1
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Rothschild AJ. Should Antipsychotic Medications Be Prescribed to Patients With Nonpsychotic Depression? J Clin Psychopharmacol 2022; 42:231-233. [PMID: 35475846 DOI: 10.1097/jcp.0000000000001550] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Anthony J Rothschild
- From the Department of Psychiatry, University of Massachusetts Chan Medical School and UMass Memorial Health Care, Worcester, MA
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2
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Prasad K, Rubin J, Mitra A, Lewis M, Theis N, Muldoon B, Iyengar S, Cape J. Structural covariance networks in schizophrenia: A systematic review Part I. Schizophr Res 2022; 240:1-21. [PMID: 34906884 PMCID: PMC8917984 DOI: 10.1016/j.schres.2021.11.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/02/2021] [Accepted: 11/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Schizophrenia is proposed as a disorder of dysconnectivity. However, examination of complexities of dysconnectivity has been challenging. Structural covariance networks (SCN) provide important insights into the nature of dysconnectivity. This systematic review examines the SCN studies that employed statistical approaches to elucidate covariation of regional morphometric variations. METHODS A systematic search of literature was conducted for peer-reviewed publications using different keywords and keyword combinations for schizophrenia. Fifty-two studies met the criteria. RESULTS Early SCN studies began using correlational structure of selected regions. Over the last 3 decades, methodological approaches have grown increasingly sophisticated from examining selected brain regions using correlation tests on small sample sizes to recent approaches that use advanced statistical methods to examine covariance structure of whole-brain parcellations on larger samples. Although the results are not fully consistent across all studies, a pattern of fronto-temporal, fronto-parietal and fronto-thalamic covariation is reported. Attempts to associate SCN alterations with functional connectivity, to differentiate between disease-related and neurodevelopment-related morphometric changes, and to develop "causality-based" models are being reported. Clinical correlation with outcome, psychotic symptoms, neurocognitive and social cognitive performance are also reported. CONCLUSIONS Application of advanced statistical methods are beginning to provide insights into interesting patterns of regional covariance including correlations with clinical and cognitive data. Although these findings appear similar to morphometric studies, SCNs have the advantage of highlighting topology of these regions and their relationship to the disease and associated variables. Further studies are needed to investigate neurobiological underpinnings of shared covariance, and causal links to clinical domains.
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Affiliation(s)
- Konasale Prasad
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara St, Pittsburgh, PA 15213, United States of America; University of Pittsburgh Swanson School of Engineering, 3700 O'Hara St, Pittsburgh, PA 15213, United States of America; VA Pittsburgh Healthcare System, University Dr C, Pittsburgh, PA 15240, United States of America.
| | - Jonathan Rubin
- Department of Mathematics, University of Pittsburgh, 301 Thackeray Hall, Pittsburgh PA 15260
| | - Anirban Mitra
- Department of Statistics, University of Pittsburgh, 1826 Wesley W. Posvar Hall, Pittsburgh PA 15260
| | - Madison Lewis
- University of Pittsburgh Swanson School of Engineering, 3700 O’Hara St, Pittsburgh PA 15213
| | - Nicholas Theis
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara St, Pittsburgh PA 15213
| | - Brendan Muldoon
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara St, Pittsburgh PA 15213
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, 1826 Wesley W. Posvar Hall, Pittsburgh PA 15260
| | - Joshua Cape
- Department of Statistics, University of Pittsburgh, 1826 Wesley W. Posvar Hall, Pittsburgh PA 15260
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3
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Lin Y, Li M, Zhou Y, Deng W, Ma X, Wang Q, Guo W, Li Y, Jiang L, Hu X, Zhang N, Li T. Age-Related Reduction in Cortical Thickness in First-Episode Treatment-Naïve Patients with Schizophrenia. Neurosci Bull 2019; 35:688-696. [PMID: 30790217 DOI: 10.1007/s12264-019-00348-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 10/25/2018] [Indexed: 02/05/2023] Open
Abstract
Substantial evidence supports the neurodevelopmental hypothesis of schizophrenia. Meanwhile, progressive neurodegenerative processes have also been reported, leading to the hypothesis that neurodegeneration is a characteristic component in the neuropathology of schizophrenia. However, a major challenge for the neurodegenerative hypothesis is that antipsychotic drugs used by patients have profound impact on brain structures. To clarify this potential confounding factor, we measured the cortical thickness across the whole brain using high-resolution T1-weighted magnetic resonance imaging in 145 first-episode and treatment-naïve patients with schizophrenia and 147 healthy controls. The results showed that, in the patient group, the frontal, temporal, parietal, and cingulate gyri displayed a significant age-related reduction of cortical thickness. In the control group, age-related cortical thickness reduction was mostly located in the frontal, temporal, and cingulate gyri, albeit to a lesser extent. Importantly, relative to healthy controls, patients exhibited a significantly smaller age-related cortical thickness in the anterior cingulate, inferior temporal, and insular gyri in the right hemisphere. These results provide evidence supporting the existence of neurodegenerative processes in schizophrenia and suggest that these processes already occur in the early stage of the illness.
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Affiliation(s)
- Yin Lin
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China.,Department of Psychology, Shenzhen Children's Hospital, Shenzhen, 518038, China
| | - Mingli Li
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yi Zhou
- Department of Radiology, Hospital for Chengdu Office of Tibetan Autonomous Region, Branch Hospital of West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wei Deng
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaohong Ma
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qiang Wang
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wanjun Guo
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yinfei Li
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lijun Jiang
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xun Hu
- Huaxi Biobank, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Nanyin Zhang
- Department of Biomedical Engineering, Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, 16802, USA.
| | - Tao Li
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China. .,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China.
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4
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Emsley R, Asmal L, du Plessis S, Chiliza B, Phahladira L, Kilian S. Brain volume changes over the first year of treatment in schizophrenia: relationships to antipsychotic treatment. Psychol Med 2017; 47:2187-2196. [PMID: 28347393 DOI: 10.1017/s0033291717000642] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Progressive brain volume reductions have been described in schizophrenia, and an association with antipsychotic exposure has been reported. METHODS We compared percentage changes in grey and white matter volume from baseline to month 12 in 23 previously antipsychotic-naïve patients with a first episode of schizophrenia or schizophreniform disorder who were treated with the lowest effective dose of flupenthixol decanoate depot formulation, with 53 matched healthy individuals. Total antipsychotic dose was precisely calculated and its relationship with brain volume changes investigated. Relationships between volumetric changes and treatment were further investigated in terms of treatment response (changes in psychopathology and functionality) and treatment-related adverse-events (extrapyramidal symptoms and weight gain). RESULTS Excessive cortical volume reductions were observed in patients [-4.6 (6.6)%] v. controls [-1.12 (4.0)%] (p = 0.009), with no significant group differences for changes in subcortical grey matter and white matter volumes. In a multiple regression model, the only significant predictor of cortical volume change was total antipsychotic dose received (p = 0.04). Cortical volume change was not significantly associated with the changes in psychopathology, functionality, extrapyramidal symptoms and body mass index or age, gender and duration of untreated psychosis. CONCLUSIONS Brain volume reductions associated with antipsychotic treatment are not restricted to poor outcome patients and occur even with the lowest effective dose of antipsychotic. The lack of an association with poor treatment response or treatment-related adverse effects counts against cortical volume reductions reflecting neurotoxicity, at least in the short term. On the other hand, the volume reductions were not linked to the therapeutic benefits of antipsychotics.
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Affiliation(s)
- R Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences,Stellenbosch University,Cape Town,South Africa
| | - L Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences,Stellenbosch University,Cape Town,South Africa
| | - S du Plessis
- Department of Psychiatry, Faculty of Medicine and Health Sciences,Stellenbosch University,Cape Town,South Africa
| | - B Chiliza
- Department of Psychiatry, Faculty of Medicine and Health Sciences,Stellenbosch University,Cape Town,South Africa
| | - L Phahladira
- Department of Psychiatry, Faculty of Medicine and Health Sciences,Stellenbosch University,Cape Town,South Africa
| | - S Kilian
- Department of Psychiatry, Faculty of Medicine and Health Sciences,Stellenbosch University,Cape Town,South Africa
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5
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Kumar V, Rao NP, Narasimha V, Sathyanarayanan G, Muralidharan K, Varambally S, Venkatasubramanian G, Gangadhar BN. Antipsychotic dose in maintenance treatment of schizophrenia: A retrospective study. Psychiatry Res 2016; 245:311-316. [PMID: 27567194 DOI: 10.1016/j.psychres.2016.08.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/01/2016] [Accepted: 08/13/2016] [Indexed: 12/25/2022]
Abstract
The dose of antipsychotic required for acute phase treatment of schizophrenia is well established, but there is no consensus on dose required for maintenance phase. Current guidelines do not provide definitive recommendations on the dose of antipsychotics needed in the maintenance treatment of schizophrenia, possibly due to limited research. In this retrospective study, minimum antipsychotic dose prescribed in maintenance treatment of schizophrenia in a real life situation was examined. Schizophrenia patients having Clinical Global Impression - Severity (CGI-S)≤3 for at-least six months during the maintenance phase treatment were included (n=163). The medical records of these patients were reviewed and the antipsychotic dose prescribed for acute and maintenance phase treatment was recorded. The mean antipsychotic dose used during maintenance treatment was approximately 30% lower than the dose used during acute phase. Importantly, about 40% of the subjects maintained well with a dose lesser than the recommended therapeutic range. Earlier age at onset and longer duration of illness were associated with higher antipsychotic dose requirement during the maintenance phase treatment. These findings could have important clinical implications if replicated in systematic prospective studies.
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Affiliation(s)
- Vijay Kumar
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Naren P Rao
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
| | - Venkatalakshmi Narasimha
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Gopinath Sathyanarayanan
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kesavan Muralidharan
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shivarama Varambally
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ganesan Venkatasubramanian
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Bangalore N Gangadhar
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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6
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Crum WR, Danckaers F, Huysmans T, Cotel MC, Natesan S, Modo MM, Sijbers J, Williams SCR, Kapur S, Vernon AC. Chronic exposure to haloperidol and olanzapine leads to common and divergent shape changes in the rat hippocampus in the absence of grey-matter volume loss. Psychol Med 2016; 46:3081-3093. [PMID: 27516217 PMCID: PMC5108303 DOI: 10.1017/s0033291716001768] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND One of the most consistently reported brain abnormalities in schizophrenia (SCZ) is decreased volume and shape deformation of the hippocampus. However, the potential contribution of chronic antipsychotic medication exposure to these phenomena remains unclear. METHOD We examined the effect of chronic exposure (8 weeks) to clinically relevant doses of either haloperidol (HAL) or olanzapine (OLZ) on adult rat hippocampal volume and shape using ex vivo structural MRI with the brain retained inside the cranium to prevent distortions due to dissection, followed by tensor-based morphometry (TBM) and elastic surface-based shape deformation analysis. The volume of the hippocampus was also measured post-mortem from brain tissue sections in each group. RESULTS Chronic exposure to either HAL or OLZ had no effect on the volume of the hippocampus, even at exploratory thresholds, which was confirmed post-mortem. In contrast, shape deformation analysis revealed that chronic HAL and OLZ exposure lead to both common and divergent shape deformations (q = 0.05, FDR-corrected) in the rat hippocampus. In particular, in the dorsal hippocampus, HAL exposure led to inward shape deformation, whereas OLZ exposure led to outward shape deformation. Interestingly, outward shape deformations that were common to both drugs occurred in the ventral hippocampus. These effects remained significant after controlling for hippocampal volume suggesting true shape changes. CONCLUSIONS Chronic exposure to either HAL or OLZ leads to both common and divergent effects on rat hippocampal shape in the absence of volume change. The implications of these findings for the clinic are discussed.
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Affiliation(s)
- W. R. Crum
- Department of Neuroimaging,
King's College London, Institute of
Psychiatry, Psychology and Neuroscience,
Centre for Neuroimaging Sciences, De Crespigny
Park, London, UK
| | - F. Danckaers
- Department of Physics,
iMinds-Vision Laboratory, University of
Antwerp, Antwerp, Belgium
| | - T. Huysmans
- Department of Physics,
iMinds-Vision Laboratory, University of
Antwerp, Antwerp, Belgium
| | - M.-C. Cotel
- Department of Psychosis Studies,
King's College London, Institute of
Psychiatry, Psychology and Neuroscience, De
Crespigny Park, London, UK
| | - S. Natesan
- Department of Psychosis Studies,
King's College London, Institute of
Psychiatry, Psychology and Neuroscience, De
Crespigny Park, London, UK
| | - M. M. Modo
- Department of Basic and Clinical
Neuroscience, King's College London,
Institute of Psychiatry, Psychology and
Neuroscience, Maurice Wohl Institute for Clinical
Neuroscience, London, UK
| | - J. Sijbers
- Department of Physics,
iMinds-Vision Laboratory, University of
Antwerp, Antwerp, Belgium
| | - S. C. R. Williams
- Department of Neuroimaging,
King's College London, Institute of
Psychiatry, Psychology and Neuroscience,
Centre for Neuroimaging Sciences, De Crespigny
Park, London, UK
| | - S. Kapur
- Department of Psychosis Studies,
King's College London, Institute of
Psychiatry, Psychology and Neuroscience, De
Crespigny Park, London, UK
| | - A. C. Vernon
- Department of Psychosis Studies,
King's College London, Institute of
Psychiatry, Psychology and Neuroscience, De
Crespigny Park, London, UK
- Department of Basic and Clinical
Neuroscience, King's College London,
Institute of Psychiatry, Psychology and
Neuroscience, Maurice Wohl Institute for Clinical
Neuroscience, London, UK
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7
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Wu H, Wang X, Gao Y, Lin F, Song T, Zou Y, Xu L, Lei H. NMDA receptor antagonism by repetitive MK801 administration induces schizophrenia-like structural changes in the rat brain as revealed by voxel-based morphometry and diffusion tensor imaging. Neuroscience 2016; 322:221-33. [DOI: 10.1016/j.neuroscience.2016.02.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 12/19/2022]
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8
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Schubert KO, Föcking M, Wynne K, Cotter DR. Proteome and pathway effects of chronic haloperidol treatment in mouse hippocampus. Proteomics 2016; 16:532-8. [PMID: 26607048 DOI: 10.1002/pmic.201500242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/01/2015] [Accepted: 11/19/2015] [Indexed: 11/11/2022]
Abstract
Proteomic exploration of the effects of psychotropic drugs on specific brain areas in rodents has the potential to uncover novel molecular networks and pathways affected by psychotropic medications, and may inform etiologic hypotheses on mental disorders. Haloperidol, a widely used first-generation antipsychotic, has been shown to produce structural and functional changes of the hippocampus, a brain region also implicated in the neuropathology of disorders such as schizophrenia and bipolar disorder. Seven adult male C57BL/6 mice were injected daily intraperitoneally with 0.5 mg/kg of haloperidol, for 28 days. A control group of six animals was injected with vehicle only (saline). Protein levels of postmortem hippocampus homogenate were determined using label-free LC/MS/MS. In the treatment group, 216 differentially expressed hippocampal proteins were identified as compared to controls. Ingenuity pathway analysis implicated oxidative phosphorylation and mitochondrial function as top canonical pathways, and local networks involved in tubulin-mediated cytoskeleton dynamics, clathrin-mediated endocytosis, and extracellular signal-regulated kinase and c-Jun N-terminal kinase signaling. The findings of this study could stimulate further research into the cellular mechanisms associated with haloperidol treatment and the pathophysiology of psychotic disorders, assisting treatment biomarker discovery. All MS data have been deposited in the ProteomeXchange with identifier PXD002250 (http://proteomecentral.proteomexchange.org/dataset/PXD002250).
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Affiliation(s)
- Klaus Oliver Schubert
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.,Discipline of Psychiatry, The University of Adelaide, Adelaide, Australia
| | - Melanie Föcking
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kieran Wynne
- Proteomics Resource, UCD Conway Institute of Biomolecular and Biomedical Research, Dublin, Ireland
| | - David R Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
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9
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Savadjiev P, Seidman LJ, Thermenos H, Keshavan M, Whitfield-Gabrieli S, Crow TJ, Kubicki M. Sexual dimorphic abnormalities in white matter geometry common to schizophrenia and non-psychotic high-risk subjects: Evidence for a neurodevelopmental risk marker? Hum Brain Mapp 2015; 37:254-61. [PMID: 26467751 DOI: 10.1002/hbm.23026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/30/2015] [Accepted: 10/04/2015] [Indexed: 12/23/2022] Open
Abstract
The characterization of neurodevelopmental aspects of brain alterations require neuroimaging methods that reflect correlates of neurodevelopment, while being robust to other progressive pathological processes. Newly developed neuroimaging methods for measuring geometrical features of the white matter fall exactly into this category. Our recent work shows that such features, measured in the anterior corpus callosum in diffusion MRI data, correlate with psychosis symptoms in patients with adolescent onset schizophrenia and subside a reversal of normal sexual dimorphism. Here, we test the hypothesis that similar developmental deviations will also be present in nonpsychotic subjects at familial high risk (FHR) for schizophrenia, due to genetic predispositions. Demonstrating such changes would provide a strong indication of neurodevelopmental deviation extant before, and independent of pathological changes occurring after disease onset. We examined the macrostructural geometry of corpus callosum white matter in diffusion MRI data of 35 non-psychotic subjects with genetic (familial) risk for schizophrenia, and 26 control subjects, both male and female. We report a reversal of normal sexual dimorphism in callosal white matter geometry consistent with recent results in adolescent onset schizophrenia. This pattern may be indicative of an error in neurogenesis and a possible trait marker of schizophrenia.
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Affiliation(s)
- Peter Savadjiev
- Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Larry J Seidman
- Massachusetts Mental Health Center, Division of Public Psychiatry, Boston, Massachusetts.,Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Heidi Thermenos
- Massachusetts Mental Health Center, Division of Public Psychiatry, Boston, Massachusetts.,Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Susan Whitfield-Gabrieli
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Tim J Crow
- SANE POWIC, University Department of Psychiatry, Warneford Hospital, Oxford, United Kingdom
| | - Marek Kubicki
- Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry and Radiology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
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10
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Cancel A, Comte M, Truillet R, Boukezzi S, Rousseau PF, Zendjidjian XY, Sage T, Lazerges PE, Guedj E, Khalfa S, Azorin JM, Blin O, Fakra E. Childhood neglect predicts disorganization in schizophrenia through grey matter decrease in dorsolateral prefrontal cortex. Acta Psychiatr Scand 2015; 132:244-56. [PMID: 26038817 DOI: 10.1111/acps.12455] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Psychosocial trauma during childhood is associated with schizophrenia vulnerability. The pattern of grey matter decrease is similar to brain alterations seen in schizophrenia. Our objective was to explore the links between childhood trauma, brain morphology and schizophrenia symptoms. METHOD Twenty-one patients with schizophrenia stabilized with atypical antipsychotic monotherapy and 30 healthy control subjects completed the study. Anatomical MRI images were analysed using optimized voxel-based morphometry (VBM). Childhood trauma was assessed with the Childhood Trauma Questionnaire, and symptoms were rated on the Scale for the Assessment of Negative Symptoms (SANS) and Scale for the Assessment of Positive Symptoms (SAPS) (disorganization, positive and negative symptoms). In the schizophrenia group, we used structural equation modelling in a path analysis. RESULTS Total grey matter volume was negatively associated with emotional neglect (EN) in patients with schizophrenia. Whole-brain VBM analyses of grey matter in the schizophrenia group revealed a specific inversed association between EN and the right dorsolateral prefrontal cortex (DLPFC). Path analyses identified a well-fitted model in which EN predicted grey matter density in DLPFC, which in turn predicted the disorganization score. CONCLUSION Our findings suggest that EN during childhood could have an impact on psychopathology in schizophrenia, which would be mediated by developmental effects on brain regions such as the DLPFC.
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Affiliation(s)
- A Cancel
- Timone Institute of Neuroscience, UMR 7289, CNRS and Aix-Marseille University, Marseille, France.,Department of Psychiatry, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - M Comte
- Timone Institute of Neuroscience, UMR 7289, CNRS and Aix-Marseille University, Marseille, France
| | - R Truillet
- Public Assistance for Marseille Hospitals (APHM) Unit for Clinical Pharmacology and Therapeutic Evaluation (CIC-UPCET), CHU Timone Hospital, Marseille, France
| | - S Boukezzi
- Timone Institute of Neuroscience, UMR 7289, CNRS and Aix-Marseille University, Marseille, France
| | - P-F Rousseau
- Timone Institute of Neuroscience, UMR 7289, CNRS and Aix-Marseille University, Marseille, France.,Psychiatry Unit, Saint Anne Military Training Hospital, Toulon, France
| | - X Y Zendjidjian
- Department of Psychiatry, La Conception University Hospital, Marseille, France
| | - T Sage
- Clinic of Mental Health, L'escale, Orpea-Clinéa, Saint-Victoret, France
| | - P-E Lazerges
- Department of Psychiatry, Sainte Marguerite University Hospital, Marseille, France
| | - E Guedj
- Timone Institute of Neuroscience, UMR 7289, CNRS and Aix-Marseille University, Marseille, France.,Biophysics and Nuclear Medicine Department, Timone Hospital, Marseille, France
| | - S Khalfa
- Timone Institute of Neuroscience, UMR 7289, CNRS and Aix-Marseille University, Marseille, France
| | - J-M Azorin
- Timone Institute of Neuroscience, UMR 7289, CNRS and Aix-Marseille University, Marseille, France.,Department of Psychiatry, Sainte Marguerite University Hospital, Marseille, France
| | - O Blin
- Timone Institute of Neuroscience, UMR 7289, CNRS and Aix-Marseille University, Marseille, France.,Public Assistance for Marseille Hospitals (APHM) Unit for Clinical Pharmacology and Therapeutic Evaluation (CIC-UPCET), CHU Timone Hospital, Marseille, France
| | - E Fakra
- Timone Institute of Neuroscience, UMR 7289, CNRS and Aix-Marseille University, Marseille, France.,Department of Psychiatry, University Hospital of Saint-Etienne, Saint-Etienne, France
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11
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De Hert M, Sermon J, Geerts P, Vansteelandt K, Peuskens J, Detraux J. The Use of Continuous Treatment Versus Placebo or Intermittent Treatment Strategies in Stabilized Patients with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with First- and Second-Generation Antipsychotics. CNS Drugs 2015; 29:637-58. [PMID: 26293744 DOI: 10.1007/s40263-015-0269-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although continuous treatment with antipsychotics is still recommended as the gold standard treatment paradigm for all patients with schizophrenia, some clinicians question whether continuous antipsychotic treatment is necessary, or even justified, for every patient with schizophrenia who has been stabilized on antipsychotics. OBJECTIVE The primary objectives of this systematic review and meta-analysis were (i) to compare relapse/hospitalization risks of stabilized patients with schizophrenia under active versus intermittent or placebo treatment conditions; (ii) to examine the role of several study characteristics, possibly intervening in the relationship between relapse risk and treatment condition; and (iii) to examine whether time to relapse is associated with antipsychotic treatment duration. METHODS A systematic literature search, using the MEDLINE database (1950 until November 2014), was conducted for English-language published randomized controlled trials, covering a follow-up time period of at least 6 months, and investigating relapse/rehospitalization and/or time-to-relapse rates with placebo or intermittent treatment strategies versus continuous treatment with oral and long-acting injectable first- or second-generation antipsychotics (FGAs/SGAs) in stabilized patients with schizophrenia. Additional studies were identified through searches of reference lists of other identified systematic reviews and Cochrane reports. Two meta-analyses (placebo versus continuous and intermittent versus continuous treatment) were performed to obtain an optimal estimation of the relapse/hospitalization risks of stabilized patients with schizophrenia under these treatment conditions and to assess the role of study characteristics. For time-to-relapse data, a descriptive analysis was performed. RESULTS Forty-eight reports were selected as potentially eligible for our meta-analysis. Of these, 21 met the inclusion criteria. Twenty-five records, identified through Cochrane and other systematic reviews and fulfilling the inclusion criteria, were added, resulting in a total of 46 records. Stabilized patients with schizophrenia who have been exposed for at least 6 months to intermittent or placebo strategies, respectively, have a 3 (odds ratio [OR] 3.36; 95% CI 2.36-5.45; p < 0.0001) to 6 (OR 5.64; 95% CI 4.47-7.11; p < 0.0001) times increased risk of relapse, compared with patients on continuous treatment. The availability of rescue medication (p = 0.0102) was the only study characteristic explaining systematic differences in the OR for relapse between placebo versus continuous treatment across studies. Studies reporting time-to-relapse data show that the time to (impending) relapse is always significantly delayed with continuous treatment, compared with placebo or intermittent treatment strategies. Although the interval between treatment discontinuation and symptom recurrence can be highly variable, mean time-to-relapse data seem to indicate a failure of clinical stability before 7-14 months with intermittent and before 5 months with placebo treatment strategies. For all reports included in this systematic review, median time-to-relapse rates in the continuous treatment group were not estimable as <50% of the patients in this treatment condition relapsed before the end of the study. CONCLUSIONS With continuous treatment, patients have a lower risk of relapse and remain relapse free for a longer period of time compared with placebo and intermittent treatment strategies. Moreover, 'success rates' in the intermittent treatment conditions are expected to be an overestimate of actual outcome rates. Therefore, continuous treatment remains the 'gold standard' for good clinical practice, particularly as, until now, only a few and rather general valid predictors for relapse in schizophrenia are known and subsequent relapses may contribute to functional deterioration as well as treatment resistance in patients with schizophrenia.
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Affiliation(s)
- Marc De Hert
- Department of Neurosciences, Z.org KU Leuven-University Psychiatric Centre, UPC KUL Campus Kortenberg, Leuvensesteenweg 517, 3070, Kortenberg, Belgium.
| | - Jan Sermon
- Janssen-Cilag NV, Health Economics, Market Access and Reimbursement-Neuroscience, 2340, Beerse, Belgium
| | - Paul Geerts
- Janssen-Cilag NV, Medical Affairs-Psychiatry, 2340, Beerse, Belgium
| | - Kristof Vansteelandt
- Department of Neurosciences, Z.org KU Leuven-University Psychiatric Centre, UPC KUL Campus Kortenberg, Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Joseph Peuskens
- Department of Neurosciences, Z.org KU Leuven-University Psychiatric Centre, UPC KUL Campus Kortenberg, Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Johan Detraux
- Department of Neurosciences, Z.org KU Leuven-University Psychiatric Centre, UPC KUL Campus Kortenberg, Leuvensesteenweg 517, 3070, Kortenberg, Belgium
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Nanda P, Tandon N, Mathew IT, Giakoumatos CI, Abhishekh HA, Clementz B, Pearlson G, Sweeney J, Tamminga C, Keshavan MS. Local gyrification index in probands with psychotic disorders and their first-degree relatives. Biol Psychiatry 2014; 76:447-55. [PMID: 24369266 PMCID: PMC4032376 DOI: 10.1016/j.biopsych.2013.11.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 11/12/2013] [Accepted: 11/14/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Psychotic disorders are characterized by aberrant neural connectivity. Alterations in gyrification, the pattern and degree of cortical folding, may be related to the early development of connectivity. Past gyrification studies have relatively small sample sizes, yield mixed results for schizophrenia, and are scant for psychotic bipolar and schizoaffective (SZA) disorders and for relatives of these conditions. Here, we examine gyrification in psychotic disorder patients and their first-degree relatives as a possible endophenotype. METHODS Regional local gyrification index (LGI) values, as measured by FreeSurfer software, were compared between 243 control subjects, 388 psychotic disorder probands, and 300 of their first-degree relatives. For patients, LGI values were examined grouped across psychotic diagnoses and then separately for schizophrenia, SZA, and bipolar disorder. Familiality (heritability) values and correlations with clinical measures were also calculated for regional LGI values. RESULTS Probands exhibited significant hypogyria compared with control subjects in three brain regions and relatives with Axis II cluster A disorders showed nearly significant hypogyria in these same regions. Local gyrification index values in these locations were significantly heritable and uncorrelated with any clinical measure. Observations of significant hypogyria were most widespread in SZA. CONCLUSIONS Psychotic disorders appear to be characterized by significant regionally localized hypogyria, particularly in cingulate cortex. This abnormality may be a structural endophenotype marking risk for psychotic illness and it may help elucidate etiological underpinnings of psychotic disorders.
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Affiliation(s)
- Pranav Nanda
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, Columbia University College of Physicians & Surgeons, New York, NY
| | - Neeraj Tandon
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, Baylor College ofMedicine, Houston, TX
| | - Ian T Mathew
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - Brett Clementz
- Department of Psychology, BioImaging Research Center, University of Georgia, Athens, Georgia, Department of Neuroscience, BioImaging Research Center, University of Georgia, Athens, Georgia
| | - Godfrey Pearlson
- Olin Neuropsychiatry Research Center, Institute ofLiving, Hartford, Connecticut, Departments of Psychiatry and Neurobiology, Yale University School of Medicine, New Haven, Connecticut
| | - John Sweeney
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carol Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
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13
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Veijola J, Guo JY, Moilanen JS, Jääskeläinen E, Miettunen J, Kyllönen M, Haapea M, Huhtaniska S, Alaräisänen A, Mäki P, Kiviniemi V, Nikkinen J, Starck T, Remes JJ, Tanskanen P, Tervonen O, Wink AM, Kehagia A, Suckling J, Kobayashi H, Barnett JH, Barnes A, Koponen HJ, Jones PB, Isohanni M, Murray GK. Longitudinal changes in total brain volume in schizophrenia: relation to symptom severity, cognition and antipsychotic medication. PLoS One 2014; 9:e101689. [PMID: 25036617 PMCID: PMC4103771 DOI: 10.1371/journal.pone.0101689] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 06/11/2014] [Indexed: 02/07/2023] Open
Abstract
Studies show evidence of longitudinal brain volume decreases in schizophrenia. We studied brain volume changes and their relation to symptom severity, level of function, cognition, and antipsychotic medication in participants with schizophrenia and control participants from a general population based birth cohort sample in a relatively long follow-up period of almost a decade. All members of the Northern Finland Birth Cohort 1966 with any psychotic disorder and a random sample not having psychosis were invited for a MRI brain scan, and clinical and cognitive assessment during 1999-2001 at the age of 33-35 years. A follow-up was conducted 9 years later during 2008-2010. Brain scans at both time points were obtained from 33 participants with schizophrenia and 71 control participants. Regression models were used to examine whether brain volume changes predicted clinical and cognitive changes over time, and whether antipsychotic medication predicted brain volume changes. The mean annual whole brain volume reduction was 0.69% in schizophrenia, and 0.49% in controls (p = 0.003, adjusted for gender, educational level, alcohol use and weight gain). The brain volume reduction in schizophrenia patients was found especially in the temporal lobe and periventricular area. Symptom severity, functioning level, and decline in cognition were not associated with brain volume reduction in schizophrenia. The amount of antipsychotic medication (dose years of equivalent to 100 mg daily chlorpromazine) over the follow-up period predicted brain volume loss (p = 0.003 adjusted for symptom level, alcohol use and weight gain). In this population based sample, brain volume reduction continues in schizophrenia patients after the onset of illness, and antipsychotic medications may contribute to these reductions.
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Affiliation(s)
- Juha Veijola
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
- * E-mail:
| | - Joyce Y. Guo
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Jani S. Moilanen
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Erika Jääskeläinen
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Jouko Miettunen
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland
- Institute of Health Sciences, University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Merja Kyllönen
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Marianne Haapea
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Sanna Huhtaniska
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Antti Alaräisänen
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Pirjo Mäki
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Vesa Kiviniemi
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Juha Nikkinen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Tuomo Starck
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Jukka J. Remes
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Päivikki Tanskanen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Osmo Tervonen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Alle-Meije Wink
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- VU University Medical Centre, Department of Radiology, Amsterdam, The Netherlands
| | - Angie Kehagia
- Department of Neuroimaging, Institute of Psychiatry, King's College London, London, United Kingdom
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Hiroyuki Kobayashi
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Neuropsychiatry, School of Medicine, Toho University, Tokyo, Japan
| | - Jennifer H. Barnett
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Cambridge Cognition Ltd, Bottisham, Cambridge, United Kingdom
| | - Anna Barnes
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Hannu J. Koponen
- University of Eastern Finland, Faculty of Health Sciences, Institute of Clinical Medicine and Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Matti Isohanni
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Graham K. Murray
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
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Vernon AC, Crum WR, Lerch JP, Chege W, Natesan S, Modo M, Cooper JD, Williams SCR, Kapur S. Reduced cortical volume and elevated astrocyte density in rats chronically treated with antipsychotic drugs-linking magnetic resonance imaging findings to cellular pathology. Biol Psychiatry 2014; 75:982-90. [PMID: 24143881 DOI: 10.1016/j.biopsych.2013.09.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/04/2013] [Accepted: 09/09/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Increasing evidence suggests that antipsychotic drugs (APD) might affect brain structure directly, particularly the cerebral cortex. However, the precise anatomical loci of these effects and their underlying cellular basis remain unclear. METHODS With ex vivo magnetic resonance imaging in rats treated chronically with APDs, we used automated analysis techniques to map the regions that show maximal impact of chronic (8 weeks) treatment with either haloperidol or olanzapine on the rat cortex. Guided by these imaging findings, we undertook a focused postmortem investigation with stereology. RESULTS We identified decreases in the volume and thickness of the anterior cingulate cortex (ACC) after chronic APD treatment, regardless of the APD administered. Postmortem analysis confirmed these volumetric findings and demonstrated that chronic APD treatment had no effect on the total number of neurons or S100β+ astrocytes in the ACC. In contrast, an increase in the density of these cells was observed. CONCLUSIONS This study demonstrates region-specific structural effects of chronic APD treatment on the rat cortex, primarily but not exclusively localized to the ACC. At least in the rat, these changes are not due to a loss of either neurons or astrocytes and are likely to reflect a loss of neuropil. Although caution needs to be exerted when extrapolating results from animals to patients, this study highlights the power of this approach to link magnetic resonance imaging findings to their histopathological origins.
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Affiliation(s)
| | - William R Crum
- Department of Neuroimaging, Centre for Neuroimaging Sciences
| | - Jason P Lerch
- Mouse Imaging Centre, The Hospital for Sick Children and Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | | | | | - Michel Modo
- Department of Neuroscience, Centre for the Cellular Basis of Behaviour, The James Black Centre, King's College London, Institute of Psychiatry
| | - Jonathan D Cooper
- Department of Neuroscience, Centre for the Cellular Basis of Behaviour, The James Black Centre, King's College London, Institute of Psychiatry
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15
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Ebdrup BH, Nørbak H, Borgwardt S, Glenthøj B. Volumetric changes in the basal ganglia after antipsychotic monotherapy: a systematic review. Curr Med Chem 2014; 20:438-47. [PMID: 23157636 PMCID: PMC3715891 DOI: 10.2174/0929867311320030015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 09/09/2012] [Accepted: 09/26/2012] [Indexed: 11/22/2022]
Abstract
Introduction: Exposure to antipsychotic medication has been extensively associated with structural brain changes in the basal ganglia (BG). Traditionally antipsychotics have been divided into first and second generation antipsychotics (FGAs and SGAs) however, the validity of this classification has become increasingly controversial. To address if specific antipsychotics induce differential effects on BG volumes or whether volumetric effects are explained by FGA or SGA classification, we reviewed longitudinal structural magnetic resonance imaging (MRI) studies investigating effects of antipsychotic monotherapy. Material and Methods: We systematically searched PubMed for longitudinal MRI studies of patients with schizophrenia or non-affective psychosis who had undergone a period of antipsychotic monotherapy. We used specific, predefined search terms and extracted studies were hand searched for additional studies. Results: We identified 13 studies published in the period from 1996 to 2011. Overall six compounds (two classified as FGAs and four as SGAs) have been investigated: haloperidol, zuclophentixol, risperidone, olanzapine, clozapine, and quetiapine. The follow-up period ranged from 3-24 months. Unexpectedly, no studies found that specific FGAs induce significant BG volume increases. Conversely, both volumetric increases and decreases in the BG have been associated with SGA monotherapy. Discussion: Induction of striatal volume increases is not a specific feature of FGAs. Except for clozapine treatment in chronic patients, volume reductions are not restricted to specific SGAs. The current review adds brain structural support to the notion that antipsychotics should no longer be classified as either FGAs or SGAs. Future clinical MRI studies should strive to elucidate effects of specific antipsychotic drugs.
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Affiliation(s)
- B H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research, CNSR & Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Psychiatric Center Glostrup, University Hospital DK-Glostrup, Denmark.
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16
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Torres US, Portela-Oliveira E, Borgwardt S, Busatto GF. Structural brain changes associated with antipsychotic treatment in schizophrenia as revealed by voxel-based morphometric MRI: an activation likelihood estimation meta-analysis. BMC Psychiatry 2013; 13:342. [PMID: 24359128 PMCID: PMC3878502 DOI: 10.1186/1471-244x-13-342] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 12/09/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The results of multiple studies on the association between antipsychotic use and structural brain changes in schizophrenia have been assessed only in qualitative literature reviews to date. We aimed to perform a meta-analysis of voxel-based morphometry (VBM) studies on this association to quantitatively synthesize the findings of these studies. METHODS A systematic computerized literature search was carried out through MEDLINE/PubMed, EMBASE, ISI Web of Science, SCOPUS and PsycINFO databases aiming to identify all VBM studies addressing this question and meeting predetermined inclusion criteria. All studies reporting coordinates representing foci of structural brain changes associated with antipsychotic use were meta-analyzed by using the activation likelihood estimation technique, currently the most sophisticated and best-validated tool for voxel-wise meta-analysis of neuroimaging studies. RESULTS Ten studies (five cross-sectional and five longitudinal) met the inclusion criteria and comprised a total of 548 individuals (298 patients on antipsychotic drugs and 250 controls). Depending on the methodologies of the selected studies, the control groups included healthy subjects, drug-free patients, or the same patients evaluated repeatedly in longitudinal comparisons (i.e., serving as their own controls). A total of 102 foci associated with structural alterations were retrieved. The meta-analysis revealed seven clusters of areas with consistent structural brain changes in patients on antipsychotics compared to controls. The seven clusters included four areas of relative volumetric decrease in the left lateral temporal cortex [Brodmann area (BA) 20], left inferior frontal gyrus (BA 44), superior frontal gyrus extending to the left middle frontal gyrus (BA 6), and right rectal gyrus (BA 11), and three areas of relative volumetric increase in the left dorsal anterior cingulate cortex (BA 24), left ventral anterior cingulate cortex (BA 24) and right putamen. CONCLUSIONS Our results identify the specific brain regions where possible associations between antipsychotic drug usage and structural brain changes in schizophrenia patients are more consistently reported. Additional longitudinal VBM studies including larger and more homogeneous samples of schizophrenia patients may be needed to further disentangle such alterations from those possibly linked to the intrinsic pathological progressive process in schizophrenia.
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Affiliation(s)
- Ulysses S Torres
- Post-Graduate Program in Radiology, Institute of Radiology (INRAD), University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | - Eduardo Portela-Oliveira
- Department of Radiology, Hospital de Base, São José do Rio Preto Medical School, Sao Paulo, Brazil
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel, Basel, Switzerland,Department of Psychosis Studies, Institute of Psychiatry, King’s College, London, UK
| | - Geraldo F Busatto
- Post-Graduate Program in Radiology, Institute of Radiology (INRAD), University of Sao Paulo Medical School, Sao Paulo, Brazil,Laboratory of Neuroimaging in Psychiatry (LIM-21), Institute of Psychiatry, University of Sao Paulo Medical School, Centro de Medicina Nuclear, 3º andar, Rua Dr. Ovídio Pires Campos, s/n, Sao Paulo, Sao Paulo, 05403-010, Brazil,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Sao Paulo, Brazil
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17
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Wang Q, Cheung C, Deng W, Li M, Huang C, Ma X, Wang Y, Jiang L, Sham PC, Collier DA, Gong Q, Chua SE, McAlonan GM, Li T. White-matter microstructure in previously drug-naive patients with schizophrenia after 6 weeks of treatment. Psychol Med 2013; 43:2301-2309. [PMID: 23442742 DOI: 10.1017/s0033291713000238] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND It is not clear whether the progressive changes in brain microstructural deficits documented in previous longitudinal magnetic resonance imaging (MRI) studies might be due to the disease process or to other factors such as medication. It is important to explore the longitudinal alterations in white-matter (WM) microstructure in antipsychotic-naive patients with first-episode schizophrenia during the very early phase of treatment when relatively 'free' from chronicity. METHOD Thirty-five patients with first-episode schizophrenia and 22 healthy volunteers were recruited. High-resolution diffusion tensor imaging (DTI) was obtained from participants at baseline and after 6 weeks of treatment. A 'difference map' for each individual was calculated from the 6-week follow-up fractional anisotropy (FA) of DTI minus the baseline FA. Differences in Positive and Negative Syndrome Scale (PANSS) scores and Global Assessment of Functioning (GAF) scores between baseline and 6 weeks were also evaluated and expressed as a 6-week/baseline ratio. RESULTS Compared to healthy controls, there was a significant decrease in absolute FA of WM around the bilateral anterior cingulate gyrus and the right anterior corona radiata of the frontal lobe in first-episode drug-naive patients with schizophrenia following 6 weeks of treatment. Clinical symptoms improved during this period but the change in FA did not correlate with the changes in clinical symptoms or the dose of antipsychotic medication. CONCLUSIONS During the early phase of treatment, there is an acute reduction in WM FA that may be due to the effects of antipsychotic medications. However, it is not possible to entirely exclude the effects of underlying progression of illness.
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Affiliation(s)
- Q Wang
- Mental Health Centre and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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18
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Cohen JD, Nichols T, Keller J, Gomez RG, Schatzberg AF, Reiss AL. Insular cortex abnormalities in psychotic major depression: relationship to gender and psychotic symptoms. Neurosci Res 2013; 75:331-9. [PMID: 23471015 DOI: 10.1016/j.neures.2013.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 01/21/2013] [Accepted: 02/04/2013] [Indexed: 11/18/2022]
Abstract
Recent data suggests that psychotic major depression (PMD) may be a discrete disorder distinguishable from nonpsychotic major depression (NPMD), and that patients with PMD may be more similar to individuals with schizophrenia than individuals with NPMD. The insula is a brain region in which morphometric changes have been associated with psychotic symptom severity in schizophrenia and affective psychosis. It was hypothesized that insular volumes would be reduced in PMD compared to NPMD and controls, and insular volumes would correlate with psychosis but not depression severity. Insular gray matter volumes were measured in PMD and NPMD patients and matched healthy controls using magnetic resonance images and manual morphometry. Clinical measures of illness severity were obtained to determine their relationship with insular volume. Posterior insular volumes were significantly reduced in PMD compared to HC. There were also significant group-by-gender interactions for total, anterior and posterior insular volumes. Using Pearson product-moment correlations, anterior insular volumes did not correlate with depression severity. Left anterior insular volume was significantly correlated with total and positive symptom psychosis severity in the PMD group. Atypical insular morphometry may be related to the inability to distinguish between internally and externally generated sensory inputs characteristic of psychosis.
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Affiliation(s)
- Jeremy D Cohen
- Center for Interdisciplinary Brain Sciences Research, Stanford University School of Medicine, Stanford, CA, United States.
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Pepe A, Zhao L, Koikkalainen J, Hietala J, Ruotsalainen U, Tohka J. Automatic statistical shape analysis of cerebral asymmetry in 3D T1-weighted magnetic resonance images at vertex-level: application to neuroleptic-naïve schizophrenia. Magn Reson Imaging 2013; 31:676-87. [PMID: 23337078 DOI: 10.1016/j.mri.2012.10.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 10/30/2012] [Accepted: 10/30/2012] [Indexed: 12/13/2022]
Abstract
The study of the structural asymmetries in the human brain can assist the early diagnosis and progression of various neuropsychiatric disorders, and give insights into the biological bases of several cognitive deficits. The high inter-subject variability in cortical morphology complicates the detection of abnormal asymmetries especially if only small samples are available. This work introduces a novel automatic method for the local (vertex-level) statistical shape analysis of gross cerebral hemispheric surface asymmetries which is robust to the individual cortical variations. After segmentation of the cerebral hemispheric volumes from three-dimensional (3D) T1-weighted magnetic resonance images (MRI) and their spatial normalization to a common space, the right hemispheric masks were reflected to match with the left ones. Cerebral hemispheric surfaces were extracted using a deformable model-based algorithm which extracted the salient morphological features while establishing the point correspondence between the surfaces. The interhemispheric asymmetry, quantified by customized measures of asymmetry, was evaluated in a few thousands of corresponding surface vertices and tested for statistical significance. The developed method was tested on scans obtained from a small sample of healthy volunteers and first-episode neuroleptic-naïve schizophrenics. A significant main effect of the disease on the local interhemispheric asymmetry was observed, both in females and males, at the frontal and temporal lobes, the latter being often linked to the cognitive, auditory, and memory deficits in schizophrenia. The findings of this study, although need further testing in larger samples, partially replicate previous studies supporting the hypothesis of schizophrenia as a neurodevelopmental disorder.
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Affiliation(s)
- Antonietta Pepe
- Department of Signal Processing, Tampere University of Technology, PO Box 553, FIN-33101 Tampere, Finland.
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20
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Collin G, de Reus MA, Cahn W, Hulshoff Pol HE, Kahn RS, van den Heuvel MP. Disturbed grey matter coupling in schizophrenia. Eur Neuropsychopharmacol 2013; 23:46-54. [PMID: 23036782 DOI: 10.1016/j.euroneuro.2012.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 09/03/2012] [Indexed: 11/25/2022]
Abstract
In schizophrenia, grey matter deficits have been shown for many regions throughout the brain. These regions do not operate in isolation. Rather, they form a structural network of interconnected grey matter regions. To examine the mutual dependence of brain regions, this study investigated interregional coupling in lobar and regional grey matter volumes obtained from 146 schizophrenia patients and 122 healthy comparison subjects. Compared to healthy controls, schizophrenia patients showed both decreased (e.g. between left frontal and bilateral subcortical, p≤0.005) and increased (e.g. between left temporal and bilateral subcortical, p≤0.001) coupling between lobar grey matter volumes. On a regional scale, decreased coupling was most pronounced between fronto-parietal cortical regions and subcortical structures, and between frontal and occipital regions. In addition, an increased association was found among frontal and limbic regions, and for temporo-occipital connexions. Consistent with dysconnectivity theories of schizophrenia, impaired grey matter coupling may be reflective of reduced integrity of the brain's network. Furthermore, as cross-sectional volumetric coupling is indicative of maturational coupling, aberrant grey matter coupling may be a marker of neurodevelopmental abnormalities in schizophrenia.
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Affiliation(s)
- Guusje Collin
- Rudolf Magnus Institute of Neuroscience, Utrecht, The Netherlands.
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Malchow B, Hasan A, Fusar-Poli P, Schmitt A, Falkai P, Wobrock T. Cannabis abuse and brain morphology in schizophrenia: a review of the available evidence. Eur Arch Psychiatry Clin Neurosci 2013; 263:3-13. [PMID: 22907121 PMCID: PMC3560946 DOI: 10.1007/s00406-012-0346-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 07/24/2012] [Indexed: 11/03/2022]
Abstract
Substance abuse is the most prevalent comorbid psychiatric condition associated with schizophrenia, and cannabis is the illicit drug most often abused. Apart from worsening the course of schizophrenia, frequent cannabis use especially at an early age seems to be an important risk factor for developing schizophrenia. Although a large body of neuroimaging studies gives evidence for structural alterations in many different brain regions in schizophrenia patients, there is still limited knowledge of the impact of cannabis abuse on brain structure in schizophrenia. We performed a systematic review including structural magnetic resonance imaging studies comparing high-risk and schizophrenia patients with and without cannabis abuse and found inconclusive results. While there is some evidence that chronic cannabis abuse could alter brain morphology in schizophrenia in patients continuing their cannabis consumption, there is no convincing evidence that this alteration takes place before the onset of schizophrenia when looking at first-episode patients. There is some weak evidence that cannabis abuse could affect brain structures in high-risk subjects, but replication of these studies is needed.
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Affiliation(s)
- Berend Malchow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Georg-August-University, Germany.
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Georg-August-University, von-Siebold-Strasse 5, 37075 Göttingen, Germany
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Georg-August-University, von-Siebold-Strasse 5, 37075 Göttingen, Germany ,Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Georg-August-University, von-Siebold-Strasse 5, 37075 Göttingen, Germany ,Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Georg-August-University, von-Siebold-Strasse 5, 37075 Göttingen, Germany ,Center of Mental Health, County Hospitals Darmstadt-Dieburg, Gross-Umstadt, Germany
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Evidences of possible side effects of neuroleptic drugs: A systematic review. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2012. [DOI: 10.1016/s2305-0500(13)60105-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Collin G, Derks EM, van Haren NEM, Schnack HG, Hulshoff Pol HE, Kahn RS, Cahn W. Symptom dimensions are associated with progressive brain volume changes in schizophrenia. Schizophr Res 2012; 138:171-6. [PMID: 22534419 DOI: 10.1016/j.schres.2012.03.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 03/19/2012] [Accepted: 03/26/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND There is considerable variation in progressive brain volume changes in schizophrenia. Whether this is related to the clinical heterogeneity that characterizes the illness remains to be determined. This study examines the relationship between change in brain volume over time and individual variation in psychopathology, as measured by five continuous symptom dimensions (i.e. negative, positive, disorganization, mania and depression). METHODS Global brain volume measurements from 105 schizophrenia patients and 100 healthy comparison subjects, obtained at inclusion and 5-year follow-up, were used in this study. Symptom dimension scores were calculated by factor analysis of clinical symptoms. Using linear regression analyses and independent-samples t-tests, the relationship between symptom dimensions and progressive brain volume changes, corrected for age, gender and intracranial volume, was examined. Antipsychotic medication, outcome and IQ were investigated as potential confounders. RESULTS In patients, the disorganization dimension was associated with change in total brain (β=-0.295, p=0.003) and cerebellar (β=-0.349, p<0.001) volume. Furthermore, higher levels of disorganization were associated with lower IQ, irrespective of psychiatric status (i.e. patient or control). In healthy comparison subjects, disorganization score was not associated with progressive brain volume changes. CONCLUSION Heterogeneity in progressive brain volume changes in schizophrenia is particularly associated with variation in disorganization. Schizophrenia patients with high levels of disorganization exhibit more progressive decrease of global brain volumes and have lower total IQ. We propose that these patients form a phenotypically and biologically homogenous subgroup that may be useful for etiological (e.g., genetic) studies.
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Affiliation(s)
- G Collin
- University Medical Center Utrecht, Department of Psychiatry, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Abstract
Despite being a first-line treatment for adolescent depression and anxiety, antidepressant drugs appear to have questionable efficacy and carry an increased risk of adverse effects in this population. The neural mechanisms underlying this phenomenon are currently unknown. Recent research into the neural effects of alcohol and recreational drugs suggests that the developmental trajectory of the adolescent brain may be particularly vulnerable to pharmacological disturbance. It is therefore important to consider whether prescription psychotropic drugs may have analogous effects. This article reviews the contribution of recent preclinical, clinical and pharmacogenetic literature to current knowledge on the short-term and enduring neural effects of antidepressants on the adolescent brain, with a particular focus on the major neurotransmitter systems and neuroplasticity.
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Affiliation(s)
- Emily Karanges
- School of Psychology A18, University of Sydney, Sydney, NSW 2006, Australia
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Expression profiling in neuropsychiatric disorders: emphasis on glutamate receptors in bipolar disorder. Pharmacol Biochem Behav 2011; 100:705-11. [PMID: 22005598 DOI: 10.1016/j.pbb.2011.09.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 09/20/2011] [Accepted: 09/30/2011] [Indexed: 02/08/2023]
Abstract
Functional genomics and proteomics approaches are being employed to evaluate gene and encoded protein expression changes with the tacit goal to find novel targets for drug discovery. Genome-wide association studies (GWAS) have attempted to identify valid candidate genes through single nucleotide polymorphism (SNP) analysis. Furthermore, microarray analysis of gene expression in brain regions and discrete cell populations has enabled the simultaneous quantitative assessment of relevant genes. The ability to associate gene expression changes with neuropsychiatric disorders, including bipolar disorder (BP), and their response to therapeutic drugs provides a novel means for pharmacotherapeutic interventions. This review summarizes gene and pathway targets that have been identified in GWAS studies and expression profiling of human postmortem brain in BP, with an emphasis on glutamate receptors (GluRs). Although functional genomic assessment of BP is in its infancy, results to date point towards a dysregulation of GluRs that bear some similarity to schizophrenia (SZ), although the pattern is complex, and likely to be more complementary than overlapping. The importance of single population expression profiling of specific neurons and intrinsic circuits is emphasized, as this approach provides informative gene expression profile data that may be underappreciated in regional studies with admixed neuronal and non-neuronal cell types.
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Abstract
Schizophrenia is associated with progressive brain changes, including progressive brain tissue decreases and lateral ventricular volume increases for up to at least 20 years after disease onset. In view of the fact that the vast majority of such patients are treated with antipsychotic medication and that recent non-human mammalian studies have reported an association between antipsychotic medication and brain tissue changes, the important question arises as to whether the brain changes seen in schizophrenia are associated with antipsychotic medication. The reviewed article presents structural magnetic resonance neuroimaging data relating to 211 patients with schizophrenia from the Iowa Longitudinal Study, which demonstrates that greater intensity of antipsychotic treatment was associated with indicators of generalized and specific brain tissue changes, after controlling for the effects of illness duration, illness severity and substance abuse. The study and its implications are discussed in the context of the current state of knowledge regarding the pathophysiology of schizophrenia.
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Affiliation(s)
- Basant K Puri
- Department of Imaging, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK and Imperial College London, London, UK.
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Mathalon DH. Challenges associated with application of clinical staging models to psychotic disorders. Biol Psychiatry 2011; 70:600-1. [PMID: 21924130 PMCID: PMC4096294 DOI: 10.1016/j.biopsych.2011.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 08/19/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Daniel H. Mathalon
- Department of Psychiatry, University of California, San Francisco,San Francisco VA Medical Center,Department of Psychiatry, Yale University
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