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Kendler KS, Ohlsson H, Sundquist J, Sundquist K. The genetic epidemiology of schizotypal personality disorder. Psychol Med 2024:1-8. [PMID: 38362845 DOI: 10.1017/s0033291724000230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND The concept of schizotypal personality disorder (SPD) emerged from observations of personality characteristics common in relatives of schizophrenic patients. While often studied in family designs, few studies and none with genetic measures, have examined SPD in epidemiological samples. METHODS We studied individuals born in Sweden 1940-2000 with an ICD-10 diagnosis of SPD with no prior schizophrenia (SZ) diagnosis (n = 2292). Demographic features, patterns of comorbidity, and Family Genetic Risk Scores (FGRS) were assessed from multiple Swedish registries. Prediction of progression to SZ was assessed by Cox models. RESULTS SPD was rare, with a prevalence of 0.044%, and had high levels of comorbidity with autism spectrum disorder (ASD), OCD, ADHD, and major depression (MD), and increased rates of being single, unemployed and in receipt of welfare. Affected individuals had elevated levels of FGRS for SZ (+0.42), ASD (+0.30), MD (+0.29), and ADHD (+0.20). Compared to cases of schizophrenia, they had significantly lower rates of FGRSSZ, but significantly elevated rates of genetic risk for ASD, MD, and ADHD. Over a mean follow-up of 8.7 years, 14.6% of SPD cases received a first diagnosis of SZ, the risk for which was significantly increased by levels of FGRSSZ, male sex, young age at SPD diagnosis and an in-patient SPD diagnosis and significantly decreased by comorbidity with MD, ASD, and ADHD. CONCLUSIONS Our results not only support the designation of SPD as a schizophrenia spectrum disorder but also suggest potentially important etiologic links between SPD and ASD and, to a lesser extent, ADHD, OCD, and MD.
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Affiliation(s)
- Kenneth S Kendler
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- University Clinic Primary Care Skane, Sweden
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- University Clinic Primary Care Skane, Sweden
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, USA
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Ahangari M, Kirkpatrick R, Nguyen TH, Gillespie N, Kendler KS, Bacanu SA, Webb BT, Verrelli BC, Riley BP. Examining the source of increased bipolar disorder and major depressive disorder common risk variation burden in multiplex schizophrenia families. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:106. [PMID: 36434002 PMCID: PMC9700852 DOI: 10.1038/s41537-022-00317-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022]
Abstract
Psychotic and affective disorders often aggregate in the relatives of probands with schizophrenia, and genetic studies show substantial genetic correlation among schizophrenia, bipolar disorder, and major depressive disorder. In this study, we examined the polygenic risk burden of bipolar disorder and major depressive disorder in 257 multiplex schizophrenia families (N = 1005) from the Irish Study of High-Density Multiplex Schizophrenia Families versus 2205 ancestry-matched controls. Our results indicate that members of multiplex schizophrenia families have an increased polygenic risk for bipolar disorder and major depressive disorder compared to population controls. However, this observation is largely attributable to the part of the genetic risk that bipolar disorder or major depressive disorder share with schizophrenia due to genetic correlation, rather than the affective portion of the genetic risk unique to them. These findings suggest that a complete interpretation of cross-disorder polygenic risks in multiplex families requires an assessment of the relative contribution of shared versus unique genetic factors to account for genetic correlations across psychiatric disorders.
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Affiliation(s)
- Mohammad Ahangari
- grid.224260.00000 0004 0458 8737Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA USA ,grid.224260.00000 0004 0458 8737Integrative Life Sciences PhD Program, Virginia Commonwealth University, Richmond, VA USA
| | - Robert Kirkpatrick
- grid.224260.00000 0004 0458 8737Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA USA ,grid.224260.00000 0004 0458 8737Department of Psychiatry, Virginia Commonwealth University, Richmond, VA USA
| | - Tan-Hoang Nguyen
- grid.224260.00000 0004 0458 8737Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA USA ,grid.224260.00000 0004 0458 8737Department of Psychiatry, Virginia Commonwealth University, Richmond, VA USA
| | - Nathan Gillespie
- grid.224260.00000 0004 0458 8737Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA USA ,grid.224260.00000 0004 0458 8737Department of Psychiatry, Virginia Commonwealth University, Richmond, VA USA
| | - Kenneth S. Kendler
- grid.224260.00000 0004 0458 8737Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA USA ,grid.224260.00000 0004 0458 8737Department of Psychiatry, Virginia Commonwealth University, Richmond, VA USA ,grid.224260.00000 0004 0458 8737Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA USA
| | - Silviu-Alin Bacanu
- grid.224260.00000 0004 0458 8737Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA USA ,grid.224260.00000 0004 0458 8737Department of Psychiatry, Virginia Commonwealth University, Richmond, VA USA
| | - Bradley T. Webb
- grid.62562.350000000100301493GenOmics, Bioinformatics, and Translational Research Center, Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC USA
| | - Brian C. Verrelli
- grid.224260.00000 0004 0458 8737Center for Biological Data Science, Virginia Commonwealth University, Richmond, VA USA
| | - Brien P. Riley
- grid.224260.00000 0004 0458 8737Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA USA ,grid.224260.00000 0004 0458 8737Department of Psychiatry, Virginia Commonwealth University, Richmond, VA USA ,grid.224260.00000 0004 0458 8737Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA USA
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Li Y, Jinxiang T, Shu Y, Yadong P, Ying L, Meng Y, Ping Z, Xiao H, Yixiao F. Childhood trauma and the plasma levels of IL-6, TNF-α are risk factors for major depressive disorder and schizophrenia in adolescents: A cross-sectional and case-control study. J Affect Disord 2022; 305:227-232. [PMID: 35151670 DOI: 10.1016/j.jad.2022.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/07/2022] [Accepted: 02/09/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND It has been reported that childhood trauma and inflammation are associated with major depressive disorder (MDD) and schizophrenia (SZ), but previous researches were almost aimed at adults. The aim of the present research is to observe the alteration of peripheral interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in adolescents (12-20 years) with MDD and SZ, to investigate the impact of childhood abuse in early-onset MDD and SZ, and to furtherly explore the correlation between childhood maltreatment and plasma IL-6, TNF-α levels. SUBJECTS AND METHODS Enzyme-linked immunosorbent assay (ELISA) is applied to obtain the plasma concentrations of IL-6 and TNF-α in 55 patients with MDD, 51 patients with SZ and 47 healthy minors. The short form of the Childhood Trauma Questionnaire (CTQ-SF) is used to assess the severity of early trauma. RESULTS Plasma IL-6 and TNF-α levels are significantly elevated in patients with early-onset MDD and SZ compared with healthy subjects (p <0.01), whose results display that the correlation between IL-6 and TNF-α is significantly positive (γ=0.787, p <0.01) in all participants. Compared with the healthy adolescents, patients with MDD and SZ show more serious childhood trauma, and the plasma IL-6, TNF-α concentrations are closely related to childhood maltreatment. CONCLUSIONS Early trauma and peripheral inflammatory response play an important role in the pathophysiology of early-onset MDD or SZ. The current findings provide effective targets for the prevention, diagnosis, and treatment of major depressive disorder and schizophrenia in adolescents.
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Affiliation(s)
- Yi Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Tang Jinxiang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; Sleep and Psychology Center, Bishan Hospital of Chongqing, Chongqing 402760, China
| | - Yang Shu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Peng Yadong
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; Department of Psychology, Chongqing Health Center for Women and Children, Chongqing 401147, China
| | - Liu Ying
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; Department of Psychology, Chongqing Health Center for Women and Children, Chongqing 401147, China
| | - Yuan Meng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zhang Ping
- Department of English, Sichuan International Study University, Chongqing 400000, China
| | - Hou Xiao
- Department of Clinical Medicine, Chongqing Medical and Pharmaceutical College, Chongqing 401331, China.
| | - Fu Yixiao
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
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Donaldson KR, Larsen EM, Jonas K, Tramazzo S, Perlman G, Foti D, Mohanty A, Kotov R. Mismatch negativity amplitude in first-degree relatives of individuals with psychotic disorders: Links with cognition and schizotypy. Schizophr Res 2021; 238:161-169. [PMID: 34695710 PMCID: PMC9235539 DOI: 10.1016/j.schres.2021.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 01/12/2023]
Abstract
Mismatch negativity (MMN) amplitude is reliably reduced in psychotic disorders. While several studies have examined this effect in first-degree relatives of individuals with schizophrenia, few have sought to quantify deficits in relatives of individuals with other psychotic disorders. While some conclude that, compared to healthy subjects, first-degree relatives of schizophrenia show reduced MMN, others contradict this finding. Furthermore, though MMN is often shown to be associated with cognitive impairments and clinical symptoms in psychotic disorders, to our knowledge no studies have sought to fully examine these relationships in studies of first-degree relatives. The present study sought to clarify the extent of MMN amplitude reductions in a large sample of siblings of individuals with diverse psychotic disorders (n = 67), compared to probands with psychosis (n = 221) and never psychotic comparison subjects (n = 251). We further examined associations of MMN amplitude with cognition and schizotypal symptoms across these groups. We found that MMN amplitude was intact in siblings compared to probands. MMN amplitude was associated with cognition and schizotypal symptoms dimensionally across levels of familial risk. The present results imply that MMN reductions do not reflect genetic risk for psychotic disorders per se, and instead emerge as a result of, or in conjunction with, clinical features associated with psychosis. Such findings carry important implications for the utility of MMN amplitude as an indicator of inherited risk, and suggest that this component may be best conceptualized as an endophenotype for clinical symptoms and cognitive impairments, rather than risk for psychosis per se.
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Affiliation(s)
| | - Emmett M. Larsen
- Stony Brook University Department of Psychology, Stony Brook, NY
| | - Katherine Jonas
- Stony Brook Medicine, Psychiatry Department, Stony Brook, NY
| | - Sara Tramazzo
- Stony Brook Medicine, Psychiatry Department, Stony Brook, NY
| | - Greg Perlman
- Stony Brook Medicine, Psychiatry Department, Stony Brook, NY
| | - Dan Foti
- Purdue University Department of Psychological Sciences, West Lafayette, IN
| | - Aprajita Mohanty
- Stony Brook University Department of Psychology, Stony Brook, NY
| | - Roman Kotov
- Stony Brook Medicine, Psychiatry Department, Stony Brook, NY, United States of America.
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The Relationship between PID-5 Personality Traits and Mental States. A Study on a Group of Young Adults at Risk of Psychotic Onset. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57010033. [PMID: 33401519 PMCID: PMC7823839 DOI: 10.3390/medicina57010033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/26/2020] [Accepted: 12/29/2020] [Indexed: 01/10/2023]
Abstract
Background and Objectives: The diagnosis of psychosis is a challenge for the scientific community, both in terms of its definition and treatment. Some recent studies have investigated the relationship between personality and psychosis onset to prevent or intervene early. Materials and Methods: Sixty young adults were recruited during their first access in 2019 near the Community Mental Health Service of Niguarda Hospital, Milan, Italy. The assessment included the Social and Occupational Functioning Assessment Scale (SOFAS), the Global Assessment of Functioning (GAF) (clinician scales), the 16-item Version of the Prodromal Questionnaire (PQ-16), the Personality Inventory for DSM-5 (PID-5) (self-report), and a clinical session. Statistical analysis was performed by SPSS. Results: The results show a negative correlation between the Detachment domain and the GAF scores. Correlational analysis also highlights that all PID-5 domains, except for Antagonism, have positive correlations with high scores in the PQ-16. The multivariate analysis of variance showed that patients diagnosed with versus without a psychotic disorder significantly differed on Detachment, Antagonism and Psychoticism PID-5 domains. Conclusions: The involvement of the personality construct in psychopathological development is displayed. In particular, higher levels of Detachment and Psychoticism can distinguish people who are more vulnerable to psychosis or who already have overt psychosis from those who do not have a psychotic predisposition. The study highlights the fundamental role of personality traits, emerging from PID-5, to distinguish young adults at risk of onset.
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Bigdeli TB, Nuechterlein KH, Sugar CA, Subotnik KL, Kubarych T, Neale MC, Kendler KS, Asarnow RF. Evidence of shared familial factors influencing neurocognitive endophenotypes in adult- and childhood-onset schizophrenia. Psychol Med 2020; 50:1672-1679. [PMID: 31362798 DOI: 10.1017/s0033291719001715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aggregation of neurocognitive deficits among the non-psychotic first-degree relatives of adult- and childhood-onset schizophrenia patients suggests that there may be a common etiology for these deficits in childhood- and adult-onset illness. However, there is considerable heterogeneity in the presentation of neurobiological abnormalities, and whether there are differences in the extent of familial transmission for specific domains of cognitive function has not been systematically addressed. METHODS We employed variance components analysis, as implemented in SOLAR-Eclipse, to evaluate the evidence of familial transmission for empirically derived composite scores representing attention, working memory, verbal learning, verbal retention, and memory for faces. We contrast estimates for adult- and childhood-onset schizophrenia families and matched community control pedigrees, and compare our findings to previous reports based on analogous neurocognitive assessments. RESULTS We observed varying degrees of familial transmission; attention and working memory yielded comparable, significant estimates for adult-onset and community control pedigrees; verbal learning was significant for childhood-onset and community control pedigrees; and facial memory demonstrated significant familial transmission only for childhood-onset schizophrenia. Model-fitting analyses indicated significant differences in familiality between adult- and childhood-onset schizophrenia for attention, working memory, and verbal learning. CONCLUSIONS By comprehensively assessing a wide range of neurocognitive domains in adult- and childhood-onset schizophrenia families, we provide additional support for specific neurocognitive domains as schizophrenia endophenotypes. Whereas comparable estimates of familial transmission for certain dimensions of cognitive functioning support a shared etiology of adult- and childhood-onset neurocognitive function, observed differences may be taken as preliminary evidence of partially divergent multifactorial architectures.
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Affiliation(s)
- Tim B Bigdeli
- Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, New York, USA
- Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Catherine A Sugar
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
- Department of Biostatistics, University of California Los Angeles, Los Angeles, CA, USA
| | - Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Thomas Kubarych
- Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Michael C Neale
- Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kenneth S Kendler
- Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Robert F Asarnow
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
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7
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White T, Langen C, Schmidt M, Hough M, James A. Comparative Neuropsychiatry: White Matter Abnormalities in Children and Adolescents with Schizophrenia, Bipolar Affective Disorder, and Obsessive-Compulsive Disorder. Eur Psychiatry 2020; 30:205-13. [DOI: 10.1016/j.eurpsy.2014.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/08/2014] [Accepted: 10/12/2014] [Indexed: 12/14/2022] Open
Abstract
AbstractBackground:There is considerable evidence that white matter abnormalities play a key role in the pathogenesis of a number of major psychiatric disorders, including schizophrenia, bipolar affective disorder, and obsessive-compulsive disorder. Few studies, however, have compared white matter abnormalities early in the course of the illness.Methods:A total of 102 children and adolescents participated in the study, including 43 with early-onset schizophrenia, 13 with early-onset bipolar affective disorder, 17 with obsessive-compulsive disorder, and 29 healthy controls. Diffusion tensor imaging scans were obtained on all children and the images were assessed for the presence of non-spatially overlapping regions of white matter differences, a novel algorithm known as the pothole approach.Results:Patients with early-onset schizophrenia and early-onset bipolar affective disorder had a significantly greater number of white matter potholes compared to controls, but the total number of potholes did not differ between the two groups. The volumes of the potholes were significantly larger in patients with early-onset bipolar affective disorder compared to the early-onset schizophrenia group. Children and adolescents with obsessive-compulsive disorder showed no differences in the total number of white matter potholes compared to controls.Conclusions:White matter abnormalities in early-onset schizophrenia and bipolar affective disorder are more global in nature, whereas children and adolescents with obsessive-compulsive disorder do not show widespread differences in FA.
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8
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LE L, R K, B M, Mj G. Risk of schizophrenia in relatives of individuals affected by schizophrenia: A meta-analysis. Psychiatry Res 2020; 286:112852. [PMID: 32065982 DOI: 10.1016/j.psychres.2020.112852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 12/31/2022]
Abstract
A meta-analysis was conducted to estimate schizophrenia incidence in first-degree relatives (FDRs) of probands diagnosed with schizophrenia. The aim was to inform future schizophrenia research and improve accuracy of risk communication to patients. Schizophrenia risk in FDRs with 1 or 2 probands with schizophrenia was investigated by conducting a systematic review of cohort and case-control studies with the following criteria: published between 1977 and 2018; reported odds ratios (OR), relative risk (RR) or sufficient raw data to calculate OR or RR; used appropriate diagnostic criteria; and reported systematic proband recruitment and ascertainment of relatives. Studies were obtained via EMBASE and MEDLINE electronic database searches. From an initial 5755 articles, 19 met the inclusion criteria. Mean effect sizes across studies were estimated using random effects methods. Estimates for schizophrenia risk were OR = 7.69 (95% CI 5.11-11.56) for FDRs of one proband with schizophrenia compared to healthy control probands, increasing to OR = 11.11 (95% CI = 1.45-85.02) for FDRs with two probands with schizophrenia. These findings support the existing literature suggesting significant genetic liability for schizophrenia. The results can be used to educate individuals with a family history of schizophrenia about their risk.
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Affiliation(s)
- Lo LE
- Psychosocial Research Group, Prince of Wales Clinical School, Sydney, NSW, Australia
| | - Kaur R
- Psychosocial Research Group, Prince of Wales Clinical School, Sydney, NSW, Australia
| | - Meiser B
- Psychosocial Research Group, Prince of Wales Clinical School, Sydney, NSW, Australia.
| | - Green Mj
- School of Psychiatry, University of New South Wales, NSW 2052, Australia; Neuroscience Research Australia, Sydney, NSW 2031, Australia
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Trotta A, Arseneault L, Caspi A, Moffitt TE, Danese A, Pariante C, Fisher HL. Mental Health and Functional Outcomes in Young Adulthood of Children With Psychotic Symptoms: A Longitudinal Cohort Study. Schizophr Bull 2020; 46:261-271. [PMID: 31361314 PMCID: PMC7442396 DOI: 10.1093/schbul/sbz069] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Childhood psychotic symptoms have been associated with various psychiatric disorders in adulthood but their role as early markers of poor outcomes during the crucial transition to adulthood is largely unknown. Therefore, we investigated associations between age-12 psychotic symptoms and a range of mental health problems and functional outcomes at age 18. METHODS Data were used from the Environmental Risk Longitudinal Twin Study, a nationally representative birth cohort of 2232 twins born in 1994-1995 in England and Wales, followed to age 18 with 93% retention. Childhood psychotic symptoms were assessed in structured interviews at age 12. At age 18, study members' mental health problems, functional outcomes, risky behaviors, and offending were measured using self-reports and official records. RESULTS Children with psychotic symptoms (N = 125, 5.9%) were more likely to experience a range of mental health problems in young adulthood than children without such symptoms. They were also more likely to be obese, smoke cigarettes, be lonely, be parents, and report a lower quality of life, but not more likely to commit crimes. Childhood psychotic symptoms predicted these poor outcomes over and above other emotional and behavioral problems during childhood. Nevertheless, twin analyses indicated that these associations were largely accounted for by shared family factors. CONCLUSIONS Psychotic symptoms in childhood signal risk for pervasive mental health and functional difficulties in young adulthood and thus may provide a useful screen for an array of later problems. However, early psychotic symptoms and poor outcomes may be manifestations of shared environmental and genetic risks.
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Affiliation(s)
- Antonella Trotta
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London UK,Tony Hillis Unit, Lambeth Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Louise Arseneault
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London UK
| | - Avshalom Caspi
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London UK,Department of Psychology and Neuroscience, Duke University, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, NC
| | - Terrie E Moffitt
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London UK,Department of Psychology and Neuroscience, Duke University, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, NC
| | - Andrea Danese
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London UK,Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London UK,National & Specialist CAMHS Clinic for Trauma, Anxiety and Depression, South London & Maudsley NHS Foundation Trust, London, UK
| | - Carmine Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London UK
| | - Helen L Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London UK,To whom correspondence should be addressed; Tel: +44 (0)207–848-5430; Fax +44 (0)207–848-0866, e-mail:
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10
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The Influence of Maternal Schizotypy on the perception of Facial Emotional Expressions during Infancy: an Event-Related Potential Study. Infant Behav Dev 2020; 58:101390. [DOI: 10.1016/j.infbeh.2019.101390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 10/15/2019] [Accepted: 10/30/2019] [Indexed: 01/05/2023]
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Abstract
The genetic architecture of schizophrenia is complex and highly polygenic. This article discusses key findings from genetic studies of childhood-onset schizophrenia (COS) and the more common adult-onset schizophrenia (AOS), including studies of familial aggregation and common, rare, and copy number variants. Extant literature suggests that COS is a rare variant of AOS involving greater familial aggregation of schizophrenia spectrum disorders and a potentially higher occurrence of pathogenic copy number variants. The direct utility of genetics to clinical practice for COS is currently limited; however, identifying common pathways through which risk genes affect brain function offers promise for novel interventions.
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Affiliation(s)
- Jennifer K Forsyth
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, USA.
| | - Robert F Asarnow
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, USA; Department of Psychology, University of California, Los Angeles, 502 Portola Plaza Los Angeles, CA 90095, USA; Brain Research Institute, University of California, Los Angeles, 695 Charles E Young Dr S, Los Angeles, CA 90095, USA.
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12
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Myllyaho T, Siira V, Wahlberg KE, Hakko H, Läksy K, Roisko R, Niemelä M, Räsänen S. Interaction of genetic vulnerability to schizophrenia and family functioning in adopted-away offspring of mothers with schizophrenia. Psychiatry Res 2019; 278:205-212. [PMID: 31226546 DOI: 10.1016/j.psychres.2019.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association of family functioning to psychiatric disorders of adoptees with and without genetic vulnerability to schizophrenia. METHODS The data is based on the Finnish Adoptive Family Study of Schizophrenia. The study sample consisted of 346 adoptive families, of which 175 adoptees had high (HR) and 171 low (LR) genetic risk for schizophrenia. DSM-III-R was used for diagnostic criteria. Family functioning was assessed using the Global Family Ratings. Childhood adversities covered early parental divorce and death occurring before 18 years of age of the adoptees. RESULTS Approximately two thirds of the adoptees had lived in families with mildly dysfunctional processes (30%) or dysfunctional processes (28.4%). An increased likelihood for psychiatric disorders of the adoptees was related to dysfunctional family processes both in HR (OR = 4.8, 95% CI 2-11.4) and LR (OR = 2.6, 95% CI 1.1-6.3) adoptees, but not to early parental death or divorce. CONCLUSIONS The risk for psychiatric disorders was increased for adoptees in families with dysfunctional processes, especially for those adoptees with genetic vulnerability to schizophrenia. These results emphasize the importance of policies and practices that aim to strengthen and support family functioning.
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Affiliation(s)
- Toni Myllyaho
- Faculty of Medicine, Department of Psychiatry, University of Oulu, P.O. Box 5000, Oulu 90014, Finland.
| | - Virva Siira
- Faculty of Education, University of Oulu, P.O. Box 2000, Oulu 90014, Finland.
| | - Karl-Erik Wahlberg
- Faculty of Medicine, Department of Psychiatry, University of Oulu, P.O. Box 5000, Oulu 90014, Finland
| | - Helinä Hakko
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, Oulu 90029, Finland
| | - Kristian Läksy
- Social Security Institute of Finland (SSI), Helsinki, Finland
| | - Riikka Roisko
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, Oulu 90029, Finland
| | - Mika Niemelä
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, Oulu 90029, Finland; Department of Medicine, Center for Life Course Health Research, University of Oulu, P.O. Box 5000, Oulu 90014, Finland
| | - Sami Räsänen
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, Oulu 90029, Finland
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Fernandez VG, Asarnow R, Narr KL, Subotnik KL, Kuppinger H, Fogelson D, Nuechterlein KH. Temporal lobe thickness and verbal memory in first-degree relatives of individuals with schizophrenia. Schizophr Res 2018; 199:221-225. [PMID: 29499968 PMCID: PMC6110998 DOI: 10.1016/j.schres.2018.02.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 02/20/2018] [Accepted: 02/21/2018] [Indexed: 01/17/2023]
Abstract
Cortical thinning in frontal and temporal regions has been reported in individuals diagnosed with schizophrenia and, less consistently, among their unaffected first-degree relatives. Likewise, first-degree relatives demonstrate attenuated differences in neurocognitive performance relative to healthy controls, indicating that neurocognitive performance may be an important endophenotype of the disorder. Less is known about how cortical thickness relates to neurocognitive performance in these individuals. Given the robust nature of temporal structural abnormalities in schizophrenia, this study aimed to identify how temporal lobe cortical thickness might relate to verbal memory in first-degree relatives. Unaffected parents and siblings of individuals with adult-onset schizophrenia (N=62) and individuals in healthy control families (N=70) participating in the UCLA Family Study received a structural MRI and completed a battery of neurocognitive tests. Cortical thickness was estimated across the cortex and thickness measures of all regions in the temporal lobe were summed, averaged, and residualized for age and sex to produce a variable. A verbal learning factor was derived from two common tests of verbal learning and memory, the CVLT-II and Logical Memory of the WMS-III. Results demonstrated a significant interaction between group and verbal learning in relationship to temporal lobe thickness. Post-hoc analyses revealed significant correlations between verbal learning and cortical thickness in the relatives of schizophrenia patients which were driven by immediate recall scores on the CVLT-II and Logical Memory. These findings indicate that cortical thickness in the temporal cortex may represent a structural correlate for encoding verbal information in unaffected relatives of individuals with schizophrenia.
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Affiliation(s)
- Vindia G. Fernandez
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine at UCLA, Los Angeles, CA,Department of Psychology, UCLA, Los Angeles, CA
| | - Robert Asarnow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
| | - Katherine L. Narr
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine at UCLA, Los Angeles, CA,Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, CA
| | - Kenneth L. Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Heidi Kuppinger
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
| | - David Fogelson
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
| | - Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine at UCLA, Los Angeles, CA,Department of Psychology, UCLA, Los Angeles, CA
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Chen Q, Sugar CA, Weiss RE. A Bayesian confirmatory factor model for multivariate observations in the form of two-way tables of data. Stat Med 2018; 37:1696-1710. [PMID: 29405427 PMCID: PMC5895511 DOI: 10.1002/sim.7612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 12/08/2017] [Accepted: 12/22/2017] [Indexed: 11/11/2022]
Abstract
Researchers collected multiple measurements on patients with schizophrenia and their relatives, as well as control subjects and their relatives, to study vulnerability factors for schizophrenics and their near relatives. Observations across individuals from the same family are correlated, and also the multiple outcome measures on the same individuals are correlated. Traditional data analyses model outcomes separately and thus do not provide information about the interrelationships among outcomes. We propose a novel Bayesian family factor model (BFFM), which extends the classical confirmatory factor analysis model to explain the correlations among observed variables using a combination of family-member and outcome factors. Traditional methods for fitting confirmatory factor analysis models, such as full-information maximum likelihood (FIML) estimation using quasi-Newton optimization (QNO), can have convergence problems and Heywood cases (lack of convergence) caused by empirical underidentification. In contrast, modern Bayesian Markov chain Monte Carlo handles these inference problems easily. Simulations compare the BFFM to FIML-QNO in settings where the true covariance matrix is identified, close to not identified, and not identified. For these settings, FIML-QNO fails to fit the data in 13%, 57%, and 85% of the cases, respectively, while MCMC provides stable estimates. When both methods successfully fit the data, estimates from the BFFM have smaller variances and comparable mean-squared errors. We illustrate the BFFM by analyzing data on data from schizophrenics and their family members.
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Affiliation(s)
- Qiaolin Chen
- Department of Biostatistics, UCLA School of Public Health, Los Angeles, California 90095-1772, USA
| | - Catherine A. Sugar
- Department of Biostatistics, UCLA School of Public Health, Los Angeles, California 90095-1772, USA
| | - Robert E. Weiss
- Department of Biostatistics, UCLA School of Public Health, Los Angeles, California 90095-1772, USA
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Abstract
Avoidant personality disorder (AVPD) is a relatively common disorder that is associated with significant distress, impairment, and disability. It is a chronic disorder with an early age at onset and a lifelong impact. Yet it is underrecognized and poorly studied. Little is known regarding the most effective treatment. The impetus for research into this condition has waxed and waned, possibly due to concerns regarding its distinctiveness from other disorders, especially social anxiety disorder (SAD), schizoid personality disorder, and dependent personality disorder. The prevailing paradigm subscribes to the "severity continuum hypothesis", in which AVPD is viewed essentially as a severe variant of SAD. However, areas of discontinuity have been described, and there is support for retaining AVPD as a distinct diagnostic category. Recent research has focused on the phenomenology of AVPD, factors of possible etiological significance such as early parenting experiences, attachment style, temperament, and cognitive processing. Self-concept, avoidant behavior, early attachments, and attachment style may represent points of difference from SAD that also have relevance to treatment. Additional areas of research not focused specifically on AVPD, including the literature on social cognition as it relates to attachment and personality style, report findings that are promising for future research aimed at better delineating AVPD and informing treatment.
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Affiliation(s)
- Lisa Lampe
- Discipline of Psychiatry, University of Newcastle, Newcastle, NSW, Australia
| | - Gin S Malhi
- Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia
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Soroka E, Lesiczka IU, Tracz M, Bereza B, Olajossy M. Treatment-refractory and super refractory schizophrenia - a case study. CURRENT PROBLEMS OF PSYCHIATRY 2017. [DOI: 10.1515/cpp-2017-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Refractoriness affects about 25% of patients treated with antipsychotics, and it is a very big challenge for clinicians. The most commonly accepted definition of refractoriness is: lack of satisfactory clinical response to treatment with at least two antipsychotic drugs, from different groups, carried out at therapeutic doses and for a sufficiently long period.
Aim : The aim of the study is to analyze the case of a patient diagnosed with schizophrenia.
Methods: Analysis of medical records, available literature from recent years on treatment-refractory and super-refractory schizophrenia.
Results: A 53-year-old patient, a bachelor, suffering from paranoid schizophrenia with an extremely severe, non-remission course with drug resistance features. The patient's father and sister also suffer from severe paranoid schizophrenia. The patient became ill at the age of 22. Despite the high doses of clozapine, in a sufficiently long period of time, the patient maintained positive and negative symptoms, cognitive deficits and behavioral disorders. The patient was 14 times psychiatrically hospitalized, twice treated with electro-convulsive therapy, which did not bring results despite the combination of electroconvulsive therapywith psycho pharmacotherapy. In addition, the patient was addicted to benzodiazepines, administered during anxiety and anxiety attacks by the mother, during the described hospitalization, gradually discontinued. Patient after several attempts of committing suicide, with a tendency to self-destructive behavior. The illustrated case meets the criteria of super-refractory schizophrenia (SRS).
Conclusions: 1. The category of refractory schizophrenia encountered in the literature is not a separate diagnostic category - it does not exist in classification systems, therefore we consider the phenomenon / symptom of drug resistance - variously defined. 2. Social relations have a big impact on the functioning of the patient as well as the course of the disease and prognosis (the role of the family). 3. There are numerous methods for the potentiating of clozapine treatment, of which combining clozapine with EC therapy is effective and safe. The strategy for combining clozapine with EC is effective, but not in all patients.
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Affiliation(s)
- Ewelina Soroka
- II Department of Psychiatry and Psychiatric Rehabilitation , Medical University of Lublin
| | - Inga-Ujma Lesiczka
- II Department of Psychiatry and Psychiatric Rehabilitation , Medical University of Lublin
| | - Magdalena Tracz
- II Department of Psychiatry and Psychiatric Rehabilitation , Medical University of Lublin
| | - Bernarda Bereza
- Department of Clinical Psychology , Catholic University of Lublin
| | - Marcin Olajossy
- II Department of Psychiatry and Psychiatric Rehabilitation , Medical University of Lublin
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Schizophrenia spectrum personality disorders in psychometrically identified schizotypes at two-year follow-up. Psychiatry Res 2017; 252:289-295. [PMID: 28288440 DOI: 10.1016/j.psychres.2017.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/05/2016] [Accepted: 03/06/2017] [Indexed: 11/21/2022]
Abstract
Earlier (Bolinskey et al., 2015), we reported that psychometrically identified schizotypes displayed greater symptom levels and higher incidences of schizophrenia spectrum (schizotypal, schizoid, paranoid, and avoidant) personality disorders (PDs). In this study, 49 schizotypes and 39 matched controls participated in follow-up assessments after two years. Participants were previously identified as schizotypes or controls based on scores on the Chapman Psychosis Proneness Scales (CPPS), and were interviewed at baseline and follow-up with the Personality Disorder Interview for DSM-IV (PDI-IV). At follow-up, schizotypes displayed significantly higher symptom levels compared to controls, with medium to large effects, and appeared to meet criteria for diagnosis of each PD more often than controls, although significant differences were only observed for paranoid PD. Overall, schizotypes were more likely to have met criteria for a diagnosis at either baseline or follow-up. Finally, we observed a widening disparity over time between schizotypes and controls in avoidant and schizoid PDs. These results suggest that schizophrenia spectrum PDs, as well as subthreshold symptoms of these disorders, can represent a greater liability for schizophrenia in individuals identified as at-risk on the basis of psychometric means only. Furthermore, these findings demonstrate that such differences persist, and in some cases increase, over time.
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Waltzman D, Knowlton BJ, Cohen JR, Bookheimer SY, Bilder RM, Asarnow RF. DTI microstructural abnormalities in adolescent siblings of patients with childhood-onset schizophrenia. Psychiatry Res Neuroimaging 2016; 258:23-29. [PMID: 27829189 DOI: 10.1016/j.pscychresns.2016.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 10/25/2016] [Accepted: 10/28/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Dana Waltzman
- War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System (VAPAHCS), United States; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States.
| | | | - Jessica Rachel Cohen
- Department of Psychology and Neurosciences, University of North Carolina at Chapel Hill, United States
| | - Susan Yost Bookheimer
- David Geffen School of Medicine at University of California Los Angeles, United States
| | - Robert Martin Bilder
- David Geffen School of Medicine at University of California Los Angeles, United States
| | - Robert Franklin Asarnow
- Department of Psychology, University of California Los Angeles, United States; David Geffen School of Medicine at University of California Los Angeles, United States
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Interplay between Schizophrenia Polygenic Risk Score and Childhood Adversity in First-Presentation Psychotic Disorder: A Pilot Study. PLoS One 2016; 11:e0163319. [PMID: 27648571 PMCID: PMC5029892 DOI: 10.1371/journal.pone.0163319] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/07/2016] [Indexed: 11/19/2022] Open
Abstract
A history of childhood adversity is associated with psychotic disorder, with an increase in risk according to number or severity of exposures. However, it is not known why only some exposed individuals go on to develop psychosis. One possibility is pre-existing genetic vulnerability. Research on gene-environment interaction in psychosis has primarily focused on candidate genes, although the genetic effects are now known to be polygenic. This pilot study investigated whether the effect of childhood adversity on psychosis is moderated by the polygenic risk score for schizophrenia (PRS). Data were utilised from the Genes and Psychosis (GAP) study set in South London, UK. The GAP sample comprises 285 first-presentation psychosis cases and 256 unaffected controls with information on childhood adversity. We studied only white subjects (80 cases and 110 controls) with PRS data, as the PRS has limited predictive ability in patients of African ancestry. The occurrence of childhood adversity was assessed with the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) and the PRS was based on genome-wide meta-analysis results for schizophrenia from the Psychiatric Genomics Consortium. Higher schizophrenia PRS and childhood adversities each predicted psychosis status. Nevertheless, no evidence was found for interaction as departure from additivity, indicating that the effect of polygenic risk scores on psychosis was not increased in the presence of a history of childhood adversity. These findings are compatible with a multifactorial threshold model in which both genetic liability and exposure to environmental risk contribute independently to the etiology of psychosis.
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20
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Sex differences in the effect of childhood trauma on the clinical expression of early psychosis. Compr Psychiatry 2016; 68:86-96. [PMID: 27234188 DOI: 10.1016/j.comppsych.2016.04.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 04/01/2016] [Accepted: 04/02/2016] [Indexed: 12/19/2022] Open
Abstract
Childhood trauma, a risk factor of psychosis, is associated the clinical expression of the illness (greater severity of psychotic symptoms; poorer cognitive performance). We aimed to explore whether there are sex differences in this relationship. We studied 79 individuals with a psychotic disorder (PD) with <3years of illness and 59 healthy subjects (HS). All participants were administered the MATRICS Cognitive Consensus Cognitive Battery (MCCB) to assess cognition. Depressive, positive and negative psychotic symptoms, and global functioning were also assessed. History of childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). Patients reported a greater history of childhood trauma on all CTQ domains (emotional, physical and sexual abuse, and physical and emotional neglect). A poorer cognitive performance was also observed in PD when compared to HS. No sex differences were found in the CTQ scores. In the relationship between childhood trauma and psychopathological symptoms, significant correlations were found between CTQ scores and positive and negative psychotic symptoms, depressive symptoms and poorer functionality, but only in women. Childhood trauma was associated with poorer social cognition in both men and women. Of all CTQ dimensions, emotional neglect and physical neglect were more clearly associated with a more severe psychopathological and cognitive profile. Our results suggest that childhood trauma, particularly emotional and physical neglect, is associated with the clinical expression of psychosis and that there are sex differences in this relationship.
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21
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Kasoff LI, Ahn K, Gochman P, Broadnax DD, Rapoport JL. Strong Treatment Response and High Maintenance Rates of Clozapine in Childhood-Onset Schizophrenia. J Child Adolesc Psychopharmacol 2016; 26:428-35. [PMID: 26784704 PMCID: PMC4931305 DOI: 10.1089/cap.2015.0103] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Childhood-onset schizophrenia (COS) is a rare but severe form of the disorder, which is often treatment refractory. Short-term studies have indicated a greater differential efficacy, evident through effect sizes, favoring clozapine over other agents in alleviating negative symptoms in COS patients compared with adult-onset patients (AOS). There have been no data for COS patients on long-term compliance with clozapine treatment. Therefore, we wanted to know, over a span of up to 24 years, how many of our COS cohort had remained on clozapine for at least 2 years. We review short-term treatment data and present updated long-term data on compliance and functioning for our patients. METHODS We present the results for long-term medication maintenance over a 24 year observation period for our cohort of 131 patients. Of this cohort, 91.6% (120) were available for follow-up information from either in-person or telephone contact with the patient and/or family members. We defined clozapine compliance as ≥2 years receiving this medication and doing well. RESULTS We were able to contact 120 of the 131 patients. In spite of the additional cost and inconvenience of regular blood monitoring, 87 patients (72.5%, 87/120) adhered to long-term clozapine maintenance therapy with dosages ranging from 50 to 900 mg, and a median dosage of 500 mg. This rate exceeds the long-term clozapine maintenance rates reported for AOS patients. CONCLUSIONS Short-term data on differential efficacy and long-term maintenance data suggest a possibly greater efficacy of clozapine, relative to other antipsychotics, in COS than in AOS. Our overall findings indicate that very early-onset schizophrenic patients may be more responsive to clozapine. This extends other support for clozapine as an option in the treatment of early-onset schizophrenia.
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Affiliation(s)
- Lauren I. Kasoff
- Child Psychiatry Branch, Division of Intramural Research Program, National Institutes of Mental Health (NIMH), Bethesda, Maryland
| | - Kwangmi Ahn
- Child Psychiatry Branch, Division of Intramural Research Program, National Institutes of Mental Health (NIMH), Bethesda, Maryland
| | - Peter Gochman
- Child Psychiatry Branch, Division of Intramural Research Program, National Institutes of Mental Health (NIMH), Bethesda, Maryland
| | - Diane D. Broadnax
- Child Psychiatry Branch, Division of Intramural Research Program, National Institutes of Mental Health (NIMH), Bethesda, Maryland
| | - Judith L. Rapoport
- Child Psychiatry Branch, Division of Intramural Research Program, National Institutes of Mental Health (NIMH), Bethesda, Maryland
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22
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Neuroimaging findings from childhood onset schizophrenia patients and their non-psychotic siblings. Schizophr Res 2016; 173:124-131. [PMID: 25819937 PMCID: PMC4583796 DOI: 10.1016/j.schres.2015.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 12/14/2022]
Abstract
Childhood onset schizophrenia (COS), with onset of psychosis before age 13, is a rare form of schizophrenia that represents a more severe and chronic form of the adult onset illness. In this review we examine structural and functional magnetic resonance imaging (MRI) studies of COS and non-psychotic siblings of COS patients in the context of studies of schizophrenia as a whole. Studies of COS to date reveal progressive loss of gray matter volume and cortical thinning, ventricular enlargement, progressive decline in cerebellar volume and a significant but fixed deficit in hippocampal volume. COS is also associated with a slower rate of white matter growth and disrupted local connectivity strength. Sibling studies indicate that non-psychotic siblings of COS patients share many of these brain abnormalities, including decreased cortical thickness and disrupted white matter growth, yet these abnormalities normalize with age. Cross-sectional and longitudinal neuroimaging studies remain some of the few methods for assessing human brain function and play a pivotal role in the quest for understanding the neurobiology of schizophrenia as well as other psychiatric disorders. Parallel studies in non-psychotic siblings provide a unique opportunity to understand both risk and resilience in schizophrenia.
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23
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Watsky RE, Pollard KL, Greenstein D, Shora L, Dillard-Broadnax D, Gochman P, Clasen LS, Berman RA, Rapoport JL, Gogtay N, Ordóñez AE. Severity of Cortical Thinning Correlates With Schizophrenia Spectrum Symptoms. J Am Acad Child Adolesc Psychiatry 2016; 55:130-136. [PMID: 26802780 PMCID: PMC4724380 DOI: 10.1016/j.jaac.2015.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/06/2015] [Accepted: 11/18/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study investigated the relationship between regional cortical gray matter thinning and symptoms of schizophrenia spectrum personality disorders (PDs) in siblings of patients with childhood-onset schizophrenia (COS). METHOD A total of 66 siblings of patients with COS were assessed for symptoms of schizophrenia spectrum PDs (avoidant, paranoid, schizoid, schizotypal). Structural magnetic resonance images were obtained at approximately 2-year intervals from the siblings and from 62 healthy volunteers matched for age, sex, ethnicity, and handedness. Cortical thickness measures were extracted. Mixed effect regression models were used to test the relationship between symptoms and cortical gray matter thickness in siblings. Cortical thinning was also tested longitudinally in healthy volunteers and siblings. RESULTS Cortical thinning was found to correlate with symptoms of schizotypal and, to a lesser extent, schizoid PDs. Thinning was most pronounced in the left temporal and parietal lobes and right frontal and parietal regions. Gray matter loss was found to be continuous with that measured in COS. Longitudinal thinning trajectories were found not to differ between siblings and healthy volunteers. CONCLUSION The present investigation of cortical thinning in siblings of patients with COS indicates that symptoms of schizophrenia spectrum PDs correlate with regional gray matter loss. This finding supports the idea of cortical thinning as a schizophrenia endophenotype.
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Affiliation(s)
- Rebecca E Watsky
- Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health
| | | | - Deanna Greenstein
- Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health
| | - Lorie Shora
- Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health
| | - Diane Dillard-Broadnax
- Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health
| | - Peter Gochman
- Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health
| | - Liv S Clasen
- Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health
| | - Rebecca A Berman
- Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health
| | - Judith L Rapoport
- Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health
| | - Nitin Gogtay
- Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health
| | - Anna E Ordóñez
- Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health
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Tiffin PA, Kitchen CEW. Authors' reply. Br J Psychiatry 2015; 207:272-3. [PMID: 26329575 DOI: 10.1192/bjp.207.3.272b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Paul A Tiffin
- Paul A. Tiffin, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK. ; Charlotte E. W. Kitchen School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
| | - Charlotte E W Kitchen
- Paul A. Tiffin, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK. ; Charlotte E. W. Kitchen School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
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25
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Acri MC, Hoagwood KE. Addressing Parental Mental Health Within Interventions for Children: A Review. RESEARCH ON SOCIAL WORK PRACTICE 2015; 25:578-586. [PMID: 26527857 PMCID: PMC4627715 DOI: 10.1177/1049731514546027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Untreated parent mental health problems have deleterious effects upon the family, yet caregivers are unlikely to receive services for their emotional health. We conducted a review of treatments and services for children and adolescents that also offered services to parents. METHODS Child treatment and service studies were included in the present study if they analyzed parent symptoms or diagnoses over time, and the intervention contained a parent component. RESULTS Of 200 studies reviewed, 20 contained a component for the parent and assessed the parent's emotional health at multiple time points. Depression and anxiety were the most commonly studied parental mental health problem; most parent components consisted of behavioral strategies in service of the child's psychological health. CONCLUSION Major shifts in health care policy affecting mental health services provide an opportunity to create integrated and coordinated health and behavioral health systems. Attention must be given to ensure that the workforce of providers, the administrative structures, and the reimbursement strategies are strengthened and connected to serve the needs of parents/caregivers and children in order to enhance family outcomes.
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Affiliation(s)
- Mary C. Acri
- New York University School of Medicine, New York, NY, USA
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26
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Lampe L. Social anxiety disorders in clinical practice: differentiating social phobia from avoidant personality disorder. Australas Psychiatry 2015; 23:343-6. [PMID: 26129819 DOI: 10.1177/1039856215592319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To outline the problems around overlap between social phobia (SAD) and avoidant personality disorder (AVPD) and provide guidelines that may assist clinicians to differentiate these conditions. CONCLUSIONS A constellation of symptoms can be identified that may distinguish AVPD from SAD, with key features being a strong and pervasively negative self-concept, a view of rejection as equating to a global evaluation of the individual as being of little worth and a sense of not fitting in socially that dates from early childhood. It is important to identify the presence of AVPD in order to anticipate potential problems with engagement and retention in therapy, to target treatment interventions and optimise outcome.
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Affiliation(s)
- Lisa Lampe
- Senior Lecturer Discipline of Psychiatry, Sydney Medical School, University of Sydney, and CADE Clinic, Department of Academic Psychiatry, Level 3, Acute Services Building, Royal North Shore Hospital, St Leonards, NSW, Australia
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27
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Trotta A, Di Forti M, Iyegbe C, Green P, Dazzan P, Mondelli V, Morgan C, Murray RM, Fisher HL. Familial risk and childhood adversity interplay in the onset of psychosis. BJPsych Open 2015; 1:6-13. [PMID: 27703716 PMCID: PMC4995579 DOI: 10.1192/bjpo.bp.115.000158] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 01/29/2015] [Accepted: 03/20/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The association between childhood adversity and psychosis in adulthood is well established. However, genetic factors might confound or moderate this association. AIMS Using a catchment-based case-control sample, we explored the main effects of, and interplay between, childhood adversity and family psychiatric history on the onset of psychosis. METHOD Childhood adversity (parental separation and death, physical and sexual abuse) was assessed retrospectively in 224 individuals with a first presentation of psychosis and 256 community controls from South London, UK. Occurrence of psychotic and affective disorders in first-degree relatives was ascertained with the Family Interview for Genetic Studies (FIGS). RESULTS Parental history of psychosis did not confound the association between childhood adversity and psychotic disorder. There was no evidence that childhood adversity and familial liability combined synergistically to increase odds of psychosis beyond the effect of each individually. CONCLUSIONS Our results do not support the hypothesis that family psychiatric history amplifies the effect of childhood adversity on odds of psychosis. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.
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Affiliation(s)
- Antonella Trotta
- , PhD, , PhD, , PhD, , PhD, , MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Marta Di Forti
- , PhD, , PhD, , PhD, , PhD, , MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Conrad Iyegbe
- , PhD, , PhD, , PhD, , PhD, , MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Priscilla Green
- , PhD, , PhD, , PhD, , PhD, , MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Paola Dazzan
- , PhD, , PhD, , PhD, , PhD, , MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Valeria Mondelli
- , PhD, Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Craig Morgan
- , PhD, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Robin M Murray
- , FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Helen L Fisher
- , PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Roisko R, Wahlberg KE, Hakko H, Tienari P. Association of adoptive child's thought disorders and schizophrenia spectrum disorders with their genetic liability for schizophrenia spectrum disorders, season of birth and parental Communication Deviance. Psychiatry Res 2015; 226:434-40. [PMID: 25746170 DOI: 10.1016/j.psychres.2014.12.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/31/2014] [Accepted: 12/22/2014] [Indexed: 12/14/2022]
Abstract
Joint effects of genotype and the environment have turned out to be significant in the development of psychotic disorders. The purpose of the present study was to assess the association of an adoptive child׳s thought and schizophrenia spectrum disorders with genetic and environmental risk indicators and their interactions. A subgroup of the total sample used in the Finnish Adoptive Family Study was considered in the present study. The subjects were 125 adoptees at a high (n=53) or low (n=72) genetic risk of schizophrenia spectrum disorders and their adoptive parents. The risk factors evaluated were the adoptive child's genetic risk for schizophrenia spectrum disorders, winter or spring birth and parental Communication Deviance (CD). Thought disorders in the adoptees were assessed using the Thought Disorder Index and diagnoses were made according to DSM-III-R criteria. The adoptive child׳s Thought Disorder Index was only associated with parental Communication Deviance. The adoptive child's heightened genetic risk or winter or spring birth or parental CD or their interactions did not predict the adoptee's schizophrenia spectrum disorder. The results suggest that studies taking several risk indicators and their interactions into account may change views on the mutual significance of well-known risk factors.
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Affiliation(s)
- Riikka Roisko
- Oulu University Hospital, Department of Psychiatry, Box 26, FI-90029 OYS, Finland.
| | - Karl-Erik Wahlberg
- Institute of Clinical Medicine, Department of Psychiatry, University of Oulu, Oulu, Finland
| | - Helinä Hakko
- Institute of Clinical Medicine, Department of Psychiatry, University of Oulu, Oulu, Finland
| | - Pekka Tienari
- Institute of Clinical Medicine, Department of Psychiatry, University of Oulu, Oulu, Finland
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Bolinskey PK, James AV, Cooper-Bolinskey D, Novi JH, Hunter HK, Hudak DV, Schuder KM, Myers KR, Iati CA, Lenzenweger MF. Revisiting the blurry boundaries of schizophrenia: spectrum disorders in psychometrically identified schizotypes. Psychiatry Res 2015; 225:335-40. [PMID: 25555416 DOI: 10.1016/j.psychres.2014.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 12/03/2014] [Accepted: 12/05/2014] [Indexed: 11/24/2022]
Abstract
Certain Personality Disorders (PDs) have been found to be present in the prodromal phase of schizophrenia at a higher rate than other personality disorders. Although schizotypal, paranoid, and schizoid PDs are traditionally viewed as spectra for schizophrenia, research suggests that avoidant PD should be included in this group (e.g., Fogelson et al., 2007). The present study examines whether a sample of psychometrically identified schizotypes (SZT) have higher incidence of schizophrenia-spectrum PDs, as well as more symptoms of these PDs, in general, than does a matched comparison (MC) sample. Eighty-five SZT and 78 MC participants were administered the Personality Disorder Interview for DSM-IV (PDI-IV) to assess PD symptoms and diagnoses. Results indicate that the SZT group evidenced significantly more symptoms of avoidant, schizoid, paranoid, and schizotypal PDs than did the MC group. Further, there were significant differences in the incidence of these PDs between the groups.
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Affiliation(s)
- P Kevin Bolinskey
- Department of Psychology, Indiana State University, Terre Haute, IN, USA.
| | - Alison V James
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | | | - Jonathan H Novi
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | - Helen K Hunter
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | - Daniel V Hudak
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | - Kelly M Schuder
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | - Kevin R Myers
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | - Carina A Iati
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mark F Lenzenweger
- Department of Psychology, State University of New York at Binghamton, Binghamton, NY USA
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30
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Abstract
Avoidant personality disorder (AvPD) is regarded as a severe variant of social phobia (SP), consistent with a dimensional model. However, these conclusions are largely drawn from studies based on individuals with SP, with or without comorbid AvPD. The present study hypothesized that there are qualitative differences between AvPD and SP that are undermined by limiting research to participants with SP. The authors sought to test this hypothesis by comparing three groups-SP only, AvPD only, and SP+AvPD-using data extracted from an epidemiological sample of 10,641 adults aged 18 years and over. Screening questions were used in the epidemiological survey to identify ICD-10 personality disorders; from this the author developed a proxy measure for DSM-IV AvPD. Axis I diagnoses, including DSM-IV SP, were identified using the Composite International Diagnostic Interview (CIDI). In this sample, the majority of those with AvPD did not also have SP: The authors found 116 persons with AvPD only, 196 with SP only, and 69 with SP+AvPD. There was little difference between any of the groups on sex, marital status, employment, education, or impairment variables. The SP+AvPD group reported more distress and comorbidity than the SP only and AvPD only groups, which did not differentiate from each other. More feared social situations were endorsed in the SP only group compared to the AvPD only group. Although the finding of few differences between SP only and AvPD only groups among the variables measured in this epidemiological survey fails to provide support for the hypothesis of qualitative differences, the finding that the AvPD only group appears more similar to the SP only group than to the SP+AvPD group also fails to provide support for the alternative continuity hypothesis. The greater distress and additional comorbidity with depression associated with SP+AvPD may be due to the additional symptom load of a second disorder rather than simply representing a more severe variant of social phobia. The use of a proxy for AvPD is a limitation of the study. Future studies should focus on broader clinical variables that have been proposed as qualitatively different between these disorders, and on the possible genetic and environmental factors that might help explain such differences.
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31
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Wagshal D, Knowlton BJ, Cohen JR, Bookheimer SY, Bilder RM, Fernandez VG, Asarnow RF. Cognitive correlates of gray matter abnormalities in adolescent siblings of patients with childhood-onset schizophrenia. Schizophr Res 2015; 161:345-50. [PMID: 25541139 PMCID: PMC4405249 DOI: 10.1016/j.schres.2014.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 12/03/2014] [Accepted: 12/05/2014] [Indexed: 01/04/2023]
Abstract
Patients with childhood onset schizophrenia (COS) display widespread gray matter (GM) structural brain abnormalities. Healthy siblings of COS patients share some of these structural abnormalities, suggesting that GM abnormalities are endophenotypes for schizophrenia. Another possible endophenotype for schizophrenia that has been relatively unexplored is corticostriatal dysfunction. The corticostriatal system plays an important role in skill learning. Our previous studies have demonstrated corticostriatal dysfunction in COS siblings with a profound skill learning deficit and abnormal pattern of brain activation during skill learning. This study investigated whether structural abnormalities measured using volumetric brain morphometry (VBM) were present in siblings of COS patients and whether these were related to deficits in cognitive skill learning. Results revealed smaller GM volume in COS siblings relative to controls in a number of regions, including occipital, parietal, and subcortical regions including the striatum, and greater GM volume relative to controls in several subcortical regions. Volume in the right superior frontal gyrus and cerebellum were related to performance differences between groups on the weather prediction task, a measure of cognitive skill learning. Our results support the idea that corticostriatal and cerebellar impairment in unaffected siblings of COS patients are behaviorally relevant and may reflect genetic risk for schizophrenia.
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Affiliation(s)
- Dana Wagshal
- University of California San Francisco, United States.
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32
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A joint history of the nature of genetic variation and the nature of schizophrenia. Mol Psychiatry 2015; 20:77-83. [PMID: 25134695 PMCID: PMC4318712 DOI: 10.1038/mp.2014.94] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/30/2014] [Accepted: 06/24/2014] [Indexed: 12/13/2022]
Abstract
This essay traces the history of concepts of genetic variation and schizophrenia from Darwin and Mendel to the present. For Darwin, the important form of genetic variation for evolution is continuous in nature and small in effect. Biometricians led by Pearson agreed and developed statistical genetic approaches utilizing trait correlations in relatives. Mendel studied discontinuous traits and subsequent Mendelians, led by Bateson, assumed that important genetic variation was large in effect producing discontinuous phenotypes. Although biometricians studied 'insanity', schizophrenia genetics under Kraepelin and Rüdin utilized Mendelian approaches congruent with their anatomical-clinical disease model of dementia praecox. Fisher showed, assuming many genes of small effect, Mendelian and Biometrical models were consilient. Echoing prior conflicts, psychiatric genetics since then has utilized both biometrical models, largely in twins, and Mendelian models, based on advancing molecular techniques. In 1968, Gottesman proposed a polygenic model for schizophrenia based on a threshold version of Fisher's theory. Since then, rigorous studies of the schizophrenia spectrum suggest that genetic risk for schizophrenia is more likely continuous than categorical. The last 5 years has seen increasingly convincing evidence from genome-wide association study (GWAS) and sequencing that genetic risk for schizophrenia is largely polygenic, and congruent with Fisher's and Gottesman's models. The gap between biometrical and molecular Mendelian models for schizophrenia has largely closed. The efforts to ground a categorical biomedical model of schizophrenia in Mendelian genetics have failed. The genetic risk for schizophrenia is widely distributed in human populations so that we all carry some degree of risk.
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Abstract
Individuals with schizophrenia exhibit a range of cognitive impairments, including tasks assessing theory of mind (ToM) and autobiographical memory (AM). This study appears to be the first to examine how ToM and AM abilities interact in relation to schizotypy. Forty-seven undergraduate students reporting a wide continuous range of scores on the Schizotypal Personality Questionnaire (SPQ) completed a measure of ToM and a measure assessing various phenomenological qualities of AM. Female participants exhibited a negative correlation between the ToM score and the SPQ total score and a positive correlation between enhanced phenomenological qualities of AM and the SPQ disorganized factor score. No statistically significant relationships were found for male participants. ToM was negatively correlated with AM across the entire sample, which was not moderated by sex or schizotypy. It is possible that distinct underlying mechanisms account for the observed sex differences on ToM and AM performance in schizophrenia-related conditions.
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34
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Moran ME, Luscher ZI, McAdams H, Hsu JT, Greenstein D, Clasen L, Ludovici K, Lloyd J, Rapoport J, Mori S, Gogtay N. Comparing fractional anisotropy in patients with childhood-onset schizophrenia, their healthy siblings, and normal volunteers through DTI. Schizophr Bull 2015; 41:66-73. [PMID: 25217482 PMCID: PMC4266298 DOI: 10.1093/schbul/sbu123] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Diffusion tensor imaging is a neuroimaging method that quantifies white matter (WM) integrity and brain connectivity based on the diffusion of water in the brain. White matter has been hypothesized to be of great importance in the development of schizophrenia as part of the dysconnectivity model. Childhood-onset schizophrenia (COS), is a rare, severe form of the illness that resembles poor outcome adult-onset schizophrenia. We hypothesized that COS would be associated with WM abnormalities relative to a sample of controls. METHODS To evaluate WM integrity in this population 39 patients diagnosed with COS, 39 of their healthy (nonpsychotic) siblings, and 50 unrelated healthy volunteers were scanned using a diffusion tensor imaging (DTI) sequence during a 1.5 T MRI acquisition. Each DTI scan was processed via atlas-based analysis using a WM parcellation map, and diffeomorphic mapping that shapes a template atlas to each individual subject space. Fractional anisotropy (FA), a measure of WM integrity was averaged over each of the 46 regions of the atlas. Eleven WM regions were examined based on previous reports of WM growth abnormalities in COS. RESULTS Of those regions, patients with COS, and their healthy siblings had significantly lower mean FA in the left and right cuneus as compared to the healthy volunteers (P < .005). Together, these findings represent the largest DTI study in COS to date, and provide evidence that WM integrity is significantly impaired in COS. Shared deficits in their healthy siblings might result from increased genetic risk.
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Affiliation(s)
- Marcel E. Moran
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD;,These authors contributed equally to the article
| | - Zoe I. Luscher
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD;,These authors contributed equally to the article
| | - Harrison McAdams
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - John T. Hsu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Deanna Greenstein
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Liv Clasen
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Katharine Ludovici
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Jonae Lloyd
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Judith Rapoport
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Susumu Mori
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Nitin Gogtay
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD;
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Wiguna T, Guerrero APS, Honjo S, Ismail I, Wr NS, Kaligis F. Executive Dysfunction among Children with Antipsychotic Treated Schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2014; 12:203-8. [PMID: 25598823 PMCID: PMC4293165 DOI: 10.9758/cpn.2014.12.3.203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 04/07/2014] [Accepted: 04/09/2014] [Indexed: 11/21/2022]
Abstract
Objective To investigate the executive function among adolescents with antipsychotic-treated schizophrenia in Child and Adolescent Outpatient Clinic at Cipto Mangunkusumo General Hospital, Jakarta. Methods This was a cross sectional study with control group. Case was defined as adolescents with antipsychotic-treated schizophrenia without any mental retardation or other physical illnesses (n=45). The control group consisted of healthy and age-matched adolescents (n=135). Executive function is determined by using Indonesian version of Behavior Rating Inventory of Executive Function (BRIEF-Indonesian version). We used SPSS 16.0 program for windows to calculate the prevalence risk ratio (PRR) and set up the p value <0.05. Results Mean of age was 16.27 (standard deviation 1.86) year-old. Most of the case group (95%) has been treated with atypical antipsychotic such as risperidone, aripipripazole, olanzapine, and clozapine. Duration of having antipsychotic medication was ranged from one to 36 months. Adolescents with antipsychotic treated-schizophrenia had higher BRIEF T-score, except for inhibit scale, shift scale and behavior regulation index. The prevalence risk ratio on several clinical scales were higher in children with antipsychotic-treated schizophrenia compared to control group, such as on emotional state (PRR=7.43, 95% confidence interval [CI]=2.38-23.15), initiate scale (PRR=6.32, 95% CI=2.51-15.95), monitor scale (PRR=8.11, 95% CI=2.0-32.86), and behavior regulation index (PRR=4.09, 95% CI=1.05-15.98). Conclusion In general, the results showed that adolescents with atypical antipsychotic treated-schizophrenia had higher BRIEF T-score compared, and comparable with their normal group control.
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Affiliation(s)
- Tjhin Wiguna
- Child and Adolescent Psychiatry Division, Department of Psychiatry, University of Indonesia, Jakarta, Indonesia
| | - Anthony Paul Sison Guerrero
- Department of Psychiatry and Pediatrics, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI, USA
| | - Shuji Honjo
- Department of Child Psychiatry, Center for Developmental Clinical Psychology and Psychiatry, Nagoya, Japan
| | - Irawati Ismail
- Child and Adolescent Psychiatry Division, Department of Psychiatry, University of Indonesia, Jakarta, Indonesia
| | - Noorhana Setyowati Wr
- Child and Adolescent Psychiatry Division, Department of Psychiatry, University of Indonesia, Jakarta, Indonesia
| | - Fransiska Kaligis
- Child and Adolescent Psychiatry Division, Department of Psychiatry, University of Indonesia, Jakarta, Indonesia
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36
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Vyas NS, Ahn K, Stahl DR, Caviston P, Simic M, Netherwood S, Puri BK, Lee Y, Aitchison KJ. Association of KIBRA rs17070145 polymorphism with episodic memory in the early stages of a human neurodevelopmental disorder. Psychiatry Res 2014; 220:37-43. [PMID: 25146696 DOI: 10.1016/j.psychres.2014.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 07/09/2014] [Accepted: 07/13/2014] [Indexed: 12/22/2022]
Abstract
A common T/C polymorphism within the ninth intron of the KIBRA gene (rs17070145) is thought to influence memory in humans. Since cognitive impairment, including memory, is a core feature of schizophrenia, we attempted to investigate this association in an independent sample of adolescent patients with early-onset schizophrenia (EOS; onset before age 18) probands and their healthy siblings. In a sample of 25 pairs of EOS proband-healthy full sibling, we sought to investigate the association of KIBRA with memory performance. Episodic memory was measured using immediate and delayed recall measures of the California Verbal Learning Test. EOS underperformed at immediate and delayed recall compared with siblings. In a combined analysis (TT vs. TC/CC) assuming a C dominant model of inheritance, we found a main effect of genotype where individuals with TT genotype outperformed non-TT-carriers at immediate and delayed recall. A genotype by group interaction showed that EOS with TT genotype did not show a memory advantage over siblings with TT or non-TT-carriers at immediate or delayed recall. Siblings with TT genotype showed enhanced immediate recall (not delayed recall) compared with non-TT-carriers. This study demonstrates an association between the KIBRA gene and episodic memory (immediate free recall) and suggests a differential effect of this genetic variant in EOS and healthy siblings.
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Affiliation(s)
- Nora S Vyas
- Kingston University London, Department of Psychology, Kingston, Surrey KT1 2EE, UK; National Institutes of Health, National Institute of Mental Health, Child Psychiatry Branch, 10 Center Drive, Bethesda, MD 20892-1600, USA; Institute of Psychiatry, King's College London, MRC SGDP Centre, SE5 8AF, UK.
| | - Kwangmi Ahn
- National Institutes of Health, National Institute of Mental Health, Child Psychiatry Branch, 10 Center Drive, Bethesda, MD 20892-1600, USA
| | - Daniel R Stahl
- NIHR Biomedical Research Centre for Mental Health and Institute of Psychiatry, King's College London, Department of Biostatistics, SE5 8AF, London, UK
| | - Paul Caviston
- North East London NHS Foundation Trust, Child and Adolescent Mental Health Services, Essex IG38XQ, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, CAMHS National and Specialist Services, London SE5 8AF, UK
| | - Siobhan Netherwood
- South London and Maudsley NHS Foundation Trust, Croydon, CAMHS, CR0 1QG, UK
| | - Basant K Puri
- Imperial College London, Department of Medicine, Du Cane Road, W12 OHS, UK
| | - Yohan Lee
- Institute of Psychiatry, King's College London, MRC SGDP Centre, SE5 8AF, UK
| | - Katherine J Aitchison
- Institute of Psychiatry, King's College London, MRC SGDP Centre, SE5 8AF, UK; University of Alberta, Department of Psychiatry and Medical Genetics, Edmonton, Alberta, T6G 2E1, Canada
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Chakravarty MM, Rapoport JL, Giedd JN, Raznahan A, Shaw P, Collins DL, Lerch JP, Gogtay N. Striatal shape abnormalities as novel neurodevelopmental endophenotypes in schizophrenia: a longitudinal study. Hum Brain Mapp 2014; 36:1458-69. [PMID: 25504933 DOI: 10.1002/hbm.22715] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 11/15/2014] [Accepted: 11/30/2014] [Indexed: 01/04/2023] Open
Abstract
There are varying, often conflicting, reports with respect to altered striatal volume and morphometry in the major psychoses due to the influences of antipsychotic medications on striatal volume. Thus, disassociating disease effects from those of medication become exceedingly difficult. For the first time, using a longitudinally studied sample of structural magnetic resonance images from patients with childhood onset schizophrenia (COS; neurobiologically contiguous with the adult onset form of schizophrenia), their nonpsychotic siblings (COSSIBs), and novel shape mapping algorithms that are volume independent, we report the familial contribution of striatal morphology in schizophrenia. The results of our volumetric analyses demonstrate age-related increases in overall striatal volumes specific only to COS. However, both COS and COSSIBs showed overlapping shape differences in the striatal head, which normalized in COSSIBs by late adolescence. These results mirror previous studies from our group, demonstrating cortical thickness deficits in COS and COSSIBs as these deficits normalize in COSSIBs in the same age range as our striatal findings. Finally, there is a single region of nonoverlapping outward displacement in the dorsal aspect of the caudate body, potentially indicative of a response to medication. Striatal shape may be considered complimentary to volume as an endophenotype, and, in some cases may provide information that is not detectable using standard volumetric techniques. Our striatal shape findings demonstrate the striking localization of abnormalities in striatal the head. The neuroanatomical localization of these findings suggest the presence of abnormalities in the striatal-prefrontal circuits in schizophrenia and resilience mechanisms in COSSIBs with age dependent normalization.
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Affiliation(s)
- M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Verdun, Canada; Department of Psychiatry, McGill University, Montreal, Canada; Department of Biomedical Engineering, McGill University, Montreal, Canada
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38
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Fisher HL, McGuffin P, Boydell J, Fearon P, Craig TK, Dazzan P, Morgan K, Doody GA, Jones PB, Leff J, Murray RM, Morgan C. Interplay between childhood physical abuse and familial risk in the onset of psychotic disorders. Schizophr Bull 2014; 40:1443-51. [PMID: 24399191 PMCID: PMC4193698 DOI: 10.1093/schbul/sbt201] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Childhood abuse is considered one of the main environmental risk factors for the development of psychotic symptoms and disorders. However, this association could be due to genetic factors influencing exposure to such risky environments or increasing sensitivity to the detrimental impact of abuse. Therefore, using a large epidemiological case-control sample, we explored the interplay between a specific form of childhood abuse and family psychiatric history (a proxy for genetic risk) in the onset of psychosis. METHODS Data were available on 172 first presentation psychosis cases and 246 geographically matched controls from the Aetiology and Ethnicity of Schizophrenia and Other Psychoses study. Information on childhood abuse was obtained retrospectively using the Childhood Experience of Care and Abuse Questionnaire and occurrence of psychotic and affective disorders in first degree relatives with the Family Interview for Genetic Studies. RESULTS Parental psychosis was more common among psychosis cases than unaffected controls (adjusted OR = 5.96, 95% CI: 2.09-17.01, P = .001). Parental psychosis was also associated with physical abuse from mothers in both cases (OR = 3.64, 95% CI: 1.06-12.51, P = .040) and controls (OR = 10.93, 95% CI: 1.03-115.90, P = .047), indicative of a gene-environment correlation. Nevertheless, adjusting for parental psychosis did not measurably impact on the abuse-psychosis association (adjusted OR = 3.31, 95% CI: 1.22-8.95, P = .018). No interactions were found between familial liability and maternal physical abuse in determining psychosis caseness. CONCLUSIONS This study found no evidence that familial risk accounts for associations between childhood physical abuse and psychotic disorder nor that it substantially increases the odds of psychosis among individuals reporting abuse.
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Affiliation(s)
- Helen L. Fisher
- MRC Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK;,*To whom correspondence should be addressed; MRC Social, Genetic & Developmental Psychiatry Centre, PO80, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK; tel: +44 (0)207-848-5430, fax +44 (0)207-848-0866, e-mail:
| | - Peter McGuffin
- MRC Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
| | - Jane Boydell
- Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Paul Fearon
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Thomas K. Craig
- Health Services & Population Research, Institute of Psychiatry, King’s College London, London, UK
| | - Paola Dazzan
- Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK;,National Institute of Health Research Biomedical Research Centre for Mental Health, London, UK
| | - Kevin Morgan
- Department of Psychology, University of Westminster, London, UK
| | - Gillian A. Doody
- Division of Psychiatry, University of Nottingham, Nottingham, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Julian Leff
- Mental Health Sciences, University College London, London, UK
| | - Robin M. Murray
- Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK;,National Institute of Health Research Biomedical Research Centre for Mental Health, London, UK
| | - Craig Morgan
- Health Services & Population Research, Institute of Psychiatry, King’s College London, London, UK;,National Institute of Health Research Biomedical Research Centre for Mental Health, London, UK
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39
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Wagshal D, Knowlton BJ, Suthana NA, Cohen JR, Poldrack RA, Bookheimer SY, Bilder RM, Asarnow RF. Evidence for corticostriatal dysfunction during cognitive skill learning in adolescent siblings of patients with childhood-onset schizophrenia. Schizophr Bull 2014; 40:1030-9. [PMID: 24162516 PMCID: PMC4133665 DOI: 10.1093/schbul/sbt147] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with schizophrenia perform poorly on cognitive skill learning tasks. This study is the first to investigate the neural basis of impairment in cognitive skill learning in first-degree adolescent relatives of patients with schizophrenia. We used functional magnetic resonance imaging to compare activation in 16 adolescent siblings of patients with childhood-onset schizophrenia (COS) and 45 adolescent controls to determine whether impaired cognitive skill learning in individuals with genetic risk for schizophrenia was associated with specific patterns of neural activation. The siblings of patients with COS were severely impaired on the Weather Prediction Task (WPT) and showed a relative deactivation in frontal regions and in the striatum after extensive training on the WPT compared with controls. These differences were not accounted for by performance differences in the 2 groups. The results suggest that corticostriatal dysfunction may be part of the liability for schizophrenia.
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Affiliation(s)
- Dana Wagshal
- Department of Neurology, University of California San Francisco, San Francisco, CA;
| | | | | | | | - Russel Alan Poldrack
- Departments of Psychology and Neurobiology, Imaging Research Center, University of Texas at Austin, Austin, TX
| | - Susan Yost Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
| | - Robert Martin Bilder
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
| | - Robert Franklin Asarnow
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
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Heimberg RG, Hofmann SG, Liebowitz MR, Schneier FR, Smits JAJ, Stein MB, Hinton DE, Craske MG. Social anxiety disorder in DSM-5. Depress Anxiety 2014; 31:472-9. [PMID: 24395386 DOI: 10.1002/da.22231] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/09/2013] [Accepted: 11/28/2013] [Indexed: 11/09/2022] Open
Abstract
With the publication of DSM-5, the diagnostic criteria for social anxiety disorder (SAD, also known as social phobia) have undergone several changes, which have important conceptual and clinical implications. In this paper, we first provide a brief history of the diagnosis. We then review a number of these changes, including (1) the primary name of the disorder, (2) the increased emphasis on fear of negative evaluation, (3) the importance of sociocultural context in determining whether an anxious response to a social situation is out of proportion to the actual threat, (4) the diagnosis of SAD in the context of a medical condition, and (5) the way in which we think about variations in the presentation of SAD (the specifier issue). We then consider the clinical implications of changes in DSM-5 related to these issues.
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Affiliation(s)
- Richard G Heimberg
- Department of Psychology, Adult Anxiety Clinic, Temple University, Philadelphia, Pennsylvania
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Skokou M, Gourzis P. Demographic features and premorbid personality disorder traits in relation to age of onset and sex in paranoid schizophrenia. Psychiatry Res 2014; 215:554-9. [PMID: 24495576 DOI: 10.1016/j.psychres.2014.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 01/08/2014] [Accepted: 01/11/2014] [Indexed: 11/25/2022]
Abstract
Personality disorders in the premorbid period of schizophrenia and particularly in relation to age of onset and sex, seem to be a rather under-researched area. In the present study, 88 patients with paranoid schizophrenia were examined, regarding demographic characteristics and premorbid personality disorder traits, in order to investigate for differences in the premorbid period of the disease, in relation to age of onset and sex. Age cutoff points were set at <30 years and ≥35 years of age for young and late onset groups, respectively. The Structured Clinical Interview for DSM-IV-Patient Edition for Axis I disorders (SCID-P) was used prospectively for diagnoses. Premorbid personality disorder traits were retrospectively assessed by using the Structured Clinical Interview for DSM-IV-Patient Edition for Axis II disorders (SCID-II). Comparisons were performed by applying the two-tailed Wilcoxon rank-sum and the χ(2) statistical tests. Young onset patients were characterized by significantly higher proportion of urban birth, single status, more avoidant premorbid personality disorder traits, and less passive-aggressive premorbid personality disorder traits, than late onset counterparts. Differences were more prominently shown in men. Earlier age of onset seems to be associated to increased social inhibition and worse psychosocial adaptation in the premorbid period of paranoid schizophrenia.
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Affiliation(s)
- Maria Skokou
- Department of Psychiatry, University Hospital of Patras, School of Medicine, University of Patras, University Campus, 26504 Rio, Patras, Greece.
| | - Philippos Gourzis
- Department of Psychiatry, University Hospital of Patras, School of Medicine, University of Patras, University Campus, 26504 Rio, Patras, Greece.
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42
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Bittner RA, Linden DEJ, Roebroeck A, Härtling F, Rotarska-Jagiela A, Maurer K, Goebel R, Singer W, Haenschel C. The When and Where of Working Memory Dysfunction in Early-Onset Schizophrenia-A Functional Magnetic Resonance Imaging Study. Cereb Cortex 2014; 25:2494-506. [PMID: 24675869 DOI: 10.1093/cercor/bhu050] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Behavioral evidence indicates that working memory (WM) in schizophrenia is already impaired at the encoding stage. However, the neurophysiological basis of this primary deficit remains poorly understood. Using event-related fMRI, we assessed differences in brain activation and functional connectivity during the encoding, maintenance and retrieval stages of a visual WM task with 3 levels of memory load in 17 adolescents with early-onset schizophrenia (EOS) and 17 matched controls. The amount of information patients could store in WM was reduced at all memory load levels. During encoding, activation in left ventrolateral prefrontal cortex (VLPFC) and extrastriate visual cortex, which in controls positively correlated with the amount of stored information, was reduced in patients. Additionally, patients showed disturbed functional connectivity between prefrontal and visual areas. During retrieval, right inferior VLPFC hyperactivation was correlated with hypoactivation of left VLPFC in patients during encoding. Visual WM encoding is disturbed by a failure to adequately engage a visual-prefrontal network critical for the transfer of perceptual information into WM. Prefrontal hyperactivation appears to be a secondary consequence of this primary deficit. Isolating the component processes of WM can lead to more specific neurophysiological markers for translational efforts seeking to improve the treatment of cognitive dysfunction in schizophrenia.
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Affiliation(s)
- Robert A Bittner
- Laboratory for Neurophysiology and Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy and Brain Imaging Center, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany Department of Neurophysiology, Max-Planck-Institute for Brain Research, Frankfurt am Main, Germany Ernst Strüngmann Institute for Neuroscience (ESI) in Cooperation with Max Planck Society, Frankfurt am Main, Germany
| | - David E J Linden
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine School of Psychology, Cardiff University, Cardiff, UK
| | - Alard Roebroeck
- Department of Neurocognition, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Fabian Härtling
- Department of Child and Adolescent Psychiatry, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Anna Rotarska-Jagiela
- Laboratory for Neurophysiology and Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy and Brain Imaging Center, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany Department of Neurophysiology, Max-Planck-Institute for Brain Research, Frankfurt am Main, Germany
| | - Konrad Maurer
- Laboratory for Neurophysiology and Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy and Brain Imaging Center, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Rainer Goebel
- Department of Neurocognition, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Wolf Singer
- Department of Neurophysiology, Max-Planck-Institute for Brain Research, Frankfurt am Main, Germany Ernst Strüngmann Institute for Neuroscience (ESI) in Cooperation with Max Planck Society, Frankfurt am Main, Germany
| | - Corinna Haenschel
- Laboratory for Neurophysiology and Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy and Brain Imaging Center, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany School of Psychology, City University, London, UK
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Stevens JR, Prince JB, Prager LM, Stern TA. Psychotic disorders in children and adolescents: a primer on contemporary evaluation and management. Prim Care Companion CNS Disord 2014; 16:13f01514. [PMID: 25133052 DOI: 10.4088/pcc.13f01514] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022] Open
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Black DW, Coryell WH, Crowe RR, McCormick B, Shaw MC, Allen J. A direct, controlled, blind family study of DSM-IV pathological gambling. J Clin Psychiatry 2014; 75:215-21. [PMID: 24500179 PMCID: PMC4221079 DOI: 10.4088/jcp.13m08566] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/01/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Pathological gambling is a major public health problem. We sought to examine the familiality of pathological gambling and determine patterns of familial aggregation of disorders. METHOD We assessed probands with DSM-IV pathological gambling, controls, and their first-degree relatives. Detailed family history information was collected on relatives who were deceased or unavailable. RESULTS Ninety-five pathological gambling probands, 91 controls, and their 1,075 first-degree relatives over age 18 (537 relatives of pathological gambling probands, 538 relatives of controls) were evaluated between February 2005 and June 2010. Relatives were assessed blind to proband status. Best estimate diagnoses were assigned. Rates of lifetime pathological gambling (definite/probable) was significantly greater among the first-degree relatives of probands with pathological gambling than among comparison relatives (11% vs 1%, OR = 8.19, P < .001). The prevalence of pathological gambling and subclinical pathological gambling combined was 16% and 3% in case and control relatives, respectively (OR = 6.57, P < .001). Pathological gambling relatives had higher rates of major depression (OR = 1.49, P < .05), bipolar disorder (OR = 3.82, P < .05), any mood disorder (OR = 1.59, P < .05), social anxiety disorder (OR = 4.76, P < .01), any substance use disorder (OR = 1.47, P < .05), posttraumatic stress disorder (OR = 2.59, P < .05), and antisocial personality disorder (OR = 3.72, P < .001). Antisocial personality disorder (OR = 3.12, P < .01), social anxiety disorder (OR = 4.15, P < .01), and posttraumatic stress disorder (OR = 2.85, P < .05) were more frequent in case relatives independent of the presence of pathological gambling. Age at onset of pathological gambling in case probands (< 40 years/≥ 40 years) was not related to familiality in their first-degree relatives (OR = 1.03, P = .927). CONCLUSIONS Pathological gambling is familial. Mood and substance use disorders may emerge as a consequence of the pathological gambling or as a more complex syndrome. In contrast, antisocial personality disorder, social anxiety disorder, and posttraumatic stress disorder may share a common familial etiology with pathological gambling. The phenotype may extend beyond pathological gambling to include subclinical forms of the disorder.
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Epstein KA, Cullen KR, Mueller BA, Robinson P, Lee S, Kumra S. White matter abnormalities and cognitive impairment in early-onset schizophrenia-spectrum disorders. J Am Acad Child Adolesc Psychiatry 2014; 53:362-72.e1-2. [PMID: 24565363 PMCID: PMC3977613 DOI: 10.1016/j.jaac.2013.12.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 11/01/2013] [Accepted: 12/19/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To characterize white matter abnormalities in adolescents with early-onset schizophrenia (EOS) relative to 3 comparison groups (adolescents at clinical high risk for developing schizophrenia [CHR], adolescents with cannabis use disorder [CUD], and healthy controls [HC]), and to identify neurocognitive correlates of white matter abnormalities in EOS. METHOD We used diffusion tensor imaging and tractography methods to examine fractional anisotropy (FA) of the cingulum bundle, superior longitudinal fasciculus, corticospinal tract (CST), inferior longitudinal fasciculus (ILF), inferior fronto-occipital fasciculus (IFOF), and uncinate fasciculus in adolescents with EOS (n = 55), CHR (n = 21), CUD (n = 31), and HC (n = 55). FA in tracts that were significantly altered in EOS was correlated with neurocognitive performance. RESULTS EOS and CHR groups had significantly lower FA than HC in 4 tracts, namely, bilateral CST, left ILF, and left IFOF. CUD had lower FA than HC in left IFOF. Lower FA in left IFOF and left ILF predicted worse neurocognitive performance in EOS. CONCLUSIONS This study identified white matter abnormalities of the left ILF and left IFOF as possible biomarkers of vulnerability for developing schizophrenia. Lower FA in these tracts may disrupt functioning of ventral visual and language streams, producing domain-specific neurocognitive deficits that interfere with higher-order cognitive abilities.
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Wagshal D, Knowlton BJ, Cohen JR, Poldrack RA, Bookheimer SY, Bilder RM, Asarnow RF. Impaired automatization of a cognitive skill in first-degree relatives of patients with schizophrenia. Psychiatry Res 2014; 215:294-9. [PMID: 24359887 PMCID: PMC4191851 DOI: 10.1016/j.psychres.2013.11.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/04/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
We studied healthy, first-degree relatives of patients with schizophrenia to test the hypothesis that deficits in cognitive skill learning are associated with genetic liability to schizophrenia. Using the Weather Prediction Task (WPT), 23 healthy controls and 10 adult first-degree Relatives Of Schizophrenia (ROS) patients were examined to determine the extent to which cognitive skill learning was automated using a dual-task paradigm to detect subtle impairments in skill learning. Automatization of a skill is the ability to execute a task without the demand for executive control and effortful behavior and is a skill in which schizophrenia patients possess a deficit. ROS patients did not differ from healthy controls in accuracy or reaction time on the WPT either during early or late training on the single-task trials. In contrast, the healthy control and ROS groups were differentially affected during the dual-task trials. Our results demonstrate that the ROS group did not automate the task as well as controls and continued to rely on controlled processing even after extensive practice. This suggests that adult ROS patients may engage in compensatory strategies to achieve normal levels of performance and support the hypothesis that impaired cognitive skill learning is associated with genetic risk for schizophrenia.
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Affiliation(s)
- Dana Wagshal
- University of California, San Francisco, United States.
| | | | | | - Russell Alan Poldrack
- Imaging Research Center at University of Texas at Austin, United States, Department of Psychology at University of Texas at Austin, United States, Department of Neurobiology at University of Texas at Austin, United States
| | - Susan Yost Bookheimer
- David Geffen School of Medicine at University of California, Los Angeles, United States
| | - Robert Martin Bilder
- David Geffen School of Medicine at University of California, Los Angeles, United States
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Bigdeli TB, Bacanu SA, Webb BT, Walsh D, O’Neill FA, Fanous AH, Riley BP, Kendler KS. Molecular validation of the schizophrenia spectrum. Schizophr Bull 2014; 40:60-5. [PMID: 23970557 PMCID: PMC3885304 DOI: 10.1093/schbul/sbt122] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Early descriptive work and controlled family and adoption studies support the hypothesis that a range of personality and nonschizophrenic psychotic disorders aggregate in families of schizophrenic probands. Can we validate, using molecular polygene scores from genome-wide association studies (GWAS), this schizophrenia spectrum? METHODS The predictive value of polygenic findings reported by the Psychiatric GWAS Consortium (PGC) was applied to 4 groups of relatives from the Irish Study of High-Density Schizophrenia Families (ISHDSF; N = 836) differing on their assignment within the schizophrenia spectrum. Genome-wide single nucleotide polymorphism data for affected and unaffected relatives were used to construct per-individual polygene risk scores based on the PGC stage-I results. We compared mean polygene scores in the ISHDSF with mean scores in ethnically matched population controls (N = 929). RESULTS The schizophrenia polygene score differed significantly across diagnostic categories and was highest in those with narrow schizophrenia spectrum, lowest in those with no psychiatric illness, and in-between in those classified in the intermediate, broad, and very broad schizophrenia spectrum. Relatives of all of these groups of affected subjects, including those with no diagnosis, had schizophrenia polygene scores significantly higher than the control sample. CONCLUSIONS In the relatives of high-density families, the observed pattern of enrichment of molecular indices of schizophrenia risk suggests an underlying, continuous liability distribution and validates, using aggregate common risk alleles, a genetic basis for the schizophrenia spectrum disorders. In addition, as predicted by genetic theory, nonpsychotic members of multiply-affected schizophrenia families are significantly enriched for replicated, polygenic risk variants compared with the general population.
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Affiliation(s)
- T. Bernard Bigdeli
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Silviu-Alin Bacanu
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Bradley T. Webb
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA
| | | | | | - Ayman H. Fanous
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA;,Mental Health Service Line, Washington VA Medical Center, Washington, DC
| | - Brien P. Riley
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA;,Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Kenneth S. Kendler
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA;,Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA,*To whom correspondence should be addressed; Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics of VCU, Box 980126, Richmond, VA 23298-0126, US; tel: (804)-828-8590, fax: (804)-828-1471, e-mail:
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Abstract
Paranoid personality disorder (PPD) is currently included in DSM-IV's "odd cluster" or "cluster A." In the present article, the authors review available information pertaining to the psychometric properties of PPD, as derived from the relevant literature and from databases of personality disorder study groups. There is comparatively little published evidence for the reliability and validity of PPD, and researchers by and large have tended not to study the disorder, either because of investigators' difficulty recruiting individuals with PPD into research studies, or (as seems more likely) because the trait-paranoia from which many psychiatric patients suffer has seemed better explained by other DSM-IV disorders on Axis I and/or Axis II than by PPD. Given the scant empirical evidence on PPD, it seems reasonable to remove it as an independent diagnosis from the next edition of DSM, and instead to encourage clinicians to code trait-paranoia using a dimensional approach.
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49
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Vu MAT, Thermenos HW, Terry DP, Wolfe DJ, Voglmaier MM, Niznikiewicz MA, McCarley RW, Seidman LJ, Dickey CC. Working memory in schizotypal personality disorder: fMRI activation and deactivation differences. Schizophr Res 2013; 151:113-23. [PMID: 24161536 DOI: 10.1016/j.schres.2013.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 08/19/2013] [Accepted: 09/16/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Schizotypal personality disorder (SPD) is considered a schizophrenia spectrum disorder, sharing with schizophrenia cognitive, neuropsychological, epidemiological, and biological characteristics. Working memory may be one area of shared deficit, although to date, this is only the second study to investigate working memory in SPD using fMRI. METHODS In a block-design fMRI study, fifteen antipsychotic-naïve SPD and sixteen healthy control subjects performed blocks of a 2back visual working memory task and 0back continuous performance task while undergoing whole-brain fMRI at 3T. Whole-brain analyses were performed for the 0back>rest (fixation baseline) and the 2back>0back contrasts (isolating the working memory component from the visual perception and attention component). Parameter estimates were extracted to determine whether observed differences were due to task-induced activation and/or deactivation. RESULTS Activation differences emerged between the two groups, without differences in task performance. In the 0back task, SPD showed decreased task-induced activation of the left postcentral gyrus. In the 2back>0back contrast, HC showed greater task-induced activation of the left posterior cingulate gyrus, superior temporal gyrus, insula, and middle frontal gyrus. These differences were due to SPD subjects' decreased task-induced activation in the left posterior cingulate gyrus, and task-induced deactivation in the remaining regions. CONCLUSIONS These findings suggest that compared to HC subjects, individuals with SPD may achieve comparable working memory performance. However, differences emerge at the level of functional neural activation, attributable to different task-induced activation and deactivation patterns. Such differential recruitment of neural resources may be beneficial, contributing to SPD subjects' ability to perform these tasks comparably to HC subjects.
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Affiliation(s)
- Mai-Anh T Vu
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Abstract
Schizophrenia is a heritable disorder. The genetic architecture of schizophrenia is complex and heterogeneous. This article discusses genetic studies of childhood-onset schizophrenia (COS) and compares findings in familial aggregation, common allele, and rare allele studies of COS with those for adult-onset schizophrenia (AOS). COS seems to be a rare variant of AOS with greater familial aggregation of schizophrenia spectrum disorders and higher occurrence of rare allelic variants. The usefulness of genetic screening for diagnosis and individualized treatment is limited; however, identifying common pathways through which multiple genes adversely affect neural systems offers great promise toward developing novel pharmacologic interventions.
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Affiliation(s)
- Robert F Asarnow
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California, USA,Department of Psychology, University of California at Los Angeles, Los Angeles, California, USA
| | - Jennifer K Forsyth
- Department of Psychology, University of California at Los Angeles, Los Angeles, California, USA
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