002) indicative of premorbid smaller brain size in the CIQ group. CIQ had higher levels of hs-CRP than PIQ (F(2, 131) = 5.01, p = 0.008). PIQ showed differentially impaired processing speed and verbal learning compared to IQ-matched healthy controls. CONCLUSIONS The findings add validity of a neurodevelopmental subtype of schizophrenia identified by comparing estimated premorbid and current IQ and characterised by smaller premorbid brain volume and higher measures of low-grade inflammation (CRP).
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Affiliation(s)
- Andrew J. Watson
- The Department of Clinical and Motor Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - Annalisa Giordano
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Suckling
- Brain Mapping Unit, Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, Cambridge, UK
| | | | - Nusrat Husain
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
- MAHSC, The University of Manchester, Manchester, UK
- Lancashire & South Cumbria NHS Foundation Trust, Accrington, UK
| | - Peter B. Jones
- Brain Mapping Unit, Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Carl R. Krynicki
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Stephen M. Lawrie
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Shôn Lewis
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
- MAHSC, The University of Manchester, Manchester, UK
| | - Naghmeh Nikkheslat
- Stress, Psychiatry and Immunology Lab & Perinatal Psychiatry, The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Carmine M. Pariante
- Stress, Psychiatry and Immunology Lab & Perinatal Psychiatry, The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Forward thinking Birmingham, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Bill Deakin
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Eileen M. Joyce
- The Department of Clinical and Motor Neuroscience, UCL Queen Square Institute of Neurology, London, UK
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Dwyer DB, Chand GB, Pigoni A, Khuntia A, Wen J, Antoniades M, Hwang G, Erus G, Doshi J, Srinivasan D, Varol E, Kahn RS, Schnack HG, Meisenzahl E, Wood SJ, Zhuo C, Sotiras A, Shinohara RT, Shou H, Fan Y, Schaulfelberger M, Rosa P, Lalousis PA, Upthegrove R, Kaczkurkin AN, Moore TM, Nelson B, Gur RE, Gur RC, Ritchie MD, Satterthwaite TD, Murray RM, Di Forti M, Ciufolini S, Zanetti MV, Wolf DH, Pantelis C, Crespo-Facorro B, Busatto GF, Davatzikos C, Koutsouleris N, Dazzan P. Psychosis brain subtypes validated in first-episode cohorts and related to illness remission: results from the PHENOM consortium. Mol Psychiatry 2023; 28:2008-2017. [PMID: 37147389 PMCID: PMC10575777 DOI: 10.1038/s41380-023-02069-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 03/15/2023] [Accepted: 04/05/2023] [Indexed: 05/07/2023]
Abstract
Using machine learning, we recently decomposed the neuroanatomical heterogeneity of established schizophrenia to discover two volumetric subgroups-a 'lower brain volume' subgroup (SG1) and an 'higher striatal volume' subgroup (SG2) with otherwise normal brain structure. In this study, we investigated whether the MRI signatures of these subgroups were also already present at the time of the first-episode of psychosis (FEP) and whether they were related to clinical presentation and clinical remission over 1-, 3-, and 5-years. We included 572 FEP and 424 healthy controls (HC) from 4 sites (Sao Paulo, Santander, London, Melbourne) of the PHENOM consortium. Our prior MRI subgrouping models (671 participants; USA, Germany, and China) were applied to both FEP and HC. Participants were assigned into 1 of 4 categories: subgroup 1 (SG1), subgroup 2 (SG2), no subgroup membership ('None'), and mixed SG1 + SG2 subgroups ('Mixed'). Voxel-wise analyses characterized SG1 and SG2 subgroups. Supervised machine learning analyses characterized baseline and remission signatures related to SG1 and SG2 membership. The two dominant patterns of 'lower brain volume' in SG1 and 'higher striatal volume' (with otherwise normal neuromorphology) in SG2 were identified already at the first episode of psychosis. SG1 had a significantly higher proportion of FEP (32%) vs. HC (19%) than SG2 (FEP, 21%; HC, 23%). Clinical multivariate signatures separated the SG1 and SG2 subgroups (balanced accuracy = 64%; p < 0.0001), with SG2 showing higher education but also greater positive psychosis symptoms at first presentation, and an association with symptom remission at 1-year, 5-year, and when timepoints were combined. Neuromorphological subtypes of schizophrenia are already evident at illness onset, separated by distinct clinical presentations, and differentially associated with subsequent remission. These results suggest that the subgroups may be underlying risk phenotypes that could be targeted in future treatment trials and are critical to consider when interpreting neuroimaging literature.
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Affiliation(s)
- Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany.
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
- Orygen, Melbourne, VIC, Australia.
| | - Ganesh B Chand
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Social and Affective Neuroscience Group, MoMiLab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Adyasha Khuntia
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
- Max-Planck Institute of Psychiatry, Munich, Germany
| | - Junhao Wen
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mathilde Antoniades
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gyujoon Hwang
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Guray Erus
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jimit Doshi
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dhivya Srinivasan
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Erdem Varol
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Statistics, Zuckerman Institute, Columbia University, New York, NY, USA
| | - Rene S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hugo G Schnack
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Eva Meisenzahl
- LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Stephen J Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- Orygen, Melbourne, VIC, Australia
- University of Birmingham, Edgbaston, UK
| | - Chuanjun Zhuo
- Department of Psychiatric-Neuroimaging-Genetics and Co-morbidity Laboratory (PNGC-Lab), Nankai University Affiliated Tianjin Anding Hospital; Department of Psychiatry, Tianjin Medical University, Tianjin, China
| | - Aristeidis Sotiras
- Department of Radiology and Institute for Informatics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Russell T Shinohara
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Haochang Shou
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yong Fan
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Pedro Rosa
- Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Paris A Lalousis
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, UK
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, UK
- Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Tyler M Moore
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Barnaby Nelson
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- Orygen, Melbourne, VIC, Australia
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marylyn D Ritchie
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Theodore D Satterthwaite
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Robin M Murray
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Marta Di Forti
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Simone Ciufolini
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Marcus V Zanetti
- Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | - Daniel H Wolf
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, VIC, Australia
| | - Benedicto Crespo-Facorro
- Mental Health Service, Hospital Universitario Virgen del Rocío, Seville, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Madrid, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
- Department of Psychiatry, Universidad de Sevilla, Seville, Spain
| | - Geraldo F Busatto
- Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany.
- Max-Planck Institute of Psychiatry, Munich, Germany.
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
| | - Paola Dazzan
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
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Betz LT, Penzel N, Rosen M, Bhui K, Upthegrove R, Kambeitz J. Disentangling heterogeneity of psychosis expression in the general population: sex-specific moderation effects of environmental risk factors on symptom networks. Psychol Med 2023; 53:1860-1869. [PMID: 37310332 DOI: 10.1017/s0033291721003470] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Psychosis expression in the general population may reflect a behavioral manifestation of the risk for psychotic disorder. It can be conceptualized as an interconnected system of psychotic and affective experiences; a so-called 'symptom network'. Differences in demographics, as well as exposure to adversities and risk factors, may produce substantial heterogeneity in symptom networks, highlighting potential etiological divergence in psychosis risk. METHODS To explore this idea in a data-driven way, we employed a novel recursive partitioning approach in the 2007 English National Survey of Psychiatric Morbidity (N = 7242). We sought to identify 'network phenotypes' by explaining heterogeneity in symptom networks through potential moderators, including age, sex, ethnicity, deprivation, childhood abuse, separation from parents, bullying, domestic violence, cannabis use, and alcohol. RESULTS Sex was the primary source of heterogeneity in symptom networks. Additional heterogeneity was explained by interpersonal trauma (childhood abuse and domestic violence) in women and domestic violence, cannabis use, ethnicity in men. Among women, especially those exposed to early interpersonal trauma, an affective loading within psychosis may have distinct relevance. Men, particularly those from minority ethnic groups, demonstrated a strong network connection between hallucinatory experiences and persecutory ideation. CONCLUSION Symptom networks of psychosis expression in the general population are highly heterogeneous. The structure of symptom networks seems to reflect distinct sex-related adversities, etiologies, and mechanisms of symptom-expression. Disentangling the complex interplay of sex, minority ethnic group status, and other risk factors may help optimize early intervention and prevention strategies in psychosis.
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Affiliation(s)
- Linda T Betz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
- Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Griffiths SL, Bogatsu T, Longhi M, Butler E, Alexander B, Bandawar M, Everard L, Jones PB, Fowler D, Hodgekins J, Amos T, Freemantle N, McCrone P, Singh SP, Birchwood M, Upthegrove R. Five-year illness trajectories across racial groups in the UK following a first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:569-579. [PMID: 36717434 PMCID: PMC10066114 DOI: 10.1007/s00127-023-02428-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/12/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE Psychosis disproportionally affects ethnic minority groups in high-income countries, yet evidence of disparities in outcomes following intensive early intervention service (EIS) for First Episode Psychosis (FEP) is less conclusive. We investigated 5-year clinical and social outcomes of young people with FEP from different racial groups following EIS care. METHOD Data were analysed from the UK-wide NIHR SUPEREDEN study. The sample at baseline (n = 978) included White (n = 750), Black (n = 71), and Asian (n = 157) individuals, assessed during the 3 years of EIS, and up to 2 years post-discharge (n = 296; Black [n = 23]; Asian [n = 52] and White [n = 221]). Outcome trajectories were modelled for psychosis symptoms (positive, negative, and general), functioning, and depression, using linear mixed effect models (with random intercept and slopes), whilst controlling for social deprivation. Discharge service was also explored across racial groups, 2 years following EIS. RESULTS Variation in linear growth over time was accounted for by racial group status for psychosis symptoms-positive (95% CI [0.679, 1.235]), negative (95% CI [0.315, 0.783]), and general (95% CI [1.961, 3.428])-as well as for functioning (95% CI [11.212, 17.677]) and depressive symptoms (95% CI [0.261, 0.648]). Social deprivation contributed to this variance. Black individuals experienced greater levels of deprivation (p < 0.001, 95% CI [0.187, 0.624]). Finally, there was a greater likelihood for Asian (OR = 3.04; 95% CI [2.050, 4.498]) and Black individuals (OR = 2.47; 95% CI [1.354, 4.520]) to remain in secondary care by follow-up. CONCLUSION Findings suggest variations in long-term clinical and social outcomes following EIS across racial groups; social deprivation contributed to this variance. Black and Asian individuals appear to make less improvement in long-term recovery and are less likely to be discharged from mental health services. Replication is needed in large, complete data, to fully understand disparities and blind spots to care.
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Affiliation(s)
- Siân Lowri Griffiths
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Tumelo Bogatsu
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Mia Longhi
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Emily Butler
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Beel Alexander
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Mrunal Bandawar
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Linda Everard
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge and CAMEO, Cambridge and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Brighton, UK
| | | | - Tim Amos
- Academic Unit of Psychiatry, University of Bristol, Bristol, UK
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Paul McCrone
- Institute for Life Course Development, University of Greenwich, London, UK
| | - Swaran P Singh
- Mental Health and Wellbeing Warwick Medical School, University of Warwick, Coventry, UK
| | - Max Birchwood
- Mental Health and Wellbeing Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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39
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Astle DE, Moore A, Marryat L, Viding E, Mansfield KL, Fazel M, Pierce M, Abel KM, Green J, John A, Broome MR, Upthegrove R, Bould H, Minnis H, Gajwani R, Groom MJ, Hollis C, Liddle E, Sayal K, Berry V, Collishaw S, Dawes H, Cortese S, Violato M, Pollard J, MacCabe JH, Blakemore SJ, Simonoff E, Watkins E, Hiller RM, Townsend E, Armour C, Geddes JR, Thompson L, Schwannauer M, Nicholls D, Hotopf M, Downs J, Rahman A, Sharma AN, Ford TJ. We need timely access to mental health data: implications of the Goldacre review. Lancet Psychiatry 2023; 10:242-244. [PMID: 36931773 DOI: 10.1016/s2215-0366(23)00030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 03/17/2023]
Affiliation(s)
- Duncan E Astle
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 1TN, UK.
| | - Anna Moore
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK
| | - Louise Marryat
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Essi Viding
- Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Matthias Pierce
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Kathryn M Abel
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jonathan Green
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Ann John
- Population Data Science, Swansea University, Swansea, UK
| | - Matthew R Broome
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Helen Bould
- Population Health Science, Centre for Academic Mental Health and Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Helen Minnis
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ruchika Gajwani
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Madeleine J Groom
- Academic Unit of Mental Health & Clinical Neurosciences School of Medicine, University of Nottingham, Nottingham, UK; Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- NIHR MindTech MIC & NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Elizabeth Liddle
- Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Academic Unit of Mental Health & Clinical Neurosciences School of Medicine, University of Nottingham, Nottingham, UK; Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Vashti Berry
- Children & Young People's Mental Health Research Collaboration, University of Exeter, Exeter, UK
| | - Stephan Collishaw
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Helen Dawes
- NIHR Exeter Biomedical Research Centre, University of Exeter, Exeter, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jack Pollard
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - James H MacCabe
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Rachel M Hiller
- Division of Psychology and Language Sciences, University College London, London, UK; Anna Freud National Centre for Children and Families, University College London, London, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Cherie Armour
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - John R Geddes
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Lucy Thompson
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Matthias Schwannauer
- Centre for Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Aditya Narain Sharma
- Translational and Clinical Research Institute, University of Newcastle, Newcastle, UK; Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK
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40
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Alexandros Lalousis P, Wood S, Reniers R, Schmaal L, Azam H, Mazziota A, Saeed H, Wragg C, Upthegrove R. Transdiagnostic structural neuroimaging features in depression and psychosis: A systematic review. Neuroimage Clin 2023; 38:103388. [PMID: 37031636 PMCID: PMC10120394 DOI: 10.1016/j.nicl.2023.103388] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Previous research suggests that there may be similarities in structural brain changes seen in patients with depression and psychosis compared to healthy controls. However, there is yet no systematic review collating studies comparing structural brain changes in depression and psychosis. Establishing shared and specific neuroanatomical features could aid the investigation of underlying biological processes. AIMS To identify structural neuroimaging similarities and differences between patients with depression and psychosis. METHOD We searched PubMed, PsychInfo, Embase, NICE Evidence, Medline and the Cochrane Library were searched from inception to 30/06/2021 using relevant subject headings (controlled vocabularies) and search syntax. Papers were assessed for quality using the Newcastle-Ottawa Scale. RESULTS Five-hundred and twenty papers were retrieved, seven met inclusion criteria. In narrative collation of results, grey matter volume (GMV) reductions were found in the medial frontal gyrus (MFG), hippocampus and left-sided posterior subgenual prefrontal cortex in both psychosis and depression. GMV reductions affected more brain regions in psychosis, including in the insula and thalamus. White matter volume (WMV) decline was found in both depression and psychosis. Reduced fractional anisotropy (FA) was more commonly seen in depression. CONCLUSIONS Our results suggest potential transdiagnostic patterns of GMV and WMV reductions in areas including the MFG, hippocampus, and left-sided posterior subgenual prefrontal cortex. These could be investigated as a future biomarker of transdiagnostic signature across mental illnesses. However, due to the limited number and poor quality of studies future research in large samples and harmonised imaging data is first needed.
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Affiliation(s)
- Paris Alexandros Lalousis
- Institute for Mental Health, University of Birmingham, Birmingham B15 2SA, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham B15 2SA, United Kingdom.
| | - Stephen Wood
- Institute for Mental Health, University of Birmingham, Birmingham B15 2SA, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham B15 2SA, United Kingdom; Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Renate Reniers
- Institute for Mental Health, University of Birmingham, Birmingham B15 2SA, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham B15 2SA, United Kingdom
| | - Lianne Schmaal
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Hannah Azam
- Institute for Mental Health, University of Birmingham, Birmingham B15 2SA, United Kingdom
| | - Antonella Mazziota
- Institute for Mental Health, University of Birmingham, Birmingham B15 2SA, United Kingdom
| | - Hasson Saeed
- Institute for Mental Health, University of Birmingham, Birmingham B15 2SA, United Kingdom
| | - Charlotte Wragg
- Institute for Mental Health, University of Birmingham, Birmingham B15 2SA, United Kingdom
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham B15 2SA, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham B15 2SA, United Kingdom
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41
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Foley ÉM, Griffiths SL, Murray A, Rogers J, Corsi-Zuelli F, Hickinbotham H, Warwick E, Wilson M, Kaser M, Murray GK, Deakin B, Jadon D, Suckling J, Barnes NM, Upthegrove R, Khandaker GM. Protocol for the Psychosis Immune Mechanism Stratified Medicine (PIMS) trial: a randomised double-blind placebo-controlled trial of single-dose tocilizumab in patients with psychosis. BMJ Open 2023; 13:e067944. [PMID: 36963796 PMCID: PMC10040013 DOI: 10.1136/bmjopen-2022-067944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/22/2023] [Indexed: 03/26/2023] Open
Abstract
INTRODUCTION Evidence suggests a potentially causal role of interleukin 6 (IL-6), a pleiotropic cytokine that generally promotes inflammation, in the pathogenesis of psychosis. However, no interventional studies in patients with psychosis, stratified using inflammatory markers, have been conducted to assess the therapeutic potential of targeting IL-6 in psychosis and to elucidate potential mechanism of effect. Tocilizumab is a humanised monoclonal antibody targeting the IL-6 receptor to inhibit IL-6 signalling, licensed in the UK for treatment of rheumatoid arthritis. The primary objective of this study is to test whether IL-6 contributes to the pathogenesis of first episode psychosis and to examine potential mechanisms by which IL-6 affects psychotic symptoms. A secondary objective is to examine characteristics of inflammation-associated psychosis. METHODS AND ANALYSIS A proof-of-concept study employing a randomised, parallel-group, double-blind, placebo-controlled design testing the effect of IL-6 inhibition on anhedonia in patients with psychosis. Approximately 60 participants with a diagnosis of schizophrenia and related psychotic disorders (ICD-10 codes F20, F22, F25, F28, F29) with evidence of low-grade inflammation (IL-6≥0.7 pg/mL) will receive either one intravenous infusion of tocilizumab (4.0 mg/kg; max 800 mg) or normal saline. Psychiatric measures and blood samples will be collected at baseline, 7, 14 and 28 days post infusion. Cognitive and neuroimaging data will be collected at baseline and 14 days post infusion. In addition, approximately 30 patients with psychosis without evidence of inflammation (IL-6<0.7 pg/mL) and 30 matched healthy controls will be recruited to complete identical baseline assessments to allow for comparison of the characteristic features of inflammation-associated psychosis. ETHICS AND DISSEMINATION The study is sponsored by the University of Bristol and has been approved by the Cambridge East Research Ethics Committee (reference: 22/EE/0010; IRAS project ID: 301682). Study findings will be published in peer-review journals. Findings will also be disseminated by scientific presentation and other means. TRIAL REGISTRATION NUMBER ISRCTN23256704.
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Affiliation(s)
- Éimear M Foley
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Lowri Griffiths
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Alexander Murray
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Jack Rogers
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Fabiana Corsi-Zuelli
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
- Department of Neuroscience and Behaviour, Division of Psychiatry, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Ella Warwick
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Martin Wilson
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Muzaffer Kaser
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Bill Deakin
- Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Deepak Jadon
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Nicholas M Barnes
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
- Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Golam M Khandaker
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Bristol, UK
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
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42
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Wykes T, Stringer D, Boadu J, Tinch-Taylor R, Csipke E, Cella M, Pickles A, McCrone P, Reeder C, Birchwood M, Fowler D, Greenwood K, Johnson S, Perez J, Ritunnano R, Thompson A, Upthegrove R, Wilson J, Kenny A, Isok I, Joyce EM. Cognitive Remediation Works But How Should We Provide It? An Adaptive Randomized Controlled Trial of Delivery Methods Using a Patient Nominated Recovery Outcome in First-Episode Participants. Schizophr Bull 2023; 49:614-625. [PMID: 36869733 PMCID: PMC10154711 DOI: 10.1093/schbul/sbac214] [Citation(s) in RCA: 6] [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] [Indexed: 03/05/2023]
Abstract
BACKGROUND AND HYPOTHESIS Cognitive remediation (CR) benefits cognition and functioning in psychosis but we do not know the optimal level of therapist contact, so we evaluated the potential benefits of different CR modes. STUDY DESIGN A multi-arm, multi-center, single-blinded, adaptive trial of therapist-supported CR. Participants from 11 NHS early intervention psychosis services were independently randomized to Independent, Group, One-to-One, or Treatment-as-usual (TAU). The primary outcome was functional recovery (Goal Attainment Scale [GAS]) at 15-weeks post randomization. Independent and TAU arms were closed after an interim analysis, and three informative contrasts tested (Group vs One-to-One, Independent vs TAU, Group + One-to-One vs TAU). Health economic analyses considered the cost per Quality Adjusted Life Year (QALY). All analyses used intention-to-treat principles. STUDY RESULTS We analyzed 377 participants (65 Independent, 134 Group, 112 One-to-One, 66 TAU). GAS did not differ for Group vs One-to-One: Cohen's d: 0.07, -0.25 to 0.40 95% CI, P = .655; Independent vs TAU: Cohen's d: 0.07, -0.41 to 0.55 95% CI, P = .777. GAS and the cognitive score improved for Group + One-to-One vs TAU favoring CR (GAS: Cohen's d: 0.57, 0.19-0.96 95% CI, P = .003; Cognitive score: Cohens d: 0.28, 0.07-0.48 95% CI, P = .008). The QALY costs were £4306 for Group vs TAU and £3170 for One-to-One vs TAU. Adverse events did not differ between treatment methods and no serious adverse events were related to treatment. CONCLUSIONS Both active therapist methods provided cost-effective treatment benefiting functional recovery in early psychosis and should be adopted within services. Some individuals benefited more than others so needs further investigation. TRIAL REGISTRATION ISRCTN14678860 https://doi.org/10.1186/ISRCTN14678860Now closed.
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Affiliation(s)
- Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Dominic Stringer
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Janette Boadu
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rose Tinch-Taylor
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emese Csipke
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matteo Cella
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul McCrone
- School of Health Sciences, University of Greenwich, London, UK
| | - Clare Reeder
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
| | | | - Sonia Johnson
- Faculty of Brain Sciences, University College London, London, UK
| | - Jesus Perez
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Rosa Ritunnano
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alex Kenny
- Patient Advisory Board, King's College London, London, UK
| | - Iris Isok
- Patient Advisory Board, King's College London, London, UK
| | - Eileen M Joyce
- UCL Queen Square Institute of Neurology, University College London, London, UK
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43
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Haidl TK, Hedderich DM, Rosen M, Kaiser N, Seves M, Lichtenstein T, Penzel N, Wenzel J, Kambeitz-Ilankovic L, Ruef A, Popovic D, Schultze-Lutter F, Chisholm K, Upthegrove R, Salokangas RKR, Pantelis C, Meisenzahl E, Wood SJ, Brambilla P, Borgwardt S, Ruhrmann S, Kambeitz J, Koutsouleris N. The non-specific nature of mental health and structural brain outcomes following childhood trauma. Psychol Med 2023; 53:1005-1014. [PMID: 34225834 DOI: 10.1017/s0033291721002439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Childhood trauma (CT) is associated with an increased risk of mental health disorders; however, it is unknown whether this represents a diagnosis-specific risk factor for specific psychopathology mediated by structural brain changes. Our aim was to explore whether (i) a predictive CT pattern for transdiagnostic psychopathology exists, and whether (ii) CT can differentiate between distinct diagnosis-dependent psychopathology. Furthermore, we aimed to identify the association between CT, psychopathology and brain structure. METHODS We used multivariate pattern analysis in data from 643 participants of the Personalised Prognostic Tools for Early Psychosis Management study (PRONIA), including healthy controls (HC), recent onset psychosis (ROP), recent onset depression (ROD), and patients clinically at high-risk for psychosis (CHR). Participants completed structured interviews and self-report measures including the Childhood Trauma Questionnaire, SCID diagnostic interview, BDI-II, PANSS, Schizophrenia Proneness Instrument, Structured Interview for Prodromal Symptoms and structural MRI, analyzed by voxel-based morphometry. RESULTS (i) Patients and HC could be distinguished by their CT pattern with a reasonable precision [balanced accuracy of 71.2% (sensitivity = 72.1%, specificity = 70.4%, p ≤ 0.001]. (ii) Subdomains 'emotional neglect' and 'emotional abuse' were most predictive for CHR and ROP, while in ROD 'physical abuse' and 'sexual abuse' were most important. The CT pattern was significantly associated with the severity of depressive symptoms in ROD, ROP, and CHR, as well as with the PANSS total and negative domain scores in the CHR patients. No associations between group-separating CT patterns and brain structure were found. CONCLUSIONS These results indicate that CT poses a transdiagnostic risk factor for mental health disorders, possibly related to depressive symptoms. While differences in the quality of CT exposure exist, diagnostic differentiation was not possible suggesting a multi-factorial pathogenesis.
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Affiliation(s)
- Theresa K Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Dennis M Hedderich
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine Technical University of Munich, Munich, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Nathalie Kaiser
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Mauro Seves
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Thorsten Lichtenstein
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - David Popovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katharine Chisholm
- Institute of Mental Health, University of Birmingham, Birmingham, UK
- Department of Psychology, Aston University, Birmingham, UK
| | - Rachel Upthegrove
- Institute of Mental Health, University of Birmingham, Birmingham, UK
- Early Intervention Service, Birmingham Womens and Childrens NHS Foundation Trust, UK
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Victoria, Australia
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Stephen J Wood
- Institute of Mental Health, University of Birmingham, Birmingham, UK
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefan Borgwardt
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Max-Planck Institute of Psychiatry Munich, Munich, Germany
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44
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Osimo EF, Perry BI, Mallikarjun P, Pritchard M, Lewis J, Katunda A, Murray GK, Perez J, Jones PB, Cardinal RN, Howes OD, Upthegrove R, Khandaker GM. Predicting treatment resistance from first-episode psychosis using routinely collected clinical information. Nat Ment Health 2023; 1:25-35. [PMID: 37034013 PMCID: PMC7614410 DOI: 10.1038/s44220-022-00001-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/03/2022] [Indexed: 01/21/2023]
Abstract
Around a quarter of people who experience a first episode of psychosis (FEP) will develop treatment-resistant schizophrenia (TRS), but there are currently no established clinically useful methods to predict this from baseline. We aimed to explore the predictive potential for clozapine use as a proxy for TRS of routinely collected, objective biomedical predictors at FEP onset, and to externally validate the model in a separate clinical sample of people with FEP. We developed and externally validated a forced-entry logistic regression risk prediction Model fOr cloZApine tReaTment, or MOZART, to predict up to 8-year risk of clozapine use from FEP using routinely recorded information including age, sex, ethnicity, triglycerides, alkaline phosphatase levels, and lymphocyte counts. We also produced a least-absolute shrinkage and selection operator (LASSO) based model, additionally including neutrophil count, smoking status, body mass index, and random glucose levels. The models were developed using data from two UK psychosis early intervention services (EIS) and externally validated in another UK EIS. Model performance was assessed via discrimination and calibration. We developed the models in 785 patients, and validated externally in 1,110 patients. Both models predicted clozapine use well at internal validation (MOZART: C 0.70; 95%CI 0.63,0.76; LASSO: 0.69; 95%CI 0.63,0.77). At external validation, discrimination performance reduced (MOZART: 0.63; 0.58,0.69; LASSO: 0.64; 0.58,0.69) but recovered after re-estimation of the lymphocyte predictor (C: 0.67; 0.62,0.73). Calibration plots showed good agreement between observed and predicted risk in the forced-entry model. We also present a decision-curve analysis and an online data visualisation tool. The use of routinely collected clinical information including blood-based biomarkers taken at FEP onset can help to predict the individual risk of clozapine use, and should be considered equally alongside other potentially useful information such as symptom scores in large-scale efforts to predict psychiatric outcomes.
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Affiliation(s)
- Emanuele F. Osimo
- Imperial College London Institute of Clinical Sciences and UKRI MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, London, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Benjamin I. Perry
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Pavan Mallikarjun
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, England
- Birmingham Early Intervention Service, Birmingham Women’s and Children’s NHS Foundation trust
| | | | - Jonathan Lewis
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Asia Katunda
- Birmingham Early Intervention Service, Birmingham Women’s and Children’s NHS Foundation trust
| | - Graham K. Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Norwich Medical School, University of East Anglia. Norwich, UK
- Applied Research Collaboration East of England, National Institute for Health Research (NIHR), UK
- Institute of Biomedical Research of Salamanca (IBSAL); Psychiatry Unit, Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Applied Research Collaboration East of England, National Institute for Health Research (NIHR), UK
| | - Rudolf N. Cardinal
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Oliver D. Howes
- Imperial College London Institute of Clinical Sciences and UKRI MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, England
- Birmingham Early Intervention Service, Birmingham Women’s and Children’s NHS Foundation trust
| | - Golam M. Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
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45
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Marwaha S, Palmer E, Suppes T, Cons E, Young AH, Upthegrove R. Novel and emerging treatments for major depression. Lancet 2023; 401:141-153. [PMID: 36535295 DOI: 10.1016/s0140-6736(22)02080-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 90.0] [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: 07/04/2022] [Revised: 10/09/2022] [Accepted: 10/19/2022] [Indexed: 12/23/2022]
Abstract
Depression is common, costly, debilitating, and associated with increased risk of suicide. It is one of the leading global public health problems. Although existing available pharmacological treatments can be effective, their onset of action can take up to 6 weeks, side-effects are common, and recovery can require treatment with multiple different agents. Although psychosocial interventions might also be recommended, more effective treatments than those currently available are needed for people with moderate or severe depression. In the past 10 years, treatment trials have developed and tested many new targeted interventions. In this Review, we assess novel and emerging biological treatments for major depressive disorder, evaluate their putative brain and body mechanisms, and highlight how close each might be to clinical use.
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Affiliation(s)
- Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham and Solihull Mental Health NHS Trust, Birmingham, UK
| | - Edward Palmer
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Emily Cons
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, UK.
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46
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Griffiths SL, Upthegrove R, Corsi-Zuelli F, Deakin B. Rethinking Immunity and Cognition in Clinical High Risk for Psychosis. Curr Top Behav Neurosci 2023; 63:475-497. [PMID: 36409457 DOI: 10.1007/7854_2022_399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
It is well known that schizophrenia is associated with cognitive impairment, reduced cortical grey matter and increased circulating concentrations of inflammatory cytokines. However, the relationship between these findings is not clear. We outline the influential neuroinflammatory hypotheses that raised cytokines provoke a damaging immune response in microglia that results in reduced grey matter and associated cognitive performance. We investigated whether such an interaction might be detectable in the prodromal period as illness emerges from the Clinical High Risk for Psychosis (CHR-P). Meta-analyses suggest that compared with controls, impaired cognition and reduced grey matter are already present by the prodrome and that greater decrements are present in those who later develop symptoms. In contrast, the few cytokine studies report no abnormalities in CHR-P except that interleukin-6 (IL-6) levels were raised versus controls and to a greater extent in the future patients, in one study. We noted that cognitive impairment and less cortical grey matter are more severe in schizophrenia than in affective disorders, but that increased cytokine levels are similarly prevalent across disorders. We found no studies correlating cytokine levels with cognitive impairment in CHR-P but such correlations seem unlikely given the minimal relationship reported in a recent meta-analysis of the many cytokine-cognition studies in established illness. From this and other evidence, we conclude that neuroinflammation is not a core feature of schizophrenia nor a substrate for reduced grey matter volume or cognitive function. We draw attention instead to the emerging evidence that brain-resident immune cells and signalling molecules such as Tregs and IL-6, which are influenced by schizophrenia risk genes, regulate and are necessary for the development and function of neuron-glia interaction. We suggest that cognitive impairment in schizophrenia can be seen as a convergence of genetic and immune-neurodevelopmental dysregulation whereas raised cytokines are a consequence of impaired Tregs control of systemic inflammation.
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Affiliation(s)
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Fabiana Corsi-Zuelli
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Division of Psychiatry, Department of Neuroscience and Behaviour, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Bill Deakin
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK.
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47
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Lencer R, Schwarzer J, Meyhoefer I, Antonucci LA, Kambeitz-Ilankovic L, Surmann M, Bienek O, Romer G, Dannlowski U, Hahn T, Korda A, Dwyer DB, Ruef A, Haas SS, Kambeitz J, Salokangas RK, Pantelis C, Schultze-Lutter F, Meisenzahl E, Brambilla P, Bertolino A, Borgwardt S, Upthegrove R, Koutsouleris N. Visual disturbances in recent-onset psychosis and clinical high-risk state for psychosis. J Vis 2022. [DOI: 10.1167/jov.22.14.3529] [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: 12/23/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nikolaos Koutsouleris
- Ludwig Maximilian University Munich
- Max-Planck-Institute of Psychiatry Munich
- King's College London
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48
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Griffiths SL, Lalousis PA, Wood SJ, Upthegrove R. Heterogeneity in treatment outcomes and incomplete recovery in first episode psychosis: does one size fit all? Transl Psychiatry 2022; 12:485. [PMID: 36396628 PMCID: PMC9671914 DOI: 10.1038/s41398-022-02256-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022] Open
Abstract
The heterogeneity in recovery outcomes for individuals with First Episode Psychosis (FEP) calls for a strong evidence base to inform practice at an individual level. Between 19-89% of young people with FEP have an incomplete recovery despite gold-standard evidence-based treatments, suggesting current service models, which adopt a 'one-size fits all' approach, may not be addressing the needs of many young people with psychosis. The lack of consistent terminology to define key concepts such as recovery and treatment resistance, the multidimensional nature of these concepts, and common comorbid symptoms are some of the challenges faced by the field in delineating heterogeneity in recovery outcomes. The lack of robust markers for incomplete recovery also results in potential delay in delivering prompt, and effective treatments to individuals at greatest risk. There is a clear need to adopt a stratified approach to care where interventions are targeted at subgroups of patients, and ultimately at the individual level. Novel machine learning, using large, representative data from a range of modalities, may aid in the parsing of heterogeneity, and provide greater precision and sophistication in identifying those on a pathway to incomplete recovery.
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Affiliation(s)
- Siân Lowri Griffiths
- Institute for Mental Health, University of Birmingham, Birmingham, UK. .,Centre for Human Brain Health, University of Birmingham, Birmingham, UK.
| | - Paris Alexandros Lalousis
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,grid.6572.60000 0004 1936 7486Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Stephen J. Wood
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,grid.488501.00000 0004 8032 6923Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Parkville, VIC Australia
| | - Rachel Upthegrove
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,grid.6572.60000 0004 1936 7486Centre for Human Brain Health, University of Birmingham, Birmingham, UK ,grid.498025.20000 0004 0376 6175Birmingham Early Interventions Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
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49
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Upthegrove R. From co-morbidity to transdiagnostic potential and novel immunotherapies for psychosis. Psychiatry Res 2022; 317:114866. [PMID: 36201895 DOI: 10.1016/j.psychres.2022.114866] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 01/05/2023]
Abstract
One of my first placements in psychiatry training was with the early intervention in psychosis services in Birmingham, in the late 1990's. It was in this context that I became aware of the frequency and importance of affective co- modbidity and lack of diagnostic certianty in early stages of develping severe mental illness. This challenged the established dichotomy between affective and non-affective severe mental illnesses, and has driven my work and thinking ever since- including that embracing the presence of affective symptoms in schizophrenia may open the door for new treatments. Understanding affective dysfunction as a potential intrisic component of developing psychotic disorders has also shown the potential for transdiagnostic symptoms with shared underlying biological processess, including immune dysfunction, related to remission and functional outcomes. Currently my work focuses on targeting the immune system to improve recovery in clinical trials, and further mechanistic studies that reach beyond traditional diagnostic catagories.
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Affiliation(s)
- Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health, Institute for Mental Health, Deputy Editor, British Journal of Psychiatry, Deputy Director, NIHR Mental Health Translational Research Collaboration, Honorary General Secretary British Association for Psychopharmacology, University of Birmingham and Birmingham Early Intervention Service, 52 Prichatts Road, Edgbaston, Birmingham B152TT, UK.
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Perry BI, Vandenberghe F, Garrido-Torres N, Osimo EF, Piras M, Vazquez-Bourgon J, Upthegrove R, Grosu C, De La Foz VOG, Jones PB, Laaboub N, Ruiz-Veguilla M, Stochl J, Dubath C, Canal-Rivero M, Mallikarjun P, Delacrétaz A, Ansermot N, Fernandez-Egea E, Crettol S, Gamma F, Plessen KJ, Conus P, Khandaker GM, Murray GK, Eap CB, Crespo-Facorro B. The psychosis metabolic risk calculator (PsyMetRiC) for young people with psychosis: International external validation and site-specific recalibration in two independent European samples. Lancet Reg Health Eur 2022; 22:100493. [PMID: 36039146 PMCID: PMC9418905 DOI: 10.1016/j.lanepe.2022.100493] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Cardiometabolic dysfunction is common in young people with psychosis. Recently, the Psychosis Metabolic Risk Calculator (PsyMetRiC) was developed and externally validated in the UK, predicting up-to six-year risk of metabolic syndrome (MetS) from routinely collected data. The full-model includes age, sex, ethnicity, body-mass index, smoking status, prescription of metabolically-active antipsychotic medication, high-density lipoprotein, and triglyceride concentrations; the partial-model excludes biochemical predictors. Methods To move toward a future internationally-useful tool, we externally validated PsyMetRiC in two independent European samples. We used data from the PsyMetab (Lausanne, Switzerland) and PAFIP (Cantabria, Spain) cohorts, including participants aged 16-35y without MetS at baseline who had 1-6y follow-up. Predictive performance was assessed primarily via discrimination (C-statistic), calibration (calibration plots), and decision curve analysis. Site-specific recalibration was considered. Findings We included 1024 participants (PsyMetab n=558, male=62%, outcome prevalence=19%, mean follow-up=2.48y; PAFIP n=466, male=65%, outcome prevalence=14%, mean follow-up=2.59y). Discrimination was better in the full- compared with partial-model (PsyMetab=full-model C=0.73, 95% C.I., 0.68-0.79, partial-model C=0.68, 95% C.I., 0.62-0.74; PAFIP=full-model C=0.72, 95% C.I., 0.66-0.78; partial-model C=0.66, 95% C.I., 0.60-0.71). As expected, calibration plots revealed varying degrees of miscalibration, which recovered following site-specific recalibration. PsyMetRiC showed net benefit in both new cohorts, more so after recalibration. Interpretation The study provides evidence of PsyMetRiC's generalizability in Western Europe, although further local and international validation studies are required. In future, PsyMetRiC could help clinicians internationally to identify young people with psychosis who are at higher cardiometabolic risk, so interventions can be directed effectively to reduce long-term morbidity and mortality. Funding NIHR Cambridge Biomedical Research Centre (BRC-1215-20014); The Wellcome Trust (201486/Z/16/Z); Swiss National Research Foundation (320030-120686, 324730- 144064, and 320030-173211); The Carlos III Health Institute (CM20/00015, FIS00/3095, PI020499, PI050427, and PI060507); IDIVAL (INT/A21/10 and INT/A20/04); The Andalusian Regional Government (A1-0055-2020 and A1-0005-2021); SENY Fundacion Research (2005-0308007); Fundacion Marques de Valdecilla (A/02/07, API07/011); Ministry of Economy and Competitiveness and the European Fund for Regional Development (SAF2016-76046-R and SAF2013-46292-R).For the Spanish and French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Benjamin I. Perry
- Department of Psychiatry, University of Cambridge, Cambridge, England, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, England, United Kingdom
| | - Frederik Vandenberghe
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Nathalia Garrido-Torres
- Virgen del Rocío University Hospital, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Institute of Biomedicine of Seville (IBiS), University of Seville, First-episode Psychosis Research Network of Andalusia (Red PEPSur), Spain
| | - Emanuele F. Osimo
- Department of Psychiatry, University of Cambridge, Cambridge, England, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, England, United Kingdom
- MRC London Institute of Medical Sciences, Institute of Clinical Sciences, Imperial College, Hammersmith Campus, London, England, United Kingdom
| | - Marianna Piras
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Javier Vazquez-Bourgon
- Virgen del Rocío University Hospital, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Institute of Biomedicine of Seville (IBiS), University of Seville, First-episode Psychosis Research Network of Andalusia (Red PEPSur), Spain
- Department of Psychiatry, Marques de Valdecilla University Hospital, Institute of Biomedicine Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Spain
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, England, United Kingdom
- Early Intervention Service, Birmingham Womens and Childrens NHS Foundation Trust
| | - Claire Grosu
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Victor Ortiz-Garcia De La Foz
- Department of Psychiatry, Marques de Valdecilla University Hospital, Institute of Biomedicine Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Spain
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, England, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, England, United Kingdom
| | - Nermine Laaboub
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Miguel Ruiz-Veguilla
- Virgen del Rocío University Hospital, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Institute of Biomedicine of Seville (IBiS), University of Seville, First-episode Psychosis Research Network of Andalusia (Red PEPSur), Spain
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, England, United Kingdom
- Department of Kinanthropology, Charles University, Prague, Czech Republic
| | - Celine Dubath
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Manuel Canal-Rivero
- Virgen del Rocío University Hospital, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Institute of Biomedicine of Seville (IBiS), University of Seville, First-episode Psychosis Research Network of Andalusia (Red PEPSur), Spain
| | - Pavan Mallikarjun
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, England, United Kingdom
| | - Aurélie Delacrétaz
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Nicolas Ansermot
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Cambridge, England, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, England, United Kingdom
| | - Severine Crettol
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Franziska Gamma
- Les Toises Psychiatry and Psychotherapy Centre, Lausanne, Switzerland
| | - Kerstin J. Plessen
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland
| | - Golam M. Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, England, United Kingdom
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, United Kingdom
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, United Kingdom
| | - Graham K. Murray
- Department of Psychiatry, University of Cambridge, Cambridge, England, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, England, United Kingdom
| | - Chin B. Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Benedicto Crespo-Facorro
- Virgen del Rocío University Hospital, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Institute of Biomedicine of Seville (IBiS), University of Seville, First-episode Psychosis Research Network of Andalusia (Red PEPSur), Spain
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