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Barnett P, Oshinowo I, Cooper C, Taylor C, Smith S, Pilling S. The association between social class and the impact of treatment for mental health problems: a systematic review and narrative synthesis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:581-603. [PMID: 36418643 PMCID: PMC10066076 DOI: 10.1007/s00127-022-02378-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 10/28/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This systematic review aimed to synthesise all quantitative literature on the association between social class and the effectiveness of interventions for mental health disorders. METHODS Systematic literature searches (inception-March 2021) were conducted across 7 databases, and all quantitative studies meeting inclusion criteria, examining the impact of social class on access to treatment, or intervention effectiveness, or the impact of treatment on social mobility, were synthesised narratively. RESULTS Evidence suggests that lower social class may be associated with reduced access to primary and secondary mental health care and increased likelihood of access via crisis services, and patients of lower social class may not benefit from all mental health interventions, with reduced effectiveness. While limited, there was some indication that psychosocial interventions could encourage increased employment rates. CONCLUSION Social class is associated with the effectiveness of psychological interventions, and should be considered when designing new interventions to prevent barriers to access and improve effectiveness.
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Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK.
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
| | - Iyinoluwa Oshinowo
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Christopher Cooper
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK
| | - Clare Taylor
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Shubulade Smith
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Lucarini V, Cangemi F, Daniel BD, Lucchese J, Paraboschi F, Cattani C, Marchesi C, Grice M, Vogeley K, Tonna M. Conversational metrics, psychopathological dimensions and self-disturbances in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2022; 272:997-1005. [PMID: 34476588 DOI: 10.1007/s00406-021-01329-w] [Citation(s) in RCA: 2] [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] [Received: 02/17/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022]
Abstract
Difficulties in interpersonal communication, including conversational skill impairments, are core features of schizophrenia. However, very few studies have performed conversation analyses in a clinical population of schizophrenia patients. Here we investigate the conversational patterns of dialogues in schizophrenia patients to assess possible associations with symptom dimensions, subjective self-disturbances and social functioning. Thirty-five schizophrenia patients were administered the Positive and Negative Syndrome Scale (PANSS), the Clinical Language Disorder Rating Scale (CLANG), the Scale for the Assessment of Thought, Language and Communication (TLC), the Examination of Anomalous Self-Experience Scale (EASE), and the Social and Occupational Functioning Assessment Scale (SOFAS). Moreover, participants underwent a recorded semi-structured interview, to extract conversational variables. Conversational data were associated with negative symptoms and social functioning, but not with positive or disorganization symptoms. A significant positive correlation was found between "pause duration" and the EASE item "Spatialization of thought". The present study suggests an association between conversational patterns and negative symptom dimension of schizophrenia. Moreover, our findings evoke a relationship between the natural fluidity of conversation and of the natural unraveling of thoughts.
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Affiliation(s)
- Valeria Lucarini
- Department of Mental Health, Azienda Unità Sanitaria Locale di Parma, Parma, Italy.
| | | | | | - Jacopo Lucchese
- Psychiatry Unit, Department of Medicine and Surgery, Medical Faculty, University of Parma, Parma, Italy
| | - Francesca Paraboschi
- Department of Mental Health, Azienda Unità Sanitaria Locale di Parma, Parma, Italy
| | - Chiara Cattani
- Department of Statistical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Carlo Marchesi
- Department of Mental Health, Azienda Unità Sanitaria Locale di Parma, Parma, Italy
- Psychiatry Unit, Department of Medicine and Surgery, Medical Faculty, University of Parma, Parma, Italy
| | - Martine Grice
- IfL-Phonetics, University of Cologne, Cologne, Germany
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- Cognitive Neuroscience (INM-3), Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Matteo Tonna
- Department of Mental Health, Azienda Unità Sanitaria Locale di Parma, Parma, Italy
- Psychiatry Unit, Department of Medicine and Surgery, Medical Faculty, University of Parma, Parma, Italy
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3
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Laraki Y, Lebrun C, Merenciano M, Eisenblaetter M, Attal J, Macgregor A, Decombe A, Capdevielle D, Raffard S. Validation of the French Clinical Assessment Interview for Negative Symptoms in a Sample of Stable French Individuals With Schizophrenia. Front Psychiatry 2022; 13:836600. [PMID: 35432043 PMCID: PMC9010618 DOI: 10.3389/fpsyt.2022.836600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The Clinical Assessment Interview for Negative Symptoms (CAINS) is an interview-based instrument evaluating the existence and severity of negative symptoms in people diagnosed with schizophrenia or schizoaffective disorder. The aim of this study is to translate and validate a French version of the CAINS in a French sample of outpatients diagnosed with schizophrenia or schizoaffective disorder. METHODS In this study, we included 84 outpatients with a diagnosis of schizophrenia from the University Department of Adult Psychiatry in Montpellier, France. All participants were assessed for the severity of negative symptoms as well as level of depression. Psychometric properties of the French CAINS were investigated including its factor structure, internal consistency, and interrater and test-retest reliabilities. We also determined the discriminant and convergent validity. RESULTS Exploratory factor analysis and parallel analysis reproduced the two-factor model, and explained 43.55% of the total score variation with good internal consistency (Cronbach α of 0.87). Both interrater and test-retest reliabilities were high for the CAINS and its subscales (intraclass correlation coefficient range, 0.89-0.99). The standard errors of measurement and minimal detectable change were also investigated. Convergent validity of the CAINS was underpinned by correlations obtained with various measures of negative symptoms. Adequate discriminant validity was established by showing that the CAINS did not correlate with positive symptoms. CONCLUSION Overall, our results obtained were similar to those found in the original study of the CAINS. Structural analyses also replicated the two-factor model of the CAINS. Our results indicate that the French CAINS has robust psychometric properties and is a valid tool for evaluating negative symptoms in French-speaking individuals diagnosed with schizophrenia.
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Affiliation(s)
- Yasmine Laraki
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France.,Université Paul Valéry Montpellier 3, EPSYLON EA, Montpellier, France
| | - Cindy Lebrun
- Université Paul Valéry Montpellier 3, EPSYLON EA, Montpellier, France
| | - Marine Merenciano
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France
| | | | - Jerôme Attal
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France
| | - Alexandra Macgregor
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France
| | - Amandine Decombe
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France.,IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Stéphane Raffard
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France.,Université Paul Valéry Montpellier 3, EPSYLON EA, Montpellier, France
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Redaelli S, Porffy L, Oloyede E, Dzahini O, Lewis G, Lobo M, Whiskey E, Shergill SS. Vortioxetine as adjunctive therapy in the treatment of schizophrenia. Ther Adv Psychopharmacol 2022; 12:20451253221110014. [PMID: 35833056 PMCID: PMC9272178 DOI: 10.1177/20451253221110014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/08/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The evidence for safe and effective interventions to treat the negative and cognitive symptoms of schizophrenia is lacking. OBJECTIVES Vortioxetine is a novel antidepressant that has been used as adjunctive therapy for the treatment of psychosis; however, its effectiveness in clinical practice is relatively unknown. In this study, we aimed to determine the potential clinical effectiveness and safety and tolerability of vortioxetine in psychosis. DESIGN This is a non-interventional, retrospective study on the add-on use of vortioxetine in a group of people with schizophrenia-spectrum disorders in a large UK NHS mental health trust. METHODS Clinical effectiveness of vortioxetine was retrospectively assessed through the Clinical Global Impression - Severity (CGI-S) scale at 3 months. Safety and tolerability were evaluated through treatment discontinuation rates at 3, 6, and 12 months, and clinical reasons were evaluated at the primary endpoint of 3 months. RESULTS Data were available for 40 subjects with a diagnosis of schizophrenia or schizoaffective disorder-prescribed vortioxetine treatment; 30 (75%) remained on treatment at 3 months. At CGI-S assessment, 15 of the 35 evaluated subjects reported at least a 1-point improvement, from 5 at baseline to 4 after 3 months of treatment. Twenty-six (65%) remained on treatment at 1-year follow-up. The main reasons for those discontinuing treatment were inadequate response (10%) and manic switch (7.5%), while one subject refused treatment. Tolerability to treatment was good, and 36 subjects (90%) reported no adverse events specific to vortioxetine treatment. CONCLUSION Schizophrenia is a complex illness, and there is insufficient treatment response in many individuals. A significant proportion of whom may require adjunctive treatments depending on the nature of the residual symptoms. Vortioxetine could be a potentially safe and effective option in such people, but further controlled studies are required.
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Affiliation(s)
- Sofia Redaelli
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lilla Porffy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ebenezer Oloyede
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Gabriella Lewis
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Maria Lobo
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eromona Whiskey
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Sukhi S Shergill
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Fu J, Yang S, He F, He L, Li Y, Zhang J, Xiong X. Sch-net: a deep learning architecture for automatic detection of schizophrenia. Biomed Eng Online 2021; 20:75. [PMID: 34344372 PMCID: PMC8336375 DOI: 10.1186/s12938-021-00915-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/26/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Schizophrenia is a chronic and severe mental disease, which largely influences the daily life and work of patients. Clinically, schizophrenia with negative symptoms is usually misdiagnosed. The diagnosis is also dependent on the experience of clinicians. It is urgent to develop an objective and effective method to diagnose schizophrenia with negative symptoms. Recent studies had shown that impaired speech could be considered as an indicator to diagnose schizophrenia. The literature about schizophrenic speech detection was mainly based on feature engineering, in which effective feature extraction is difficult because of the variability of speech signals. METHODS This work designs a novel Sch-net neural network based on a convolutional neural network, which is the first work for end-to-end schizophrenic speech detection using deep learning techniques. The Sch-net adds two components, skip connections and convolutional block attention module (CBAM), to the convolutional backbone architecture. The skip connections enrich the information used for the classification by emerging low- and high-level features. The CBAM highlights the effective features by giving learnable weights. The proposed Sch-net combines the advantages of the two components, which can avoid the procedure of manual feature extraction and selection. RESULTS We validate our Sch-net through ablation experiments on a schizophrenic speech data set that contains 28 patients with schizophrenia and 28 healthy controls. The comparisons with the models based on feature engineering and deep neural networks are also conducted. The experimental results show that the Sch-net has a great performance on the schizophrenic speech detection task, which can achieve 97.68% accuracy on the schizophrenic speech data set. To further verify the generalization of our model, the Sch-net is tested on open access LANNA children speech database for specific language impairment detection. The results show that our model achieves 99.52% accuracy in classifying patients with SLI and healthy controls. Our code will be available at https://github.com/Scu-sen/Sch-net . CONCLUSIONS Extensive experiments show that the proposed Sch-net can provide aided information for the diagnosis of schizophrenia and specific language impairment.
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Affiliation(s)
- Jia Fu
- College of Biomedical Engineering, Sichuan University, Chengdu, China
| | - Sen Yang
- College of Biomedical Engineering, Sichuan University, Chengdu, China
| | - Fei He
- College of Biomedical Engineering, Sichuan University, Chengdu, China
| | - Ling He
- College of Biomedical Engineering, Sichuan University, Chengdu, China
| | - Yuanyuan Li
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu, China
| | - Xi Xiong
- School of Cybersecurity, Chengdu University of Information Technology, Chengdu, China
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Ye H, Zalesky A, Lv J, Loi SM, Cetin-Karayumak S, Rathi Y, Tian Y, Pantelis C, Di Biase MA. Network Analysis of Symptom Comorbidity in Schizophrenia: Relationship to Illness Course and Brain White Matter Microstructure. Schizophr Bull 2021; 47:1156-1167. [PMID: 33693887 PMCID: PMC8266579 DOI: 10.1093/schbul/sbab015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Recent network-based analyses suggest that schizophrenia symptoms are intricately connected and interdependent, such that central symptoms can activate adjacent symptoms and increase global symptom burden. Here, we sought to identify key clinical and neurobiological factors that relate to symptom organization in established schizophrenia. METHODS A symptom comorbidity network was mapped for a broad constellation of symptoms measured in 642 individuals with a schizophrenia-spectrum disorder. Centrality analyses were used to identify hub symptoms. The extent to which each patient's symptoms formed clusters in the comorbidity network was quantified with cluster analysis and used to predict (1) clinical features, including illness duration and psychosis (positive symptom) severity and (2) brain white matter microstructure, indexed by the fractional anisotropy (FA), in a subset (n = 296) of individuals with diffusion-weighted imaging (DWI) data. RESULTS Global functioning, substance use, and blunted affect were the most central symptoms within the symptom comorbidity network. Symptom profiles for some patients formed highly interconnected clusters, whereas other patients displayed unrelated and disconnected symptoms. Stronger clustering among an individual's symptoms was significantly associated with shorter illness duration (t = 2.7; P = .0074), greater psychosis severity (ie, positive symptoms expression) (t = -5.5; P < 0.0001) and lower fractional anisotropy in fibers traversing the cortico-cerebellar-thalamic-cortical circuit (r = .59, P < 0.05). CONCLUSION Symptom network structure varies over the course of schizophrenia: symptom interactions weaken with increasing illness duration and strengthen during periods of high positive symptom expression. Reduced white matter coherence relates to stronger symptom clustering, and thus, may underlie symptom cascades and global symptomatic burden in individuals with schizophrenia.
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Affiliation(s)
- Hua Ye
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia,Melbourne School of Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Jinglei Lv
- School of Biomedical Engineering & Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Samantha M Loi
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | | | - Yogesh Rathi
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA,Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Ye Tian
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Maria A Di Biase
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia,Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA,To whom correspondence should be addressed; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Bld. 161 Barry St, Carlton South, Victoria, Australia; tel: +61-3-9035-3404, fax: +61-3-9035-8842, e-mail:
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Percelay S, Billard JM, Freret T, Andrieux A, Boulouard M, Bouet V. Functional Dysregulations in CA1 Hippocampal Networks of a 3-Hit Mouse Model of Schizophrenia. Int J Mol Sci 2021; 22:2644. [PMID: 33807989 PMCID: PMC7961987 DOI: 10.3390/ijms22052644] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
For a better translation from treatment designs of schizophrenia to clinical efficiency, there is a crucial need to refine preclinical animal models. In order to consider the multifactorial nature of the disorder, a new mouse model associating three factors (genetic susceptibility-partial deletion of the MAP6 gene, early-life stress-maternal separation, and pharmacological treatment-chronic Δ-9-tetrahydrocannabinol during adolescence) has recently been described. While this model depicts a schizophrenia-like phenotype, the neurobiological correlates remain unknown. Synaptic transmission and functional plasticity of the CA1 hippocampal region of male and female 3-hit mice were therefore investigated using electrophysiological recordings on the hippocampus slice. While basal excitatory transmission remained unaffected, NMDA receptor (NMDAr)-mediated long-term potentiation (LTP) triggered by theta-burst (TBS) but not by high-frequency (HFS) stimulation was impaired in 3-hit mice. Isolated NMDAr activation was not affected or even increased in female 3-hit mice, revealing a sexual dimorphism. Considering that the regulation of LTP is more prone to inhibitory tone if triggered by TBS than by HFS, the weaker potentiation in 3-hit mice suggests a deficiency of intrinsic GABA regulatory mechanisms. Indeed, NMDAr activation was increased by GABAA receptor blockade in wild-type but not in 3-hit mice. This electrophysiological study highlights dysregulations of functional properties and plasticity in hippocampal networks of 3-hit mice, one of the mechanisms suspected to contribute to the pathophysiology of schizophrenia. It also shows differences between males and females, supporting the sexual dimorphism observed in the disorder. Combined with the previously reported study, the present data reinforce the face validity of the 3-hit model that will help to consider new therapeutic strategies for psychosis.
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Affiliation(s)
- Solenn Percelay
- UNICAEN, INSERM, COMETE, CYCERON, CHU Caen, Normandie Université, 14000 Caen, France; (J.-M.B.); (T.F.); (M.B.); (V.B.)
| | - Jean-Marie Billard
- UNICAEN, INSERM, COMETE, CYCERON, CHU Caen, Normandie Université, 14000 Caen, France; (J.-M.B.); (T.F.); (M.B.); (V.B.)
| | - Thomas Freret
- UNICAEN, INSERM, COMETE, CYCERON, CHU Caen, Normandie Université, 14000 Caen, France; (J.-M.B.); (T.F.); (M.B.); (V.B.)
| | - Annie Andrieux
- Inserm U1216, CEA, Grenoble Institut Neurosciences, Université Grenoble Alpes, 38000 Grenoble, France;
| | - Michel Boulouard
- UNICAEN, INSERM, COMETE, CYCERON, CHU Caen, Normandie Université, 14000 Caen, France; (J.-M.B.); (T.F.); (M.B.); (V.B.)
| | - Valentine Bouet
- UNICAEN, INSERM, COMETE, CYCERON, CHU Caen, Normandie Université, 14000 Caen, France; (J.-M.B.); (T.F.); (M.B.); (V.B.)
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Bouet V, Percelay S, Leroux E, Diarra B, Léger M, Delcroix N, Andrieux A, Dollfus S, Freret T, Boulouard M. A new 3-hit mouse model of schizophrenia built on genetic, early and late factors. Schizophr Res 2021; 228:519-528. [PMID: 33298334 DOI: 10.1016/j.schres.2020.11.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Abstract
Whether the etiology of schizophrenia remains unknown, its multifactorial aspect is conversely now well admitted. However, most preclinical models of the disease still rely on a mono-factorial construction and do not allow discover unequivocal treatments, particularly for negative and cognitive symptoms. The main interaction factors that have been implicated in schizophrenia are a genetic predisposition and unfavorable environmental factors. Here we propose a new animal model combining a genetic predisposition (1st hit: partial deletion of MAP-6 (microtubule-associated protein)) with an early postnatal stress (2nd hit: 24 h maternal separation at post-natal day 9), and a late cannabinoid exposure during adolescence (3rd hit: tetrahydrocannabinol THC from post-natal day 32 to 52; 8 mg/kg/day). The 2-hit mice displayed spatial memory deficits, decreased cortical thickness and fractional anisotropy of callosal fibers. The 3-hit mice were more severely affected as attested by supplementary deficits such a decrease in spontaneous activity, sociability-related behavior, working memory performances, an increase in anxiety-like behavior, a decrease in hippocampus volume together with impaired integrity of corpus callosum fibers (less axons, less myelin). Taken together, these results show that the new 3-hit model displays several landmarks mimicking negative and cognitive symptoms of schizophrenia, conferring a high relevance for research of new treatments. Moreover, this 3-hit model possesses a strong construct validity, which fits with gene x environment interactions hypothesis of schizophrenia. The 2-hit model, which associates maternal separation with THC exposure in wild-type mice gives a less severe phenotype, and could be useful for research on other forms of psychiatric diseases.
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Affiliation(s)
- Valentine Bouet
- Normandie Université, UNICAEN, INSERM, COMETE, CYCERON, CHYU CAEN, 14000 Caen, France.
| | - Solenn Percelay
- Normandie Université, UNICAEN, INSERM, COMETE, CYCERON, CHYU CAEN, 14000 Caen, France
| | - Elise Leroux
- Normandie Université, UNICAEN, EA 7466 ISTS, GIP Cyceron, 14000 Caen, France
| | - Boubacar Diarra
- Normandie Université, UNICAEN, INSERM, COMETE, CYCERON, CHYU CAEN, 14000 Caen, France
| | - Marianne Léger
- Normandie Université, UNICAEN, INSERM, COMETE, CYCERON, CHYU CAEN, 14000 Caen, France
| | - Nicolas Delcroix
- CNRS, UMS 3408, GIP CYCERON, Bd Henri Becquerel, BP5229, 14074 Caen cedex, France
| | - Annie Andrieux
- Univ. Grenoble Alpes, Inserm U1216, CEA, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Sonia Dollfus
- Normandie Université, UNICAEN, EA 7466 ISTS, GIP Cyceron, 14000 Caen, France; CHU de Caen, Service de Psychiatrie Adulte, 14000 Caen, France
| | - Thomas Freret
- Normandie Université, UNICAEN, INSERM, COMETE, CYCERON, CHYU CAEN, 14000 Caen, France
| | - Michel Boulouard
- Normandie Université, UNICAEN, INSERM, COMETE, CYCERON, CHYU CAEN, 14000 Caen, France
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Haller N, Hasan A, Padberg F, Strube W, da Costa Lane Valiengo L, Brunoni AR, Brunelin J, Palm U. [Transcranial electrical brain stimulation methods for treatment of negative symptoms in schizophrenia]. DER NERVENARZT 2021; 93:41-50. [PMID: 33492411 PMCID: PMC8763819 DOI: 10.1007/s00115-021-01065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 11/24/2022]
Abstract
Über die letzten Jahre entwickelten sich Neuromodulationsverfahren zu einer dritten Säule neben Pharmakotherapie und Psychotherapie in der Behandlung psychischer Erkrankungen. Besonders in der Behandlung von Menschen mit einer Schizophrenie könnten Hirnstimulationsverfahren eine Alternative oder Ergänzung zu den etablierten Therapiestrategien darstellen. Die meist vorhandenen Positivsymptome können zumeist mit Antipsychotika adäquat behandelt werden. Gerade bei Patienten mit Schizophrenie besitzen jedoch Negativsymptome einen überdauernden Krankheitswert und beeinflussen den Verlauf durch globale Antriebsverarmung und beeinträchtigte Kognition im alltäglichen Leben negativ. Dieser Übersichtsartikel stellt eine Zusammenfassung über die verschiedenen nichtinvasiven Hirnstimulationsverfahren transkranielle Gleichstromstimulation (transcranial direct current stimulation, tDCS), Wechselstromstimulation (transcranial alternating current stimulation, tACS) sowie Rauschstromstimulation (transcranial random noise stimulation, tRNS) zur Behandlung der Negativsymptomatik bei Schizophrenie dar. Die neuen transkraniellen Hirnstimulationsverfahren könnten dabei helfen, gestörte neuronale Vernetzungen wieder herzustellen und die Konnektivität vor allem der dorsolateralen präfrontalen Anteile des Kortex zu verbessern. Einige Studien weisen auf eine Verbesserung der Negativsymptome durch Behandlung mit tDCS, tACS bzw. tRNS hin und könnten so neue Therapiemöglichkeiten in der Behandlung der Schizophrenie darstellen.
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Affiliation(s)
- Nikolas Haller
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Alkomiet Hasan
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland.,Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universität Augsburg, Medizinische Fakultät, BKH Augsburg, Augsburg, Deutschland
| | - Frank Padberg
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Wolfgang Strube
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universität Augsburg, Medizinische Fakultät, BKH Augsburg, Augsburg, Deutschland
| | - Leandro da Costa Lane Valiengo
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasilien
| | - Andre R Brunoni
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasilien
| | - Jerome Brunelin
- CH le Vinatier, INSERM U 1028, CNRS UMR 5292, PSYR2 Team, Centre de recherche en neuroscience de Lyon, Université de Lyon, Lyon, Frankreich
| | - Ulrich Palm
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland. .,Medical Park Chiemseeblick, Rasthausstr. 25, 83233, Bernau-Felden, Deutschland.
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10
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Căpățînă OO, Micluția IV, Fadgyas-Stănculete M. Current perspectives in treating negative symptoms of schizophrenia: A narrative review (Review). Exp Ther Med 2021; 21:276. [PMID: 33603883 PMCID: PMC7851661 DOI: 10.3892/etm.2021.9707] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022] Open
Abstract
The negative symptoms of schizophrenia are an unmet treatment target as currently approved treatments mostly control positive symptoms. The persistence of these symptoms holds back the patient's reinstatement in society, making them incapable of fulfilling their social, professional, or family roles. There is overwhelming research evidence suggesting that the negative symptoms of schizophrenia are associated with poorer functioning and lower quality of life than positive symptoms, confirming the need for developing new treatments for this particular category of symptoms. This present review aims to review clinical trials addressing novel pharmacological approaches addressing primary negative symptoms of schizophrenia. We overview both monotherapies, first-generation and second-generation antipsychotics, and add-on therapies, including psychostimulants, anti-inflammatory drugs, antidepressants, molecules targeting glutamatergic, cholinergic or serotonergic systems and hormones. Our findings suggest that the primary negative symptoms of schizophrenia may be mitigated by adjunctive therapies, and we highlight the pharmacological agents that have proven superior efficacy. Novel compounds such as cariprazine and MIN-101, to date, show promising results, but large clinical trials are needed to test their efficacy and safety.
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Affiliation(s)
- Octavia O Căpățînă
- Department of Neurosciences, 'Iuliu Haţieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ioana V Micluția
- Department of Neurosciences, 'Iuliu Haţieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Mihaela Fadgyas-Stănculete
- Department of Neurosciences, 'Iuliu Haţieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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11
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Single-Session Dance/Movement Therapy for People with Acute Schizophrenia: Development of a Treatment Protocol. AMERICAN JOURNAL OF DANCE THERAPY 2020. [DOI: 10.1007/s10465-020-09341-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Abstract
AbstractPurposeTo characterise patients with schizophrenia from four European countries treated with ziprasidone, and to compare these with patients treated with other second generation antipsychotics (SGAs) included in this survey.MethodA randomly selected, representative sample of psychiatrists (N = 744), from Germany, Greece, Italy and Spain, collected data on the five last patients with schizophrenia they had seen in consultation (N = 3996), including up to two patients treated with ziprasidone (N = 1096).ResultsZiprasidone was most frequently prescribed to patients requiring a switch from another antipsychotic. Compared to other surveyed SGAs, ziprasisone was more likely to be prescribed to women than to men (OR: 1.52), to patients with mild disease than to those with severe disease (OR: 1.94) and to outpatients than to inpatients (1.30). The most frequently cited reasons for prescribing ziprasidone were good tolerability and efficacy against positive and negative symptoms. Compared to other SGAs included in this survey, it was more likely to be prescribed due to the low risk of weight gain, metabolic syndrome and extrapyramidal symptoms.ConclusionPatients treated by ziprasidone more frequently belong to subgroups composed of more autonomous patients and those with mild to moderate disease severity.
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Impact of primary negative symptoms on functional outcomes in schizophrenia. Eur Psychiatry 2020; 29:449-55. [DOI: 10.1016/j.eurpsy.2014.01.007] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/03/2014] [Accepted: 01/26/2014] [Indexed: 11/23/2022] Open
Abstract
AbstractObjectiveNegative symptoms are known to undermine functional outcomes in people with schizophrenia; however, most studies have not accounted for whether these symptoms were primary or secondary to other psychopathological factors. The present study examined the impact of primary negative symptoms on functional outcomes in patients with schizophrenia.MethodThe sample included 1427 patients with schizophrenia who completed the baseline visit in the CATIE study. Symptoms were assessed with the Positive and Negative Syndrome Scale and Calgary Depression Scale, extrapyramidal side effects with the Simpson-Angus scale, and functional status with the Heinrichs-Carpenter Quality of Life Scale.ResultsNegative symptoms were significantly and inversely related to each domain of functioning examined. These relationships remained after statistically controlling for the influence of potential sources of secondary negative symptoms. In addition, the relationships between negative symptoms and specific domains of functioning remained in patients who had mild/absent positive, depressive, anxiety and extrapyramidal symptoms. Negative symptoms were associated with functional outcomes even in antipsychotic-free patients.ConclusionsPrimary negative symptoms significantly contribute to the functional impairment seen in people with schizophrenia. A better understanding of the etiology and pathobiology of these symptoms is required to guide the search for effective therapeutics that promote functional recovery.
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Tahir Y, Yang Z, Chakraborty D, Thalmann N, Thalmann D, Maniam Y, binte Abdul Rashid NA, Tan BL, Lee Chee Keong J, Dauwels J. Non-verbal speech cues as objective measures for negative symptoms in patients with schizophrenia. PLoS One 2019; 14:e0214314. [PMID: 30964869 PMCID: PMC6456189 DOI: 10.1371/journal.pone.0214314] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/08/2019] [Indexed: 11/18/2022] Open
Abstract
Negative symptoms in schizophrenia are associated with significant burden and possess little to no robust treatments in clinical practice today. One key obstacle impeding the development of better treatment methods is the lack of an objective measure. Since negative symptoms almost always adversely affect speech production in patients, speech dysfunction have been considered as a viable objective measure. However, researchers have mostly focused on the verbal aspects of speech, with scant attention to the non-verbal cues in speech. In this paper, we have explored non-verbal speech cues as objective measures of negative symptoms of schizophrenia. We collected an interview corpus of 54 subjects with schizophrenia and 26 healthy controls. In order to validate the non-verbal speech cues, we computed the correlation between these cues and the NSA-16 ratings assigned by expert clinicians. Significant correlations were obtained between these non-verbal speech cues and certain NSA indicators. For instance, the correlation between Turn Duration and Restricted Speech is -0.5, Response time and NSA Communication is 0.4, therefore indicating that poor communication is reflected in the objective measures, thus validating our claims. Moreover, certain NSA indices can be classified into observable and non-observable classes from the non-verbal speech cues by means of supervised classification methods. In particular the accuracy for Restricted speech quantity and Prolonged response time are 80% and 70% respectively. We were also able to classify healthy and patients using non-verbal speech features with 81.3% accuracy.
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Affiliation(s)
- Yasir Tahir
- Institute for Media Innovation, Nanyang Technological University, Singapore, Singapore
| | - Zixu Yang
- Institute of Mental Health, Singapore, Singapore
| | - Debsubhra Chakraborty
- Institute for Media Innovation, Nanyang Technological University, Singapore, Singapore
| | - Nadia Thalmann
- Institute for Media Innovation, Nanyang Technological University, Singapore, Singapore
| | - Daniel Thalmann
- Institute for Media Innovation, Nanyang Technological University, Singapore, Singapore
| | | | | | - Bhing-Leet Tan
- Institute of Mental Health, Singapore, Singapore
- Singapore Institute of Technology, Singapore, Singapore
| | - Jimmy Lee Chee Keong
- Institute of Mental Health, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Justin Dauwels
- School of Electrical and Electronics Engineering, Nanyang Technological University, Singapore, Singapore
- * E-mail:
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15
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Assessing negative symptoms in schizophrenia: Validity of the clinical assessment interview for negative symptoms in Singapore. Schizophr Res 2019; 206:177-182. [PMID: 30558979 DOI: 10.1016/j.schres.2018.11.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/25/2018] [Accepted: 11/23/2018] [Indexed: 11/20/2022]
Abstract
This study aimed to examine the validity of the Clinical Assessment Interview for Negative Symptoms (CAINS) in Singapore. 274 participants with schizophrenia were assessed on the CAINS, Scale for the Assessment of Negative Symptoms (SANS), Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), Social and Occupational Functioning Assessment Scale (SOFAS) and the Simpson-Angus Extrapyramidal Side Effects Scale (SES). Factor analyses were conducted and Cronbach's coefficient alpha was calculated. Spearman's correlation coefficient was used to assess correlations. The 2-factor model of the CAINS failed to fit our data. Exploratory factor analysis of a randomly selected split-half of the sample yielded four factors: motivation-pleasure (MAP) social, MAP vocational, MAP recreational and expression (EXP), accounting for 73.94% of the total variance. Confirmatory factor analysis on the remaining sample supported this factor structure. Cronbach's alpha for the CAINS was 0.770. Significant correlations were observed between the CAINS total and the SANS total and PANSS negative subscale scores. Good divergent validity was shown by insignificant correlations with PANSS positive subscale score and CDSS total score. The MAP social and recreational factor scores had moderate correlations with the SANS anhedonia-asociality subscale scores, whereas the MAP vocational factor had the highest correlation with the avolition-apathy subscale of the SANS. EXP factor score correlated strongly with the SANS affective flattening and alogia subscales scores. In conclusion, the CAINS has good psychometric properties and can be used by clinicians to assess negative symptoms in individuals with schizophrenia in the local population.
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Compton MT, Lunden A, Cleary SD, Pauselli L, Alolayan Y, Halpern B, Broussard B, Crisafio A, Capulong L, Balducci PM, Bernardini F, Covington MA. The aprosody of schizophrenia: Computationally derived acoustic phonetic underpinnings of monotone speech. Schizophr Res 2018; 197:392-399. [PMID: 29449060 PMCID: PMC6087691 DOI: 10.1016/j.schres.2018.01.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 01/11/2018] [Accepted: 01/14/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Acoustic phonetic methods are useful in examining some symptoms of schizophrenia; we used such methods to understand the underpinnings of aprosody. We hypothesized that, compared to controls and patients without clinically rated aprosody, patients with aprosody would exhibit reduced variability in: pitch (F0), jaw/mouth opening and tongue height (formant F1), tongue front/back position and/or lip rounding (formant F2), and intensity/loudness. METHODS Audiorecorded speech was obtained from 98 patients (including 25 with clinically rated aprosody and 29 without) and 102 unaffected controls using five tasks: one describing a drawing, two based on spontaneous speech elicited through a question (Tasks 2 and 3), and two based on reading prose excerpts (Tasks 4 and 5). We compared groups on variation in pitch (F0), formant F1 and F2, and intensity/loudness. RESULTS Regarding pitch variation, patients with aprosody differed significantly from controls in Task 5 in both unadjusted tests and those adjusted for sociodemographics. For the standard deviation (SD) of F1, no significant differences were found in adjusted tests. Regarding SD of F2, patients with aprosody had lower values than controls in Task 3, 4, and 5. For variation in intensity/loudness, patients with aprosody had lower values than patients without aprosody and controls across the five tasks. CONCLUSIONS Findings could represent a step toward developing new methods for measuring and tracking the severity of this specific negative symptom using acoustic phonetic parameters; such work is relevant to other psychiatric and neurological disorders.
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Affiliation(s)
- Michael T Compton
- Columbia University College of Physicians & Surgeons, Department of Psychiatry, New York, NY, USA.
| | - Anya Lunden
- College of William and Mary, Department of English, Linguistics Program, Williamsburg, VA, USA
| | - Sean D Cleary
- The George Washington University Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, Washington, DC, USA
| | - Luca Pauselli
- Columbia University College of Physicians & Surgeons, Department of Psychiatry, New York, NY, USA
| | - Yazeed Alolayan
- Case Western Reserve University, Department of Neurology, Cleveland, OH, USA
| | | | | | - Anthony Crisafio
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | - Francesco Bernardini
- Université Libre de Bruxelles, Erasme Hospital, Department of Psychiatry, Anderlecht, Belgium
| | - Michael A Covington
- The University of Georgia, Institute for Artificial Intelligence, Athens, GA, USA
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17
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Abstract
BACKGROUND Many individuals who have a diagnosis of schizophrenia experience a range of distressing and debilitating symptoms. These can include positive symptoms (such as delusions, hallucinations, disorganised speech), cognitive symptoms (such as trouble focusing or paying attention or using information to make decisions), and negative symptoms (such as diminished emotional expression, avolition, alogia, and anhedonia). Antipsychotic drugs are often only partially effective, particularly in treating negative symptoms, indicating the need for additional treatment. Mirtazapine is an antidepressant drug that when taken in addition to an antipsychotic may offer some benefit for negative symptoms. OBJECTIVES To systematically assess the effects of mirtazapine as adjunct treatment for people with schizophrenia. SEARCH METHODS The Information Specialist of Cochrane Schizophrenia searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (including registries of clinical trials) up to May 2018. SELECTION CRITERIA All randomised-controlled trials (RCTs) with useable data focusing on mirtazapine adjunct for people with schizophrenia. DATA COLLECTION AND ANALYSIS We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat (ITT) basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. For included studies we assessed risk of bias and created 'Summary of findings' table using GRADE. MAIN RESULTS We included nine RCTs with a total of 310 participants. All studies compared mirtazapine adjunct with placebo adjunct and were of short-term duration. We considered five studies to have a high risk of bias for either incomplete outcome data, selective reporting, or other bias.Our main outcomes of interest were clinically important change in mental state (negative and positive symptoms), leaving the study early for any reason, clinically important change in global state, clinically important change in quality of life, number of days in hospital and incidence of serious adverse events.One trial defined a reduction in the Scale for the Assessment of Negative Symptoms (SANS) overall score from baseline of at least 20% as no important response for negative symptoms. There was no evidence of a clear difference between the two treatments with similar numbers of participants from each group showing no important response to treatment (RR 0.81, 95% CI 0.57 to 1.14, 1 RCT, n = 20, very low-quality evidence).Clinically important change in positive symptoms was not reported, however, clinically important change in overall mental state was reported by two trials and data for this outcome showed a favourable effect for mirtazapine (RR 0.69, 95% CI 0.51 to 0.92; I2 = 75%, 2 RCTs, n = 77, very low-quality evidence). There was no evidence of a clear difference for numbers of participants leaving the study early (RR 1.03, 95% CI 0.64 to 1.66, 9 RCTs, n = 310, moderate-quality evidence), and no evidence of a clear difference in global state Clinical Global Impressions Scale (CGI) severity scores (MD -0.10, 95% CI -0.68 to 0.48, 1 RCT, n = 39, very low-quality evidence). A favourable effect for mirtazapine adjunct was found for the outcome clinically important change in akathisia (RR 0.33, 95% CI 0.20 to 0.52, 2 RCTs, n = 86, low-quality evidence; I2 = 61%I). No data were reported for quality life or number of days in hospital.In addition to the main outcomes of interest, there was evidence relating to adverse events that the mirtazapine adjunct groups were associated with an increased risk of weight gain (RR 3.19, 95% CI 1.17 to 8.65, 4 RCTs, n = 127) and sedation/drowsiness (RR 1.64, 95% CI 1.01 to 2.68, 7 RCTs, n = 223). AUTHORS' CONCLUSIONS The available evidence is primarily of very low quality and indicates that mirtazapine adjunct is not clearly associated with an effect for negative symptoms, but there is some indication of a positive effect on overall mental state and akathisia. No effect was found for global state or leaving the study early and data were not available for quality of life or service use. Due to limitations of the quality and applicability of the evidence it is not possible to make any firm conclusions, the role of mirtazapine adjunct in routine clinical practice remains unclear. This underscores the need for new high-quality evidence to further evaluate mirtazapine adjunct for schizophrenia.
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18
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Ghajar A, Khoaie-Ardakani MR, Shahmoradi Z, Alavi AR, Afarideh M, Shalbafan MR, Ghazizadeh-Hashemi M, Akhondzadeh S. L-carnosine as an add-on to risperidone for treatment of negative symptoms in patients with stable schizophrenia: A double-blind, randomized placebo-controlled trial. Psychiatry Res 2018; 262:94-101. [PMID: 29427913 DOI: 10.1016/j.psychres.2018.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/08/2018] [Accepted: 02/02/2018] [Indexed: 01/11/2023]
Abstract
Since l-carnosine has shown effectiveness in improvement of cognition in patients with schizophrenia, this 8-week, randomized, double-blind, placebo-controlled pilot study was conducted. Sixty-three patients with chronic schizophrenia, who were clinically stable on a stable dose of risperidone, entered the study. The patients were randomly assigned to l-carnosine (2 gr/day in two divided doses) or placebo for eight weeks. The patients were assessed using the positive and negative syndrome scale (PANSS), extrapyramidal symptom rating scale (ESRS), and Hamilton depression rating scale (HDRS) during the study course. Sixty patients completed the trial. L-carnosine resulted in greater improvement of negative scores as well as total PANSS scores but not positive subscale scores compared to placebo. HDRS scores and its changes did not differ between the two groups. Both groups demonstrated a constant ESRS score during the trial course. Frequency of other side effects was not significantly different between the two groups. In a multiple regression analysis model (controlled for positive, general psychopathology, depressive and extrapyramidal symptoms, as well as other variables), the treatment group significantly predicted changes in primary negative symptoms. In conclusion, l-carnosine add-on therapy can safely and effectively reduce the primary negative symptoms of patients with schizophrenia.
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Affiliation(s)
- Alireza Ghajar
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zahara Shahmoradi
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir-Reza Alavi
- Razi Hospital, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Mohsen Afarideh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Shalbafan
- Mental Health Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Ghazizadeh-Hashemi
- Mental Health Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Abstract
SummaryEngaging patients in first-episode psychosis services is critical in maximising the effect of early intervention and establishing a framework for longer-term treatment. Biopsychosocial assessments determine a working diagnosis and inform evidence-based treatment. Atypical antipsychotics should be used at doses that maximise therapeutic benefit and adherence while minimising side-effects. Patients are helped to construct a narrative of their illness, including a shared understanding of the contribution of biological and environmental risks, and early warning signs. Common comorbid conditions, including depression, suicidal ideation, substance misuse and anxiety, should be addressed. Management of comorbid borderline and antisocial personality disorders is difficult; their nexus with psychosis is discussed. Cognitive–behavioural therapy is a mainstay of treatment, with specific interventions developed for problems typical in first-episode presentations. Core psychosocial interventions include psychoeducation, vocational and educational support, family interventions and multimodal group programmes.
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20
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Murphy BP, Brewer WJ. Early intervention in psychosis: strengths and limitations of services. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.110.008573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryEarly intervention services were established on the basis of a number of fundamental principles, including the notions that intervening in the early stages of psychosis alters illness trajectory and prognosis, that multicomponent interventions promote psychosocial recovery and reduce iatrogenic damage, and that early targeting of non-responders reduces treatment resistance. There is growing evidence of the benefits of specialised early intervention services. These include improved clinical, social and vocational outcomes, reduced in-patient stays and better engagement. Early intervention services can also significantly reduce the risk of a second episode and are highly valued by service users and carers. Duration of treatment appears to determine long-term outcome and there remains uncertainty about how long such intensive intervention should last and whether all patients need the same length of care. Budgetary constraints are pervasive and are particularly likely to affect prodrome clinics and community awareness programmes.
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21
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Nielsen MØ, Rostrup E, Broberg BV, Wulff S, Glenthøj B. Negative Symptoms and Reward Disturbances in Schizophrenia Before and After Antipsychotic Monotherapy. Clin EEG Neurosci 2018; 49:36-45. [PMID: 29145751 DOI: 10.1177/1550059417744120] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Negative symptoms (NS) are a central part of the symptomatology of schizophrenia, which is highly correlated to the functional outcome. Disturbances of the brain reward system are suggested to be central in the pathogenesis of NS by decreasing motivation and hedonic experiences. In this study, we compared reward-related brain activity in patients improving and not improving in NS after treatment with amisulpride. METHODS Thirty-nine antipsychotic-naive patients and 49 healthy controls completed functional magnetic resonance imaging with a modified monetary incentive delay task. Psychopathology of the patients was characterised with Positive and Negative Syndrome Scale (PANSS), and they were treated with individual doses of amisulpride (mean 271 mg) for 6 weeks, after which the examinations were repeated. RESULTS Patients improved on positive, general, and total PANSS score after treatment ( P < .001). Fourteen patients had ≥20% improvement of NS, whereas 25 patients improved <20%. At baseline, one-way analysis of variance showed group difference bilaterally in the caudate nucleus and in the right nucleus accumbens (all P < .002), which was caused by decreased reward anticipation activity in the nonimproving patients compared to healthy controls. There was a significant group × time interaction, with the healthy controls and the improvers decreasing and the nonimprovers increasing in reward anticipation activity after treatment, most pronounced in the left caudate nucleus ( P = .001). DISCUSSION Patients improving in NS score had a less aberrant reward system at baseline, but reward related activity was reduced over time. Patients not improving in NS showed decreased striatal reward-activity at baseline, which improved over time. Whether this is associated with alteration in working memory and reward learning or with pronounced symptoms within specific domains of NS may be addressed in future studies.
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Affiliation(s)
- Mette Ødegaard Nielsen
- 1 Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital, Mental Health Centre Glostrup, Denmark
| | - Egill Rostrup
- 1 Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital, Mental Health Centre Glostrup, Denmark.,2 Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine Rigshospitalet, Glostrup, Denmark
| | - Brian Villumsen Broberg
- 1 Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital, Mental Health Centre Glostrup, Denmark
| | - Sanne Wulff
- 1 Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital, Mental Health Centre Glostrup, Denmark
| | - Birte Glenthøj
- 1 Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital, Mental Health Centre Glostrup, Denmark
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Chen X, Xiong Z, Li Z, Yang Y, Zheng Z, Li Y, Xie Y, Li Z. Minocycline as adjunct therapy for a male patient with deficit schizophrenia. Neuropsychiatr Dis Treat 2018; 14:2697-2701. [PMID: 30349268 PMCID: PMC6188198 DOI: 10.2147/ndt.s179658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The pathophysiology of schizophrenia may involve increased production of inflammatory cytokines by activated microglia. Minocycline can inhibit activated microglia and may improve secondary negative symptoms and/or cognitive functions when used as adjuvant to antipsychotics. Effects on minocycline on primary and enduring negative symptoms in deficit schizophrenia (DS) are unknown. We present a male patient with a 3-year history of DS. He was treated for 12 weeks with risperidone at a maximal dose of 6 mg per day, then for 10 weeks with olanzapine at 20 mg per day. Symptoms did not improve, and body mass index increased from 20.41 to 22.84 kg/m2. Serum levels of several inflammatory cytokines were elevated, so we prescribed minocycline as adjunct to aripiprazole for 12 weeks. Negative symptoms and cognitive impairment improved, and serum levels of inflammatory cytokines decreased. Our case suggests that clinicians may consider minocycline as adjunct therapy to antipsychotics in patients with DS with elevated serum levels of inflammatory cytokines. This highlights the need for further research into possible relationships of minocycline with negative symptoms and cognitive function in patients with DS.
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Affiliation(s)
- Xiaohua Chen
- Department of Central Transportation Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zhenzhen Xiong
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan 610083, China
| | - Zhixiong Li
- The Third Department of Clinical Psychology, Karamay Municipal People's Hospital, Karamay, Xinjiang 830054, China
| | - Yali Yang
- The Second Department of Clinical Psychology, Karamay Municipal People's Hospital, Karamay, Xinjiang 830054, China
| | - Zhanying Zheng
- The First Department of Clinical Psychology, Karamay Municipal People's Hospital, Karamay, Xinjiang 830054, China
| | - Yonghong Li
- The Sleep Medicine Department, Karamay Municipal People's Hospital, Karamay, Xinjiang 830054, China
| | - Yan Xie
- The Sleep Medicine Department, Karamay Municipal People's Hospital, Karamay, Xinjiang 830054, China
| | - Zhe Li
- Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China, .,The Mental Rehabilitation Center, Karamay Municipal People's Hospital, Karamay, Xinjiang 830054, China,
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Pontillo M, Costanzo F, Menghini D, Averna R, Santonastaso O, Tata MC, Vicari S. Use of Transcranial Direct Stimulation in the Treatment of Negative Symptoms of Schizophrenia. Clin EEG Neurosci 2018; 49:18-26. [PMID: 29243532 DOI: 10.1177/1550059417746531] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Schizophrenia is a debilitating disease that affects approximately 1% of the population. Negative symptoms are among the major determinants of the functional impairment and a significant proportion of patients with negative symptoms will continue to experience these symptoms despite antipsychotic medications. There are promising results in the application of brain stimulation, particularly transcranial direct current stimulation (tDCS), for the reduction of negative symptoms of schizophrenia. However, findings are still controversial. This is a selective review of the literature published between 2011 and 2017 on use of tDCS in treatment of negative symptoms of schizophrenia. We included only randomized controlled trials where schizophrenia and negative symptoms were assessed using any psychometrically validated scale (eg, Positive and Negative Symptoms Scale or Scale for the Assessment of Negative Symptoms). Studies of participants with neurological conditions were excluded, as were those that did not report any symptom outcome variables. Only 5 studies are included. Three studies showed a decrease of negative symptoms. The other studies did not show any therapeutic effects of tDCS in the severity of positive and negative symptoms compared to controls. Our findings suggest that negative symptoms in schizophrenia can be treated with tDCS over the dorsolateral prefrontal cortex, but results are affected by several factors, such as the electrode montage, the concomitant medication, the homogeneity of the sample, the intensity of the tDCS treatment. Further randomized, double-blinded, sham-controlled studies in large samples are still needed to establish the effectiveness of the tDCS in the treatment of negative symptoms in schizophrenia, but there is the potential for tDCS to become a useful complementary treatment option in this population.
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Affiliation(s)
- Maria Pontillo
- 1 Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Floriana Costanzo
- 1 Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Deny Menghini
- 1 Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Roberto Averna
- 1 Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Ornella Santonastaso
- 1 Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Maria Cristina Tata
- 1 Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Stefano Vicari
- 1 Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
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Phencyclidine increased while isolation rearing did not affect progressive ratio responding in rats: Investigating potential models of amotivation in schizophrenia. Behav Brain Res 2017; 364:413-422. [PMID: 29175446 DOI: 10.1016/j.bbr.2017.11.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Schizophrenia is a debilitating neurodevelopmental disorder affecting 1% of the global population with heterogeneous symptoms including positive, negative, and cognitive. While treatment for positive symptoms exists, none have been developed to treat negative symptoms. Animal models of schizophrenia are required to test targeted treatments and since patients exhibit reduced effort (breakpoints) for reward in a progressive ratio (PR) task, we examined the PR breakpoints of rats treated with the NMDA receptor antagonist phencyclidine or those reared in isolation - two common manipulations used to induce schizophrenia-relevant behaviors in rodents. METHODS In two cohorts, the PR breakpoint for a palatable food reward was examined in Long Evans rats after: 1) a repeated phencyclidine regimen; 2) A subchronic phencyclidine regimen followed by drug washout; and 3) post-weaning social isolation. RESULTS Rats treated with repeated phencyclidine and those following washout from phencyclidine exhibited higher PR breakpoints than vehicle-treated rats. The breakpoint of isolation reared rats did not differ from those socially reared, despite abnormalities of these rats in other schizophrenia-relevant behaviors. CONCLUSION Despite their common use for modeling other schizophrenia-relevant behaviors neither phencyclidine treatment nor isolation rearing recreated the motivational deficits observed in patients with schizophrenia, as measured by PR breakpoint. Other manipulations, and negative symptom-relevant behaviors, require investigation prior to testing putative therapeutics.
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Mikami S, Kawasaki M, Ikeda S, Negoro N, Nakamura S, Nomura I, Ashizawa T, Kokubo H, Hoffman ID, Zou H, Oki H, Uchiyama N, Hiura Y, Miyamoto M, Itou Y, Nakashima M, Iwashita H, Taniguchi T. Discovery of a Novel Series of Pyrazolo[1,5-a]pyrimidine-Based Phosphodiesterase 2A Inhibitors Structurally Different from N-((1S)-1-(3-Fluoro-4-(trifluoromethoxy)phenyl)-2-methoxyethyl)-7-methoxy-2-oxo-2,3-dihydropyrido[2,3-b]pyrazine-4(1H)-carboxamide (TAK-915), for the Treatment of Cognitive Disorders. Chem Pharm Bull (Tokyo) 2017; 65:1058-1077. [PMID: 29093293 DOI: 10.1248/cpb.c17-00564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It has been hypothesized that selective inhibition of phosphodiesterase (PDE) 2A could potentially be a novel approach to treat cognitive impairment in neuropsychiatric and neurodegenerative disorders through augmentation of cyclic nucleotide signaling pathways in brain regions associated with learning and memory. Following our earlier work, this article describes a drug design strategy for a new series of lead compounds structurally distinct from our clinical candidate 2 (TAK-915), and subsequent medicinal chemistry efforts to optimize potency, selectivity over other PDE families, and other preclinical properties including in vitro phototoxicity and in vivo rat plasma clearance. These efforts resulted in the discovery of N-((1S)-2-hydroxy-2-methyl-1-(4-(trifluoromethoxy)phenyl)propyl)-6-methyl-5-(3-methyl-1H-1,2,4-triazol-1-yl)pyrazolo[1,5-a]pyrimidine-3-carboxamide (20), which robustly increased 3',5'-cyclic guanosine monophosphate (cGMP) levels in the rat brain following an oral dose, and moreover, attenuated MK-801-induced episodic memory deficits in a passive avoidance task in rats. These data provide further support to the potential therapeutic utility of PDE2A inhibitors in enhancing cognitive performance.
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Affiliation(s)
- Satoshi Mikami
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
| | - Masanori Kawasaki
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
| | - Shuhei Ikeda
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
| | - Nobuyuki Negoro
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
| | - Shinji Nakamura
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
| | - Izumi Nomura
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
| | - Tomoko Ashizawa
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
| | - Hironori Kokubo
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
| | | | | | - Hideyuki Oki
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
| | - Noriko Uchiyama
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
| | - Yuuto Hiura
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
| | - Maki Miyamoto
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
| | - Yuuki Itou
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
| | - Masato Nakashima
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
| | - Hiroki Iwashita
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
| | - Takahiko Taniguchi
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited
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Mucci A, Merlotti E, Üçok A, Aleman A, Galderisi S. Primary and persistent negative symptoms: Concepts, assessments and neurobiological bases. Schizophr Res 2017; 186:19-28. [PMID: 27242069 DOI: 10.1016/j.schres.2016.05.014] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/10/2016] [Accepted: 05/17/2016] [Indexed: 02/01/2023]
Abstract
Primary and persistent negative symptoms (PPNS) represent an unmet need in the care of people with schizophrenia. They have an unfavourable impact on real-life functioning and do not respond to available treatments. Underlying etiopathogenetic mechanisms of PPNS are still unknown. The presence of primary and enduring negative symptoms characterizes deficit schizophrenia (DS), proposed as a separate disease entity with respect to non-deficit schizophrenia (NDS). More recently, to reduce the heterogeneity of negative symptoms by using criteria easily applicable in the context of clinical trials, the concept of persistent negative symptoms (PNS) was developed. Both PNS and DS constructs include enduring negative symptoms (at least 6months for PNS and 12months for DS) that do not respond to available treatments. PNS exclude secondary negative symptoms based on a cross-sectional evaluation of severity thresholds on commonly used rating scales for positive symptoms, depression and extrapyramidal side effects; the DS diagnosis, instead, excludes all potential sources of secondary negative symptoms based on a clinical longitudinal assessment. In this paper we review the evolution of concepts and assessment modalities relevant to PPNS, data on prevalence of DS and PNS, as well as studies on clinical, neuropsychological, brain imaging electrophysiological and psychosocial functioning aspects of DS and PNS.
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Affiliation(s)
- Armida Mucci
- Department of Psychiatry, University of Naples SUN, Naples, Italy.
| | | | - Alp Üçok
- Department of Psychiatry, Psychotic Disorders Research Program, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Department of Neuroscience and Department of Psychology, Groningen, The Netherlands
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Bergeron Y, Bureau G, Laurier-Laurin MÉ, Asselin E, Massicotte G, Cyr M. Genetic Deletion of Akt3 Induces an Endophenotype Reminiscent of Psychiatric Manifestations in Mice. Front Mol Neurosci 2017; 10:102. [PMID: 28442992 PMCID: PMC5385361 DOI: 10.3389/fnmol.2017.00102] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/24/2017] [Indexed: 11/21/2022] Open
Abstract
The protein kinase B (PKB/Akt), found in three distinctive isoforms (PKBα/Akt1, PKBβ/Akt2, PKBγ/Akt3), is implicated in a variety of cellular processes such as cell development, growth and survival. Although Akt3 is the most expressed isoform in the brain, its role in cerebral functions is still unclear. In the present study, we investigated the behavioral, electrophysiological and biochemical consequences of Akt3 deletion in mice. Motor abilities, spatial navigation, recognition memory and LTP are intact in the Akt3 knockout (KO) mice. However, the prepulse inhibition, three-chamber social, forced swim, tail suspension, open field, elevated plus maze and light-dark transition tests revealed an endophenotype reminiscent of psychiatric manifestations such as schizophrenia, anxiety and depression. Biochemical investigations revealed that Akt3 deletion was associated with reduced levels of phosphorylated GSK3α/β at serine 21/9 in several brain regions, although Akt1 and Akt2 levels were unaffected. Notably, chronic administration of lithium, a mood stabilizer, restored the decreased phosphorylated GSK3α/β levels and rescued the depressive and anxiety-like behaviors in the Akt3 KO mice. Collectively, our data suggest that Akt3 might be a critical molecule underlying psychiatric-related behaviors in mice.
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Affiliation(s)
- Yan Bergeron
- Department of Medical Biology, Université du Québec à Trois-RivièresTrois-Rivières, QC, Canada
| | - Geneviève Bureau
- Department of Medical Biology, Université du Québec à Trois-RivièresTrois-Rivières, QC, Canada
| | | | - Eric Asselin
- Department of Medical Biology, Université du Québec à Trois-RivièresTrois-Rivières, QC, Canada
| | - Guy Massicotte
- Department of Medical Biology, Université du Québec à Trois-RivièresTrois-Rivières, QC, Canada
| | - Michel Cyr
- Department of Medical Biology, Université du Québec à Trois-RivièresTrois-Rivières, QC, Canada
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Buonaguro EF, Tomasetti C, Chiodini P, Marmo F, Latte G, Rossi R, Avvisati L, Iasevoli F, de Bartolomeis A. Postsynaptic density protein transcripts are differentially modulated by minocycline alone or in add-on to haloperidol: Implications for treatment resistant schizophrenia. J Psychopharmacol 2017; 31:406-417. [PMID: 27443599 DOI: 10.1177/0269881116658987] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In this study, we investigated whether minocycline, a second-generation tetracycline proposed as an add-on to antipsychotics in treatment-resistant schizophrenia (TRS), may affect the expression of Homer and Arc postsynaptic density (PSD) transcripts, implicated in synaptic regulation. Minocycline was administered alone or with haloperidol in rats exposed or not to ketamine, mimicking acute glutamatergic psychosis or naturalistic conditions, respectively. Arc expression was significantly reduced by minocycline compared with controls. Minocycline in combination with haloperidol also significantly reduced Arc expression compared with both controls and haloperidol alone. Moreover, haloperidol/minocycline combination significantly affected Arc expression in cortical regions, while haloperidol alone was ineffective on cortical gene expression. These results suggest that minocycline may strongly affect the expression of Arc as mediated by haloperidol, both in terms of quantitative levels and of topography of haloperidol-related expression. It is noteworthy that no significant pre-treatment effect was found, suggesting that pre-exposure to ketamine did not grossly affect gene expression. Minocycline was not found to significantly affect haloperidol-related Homer1a expression. No significant changes in Homer1b/c expression were observed. These results are consistent with previous observations that minocycline may modulate postsynaptic glutamatergic transmission, affecting distinct downstream pathways initiated by N-methyl-D-aspartate (NMDA) receptor modulation, i.e. Arc-mediated but not Homer1a-mediated pathways.
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Affiliation(s)
- Elisabetta F Buonaguro
- 1 Department of Neuroscience, Reproductive Sciences and Odontostomatology, University School of Medicine 'Federico II', Naples, Italy
| | - Carmine Tomasetti
- 1 Department of Neuroscience, Reproductive Sciences and Odontostomatology, University School of Medicine 'Federico II', Naples, Italy
| | - Paolo Chiodini
- 2 Medical Statistics Unit, Second University of Naples, Naples, Italy
| | - Federica Marmo
- 1 Department of Neuroscience, Reproductive Sciences and Odontostomatology, University School of Medicine 'Federico II', Naples, Italy
| | - Gianmarco Latte
- 1 Department of Neuroscience, Reproductive Sciences and Odontostomatology, University School of Medicine 'Federico II', Naples, Italy
| | - Rodolfo Rossi
- 1 Department of Neuroscience, Reproductive Sciences and Odontostomatology, University School of Medicine 'Federico II', Naples, Italy
| | - Livia Avvisati
- 1 Department of Neuroscience, Reproductive Sciences and Odontostomatology, University School of Medicine 'Federico II', Naples, Italy
| | - Felice Iasevoli
- 1 Department of Neuroscience, Reproductive Sciences and Odontostomatology, University School of Medicine 'Federico II', Naples, Italy
| | - Andrea de Bartolomeis
- 1 Department of Neuroscience, Reproductive Sciences and Odontostomatology, University School of Medicine 'Federico II', Naples, Italy
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Turk T, Hernandez Morfin N, Alkhatib M. Blonanserin versus risperidone for schizophrenia. Hippokratia 2017. [DOI: 10.1002/14651858.cd012587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tarek Turk
- Damascus University; Faculty of Medicine; Mazzeh Street Damascus Syrian Arab Republic
| | | | - Mahmoud Alkhatib
- Damascus University; Faculty of Medicine; Mazzeh Street Damascus Syrian Arab Republic
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Hartmann-Riemer MN, Aschenbrenner S, Bossert M, Westermann C, Seifritz E, Tobler PN, Weisbrod M, Kaiser S. Deficits in reinforcement learning but no link to apathy in patients with schizophrenia. Sci Rep 2017; 7:40352. [PMID: 28071747 PMCID: PMC5223142 DOI: 10.1038/srep40352] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 12/05/2016] [Indexed: 01/28/2023] Open
Abstract
Negative symptoms in schizophrenia have been linked to selective reinforcement learning deficits in the context of gains combined with intact loss-avoidance learning. Fundamental mechanisms of reinforcement learning and choice are prediction error signaling and the precise representation of reward value for future decisions. It is unclear which of these mechanisms contribute to the impairments in learning from positive outcomes observed in schizophrenia. A recent study suggested that patients with severe apathy symptoms show deficits in the representation of expected value. Considering the fundamental relevance for the understanding of these symptoms, we aimed to assess the stability of these findings across studies. Sixty-four patients with schizophrenia and 19 healthy control participants performed a probabilistic reward learning task. They had to associate stimuli with gain or loss-avoidance. In a transfer phase participants indicated valuation of the previously learned stimuli by choosing among them. Patients demonstrated an overall impairment in learning compared to healthy controls. No effects of apathy symptoms on task indices were observed. However, patients with schizophrenia learned better in the context of loss-avoidance than in the context of gain. Earlier findings were thus partially replicated. Further studies are needed to clarify the mechanistic link between negative symptoms and reinforcement learning.
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Affiliation(s)
- Matthias N Hartmann-Riemer
- Department of Psychiatry, Psychotherapy, and Psychosomatics; Psychiatric Hospital; University of Zurich, Switzerland
| | | | | | | | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics; Psychiatric Hospital; University of Zurich, Switzerland
| | - Philippe N Tobler
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Matthias Weisbrod
- Psychiatric Hospital Karlsbad Langensteinbach, Karlsbad, Germany.,University of Heidelberg, Heidelberg, Germany
| | - Stefan Kaiser
- Department of Psychiatry, Psychotherapy, and Psychosomatics; Psychiatric Hospital; University of Zurich, Switzerland
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Dlabac-de Lange JJ, Liemburg EJ, Bais L, van de Poel-Mustafayeva AT, de Lange-de Klerk ES, Knegtering H, Aleman A. Effect of Bilateral Prefrontal rTMS on Left Prefrontal NAA and Glx Levels in Schizophrenia Patients with Predominant Negative Symptoms: An Exploratory Study. Brain Stimul 2017; 10:59-64. [DOI: 10.1016/j.brs.2016.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/25/2016] [Accepted: 08/01/2016] [Indexed: 11/28/2022] Open
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Maia TV, Frank MJ. An Integrative Perspective on the Role of Dopamine in Schizophrenia. Biol Psychiatry 2017; 81:52-66. [PMID: 27452791 PMCID: PMC5486232 DOI: 10.1016/j.biopsych.2016.05.021] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 04/19/2016] [Accepted: 05/19/2016] [Indexed: 12/14/2022]
Abstract
We propose that schizophrenia involves a combination of decreased phasic dopamine responses for relevant stimuli and increased spontaneous phasic dopamine release. Using insights from computational reinforcement-learning models and basic-science studies of the dopamine system, we show that each of these two disturbances contributes to a specific symptom domain and explains a large set of experimental findings associated with that domain. Reduced phasic responses for relevant stimuli help to explain negative symptoms and provide a unified explanation for the following experimental findings in schizophrenia, most of which have been shown to correlate with negative symptoms: reduced learning from rewards; blunted activation of the ventral striatum, midbrain, and other limbic regions for rewards and positive prediction errors; blunted activation of the ventral striatum during reward anticipation; blunted autonomic responding for relevant stimuli; blunted neural activation for aversive outcomes and aversive prediction errors; reduced willingness to expend effort for rewards; and psychomotor slowing. Increased spontaneous phasic dopamine release helps to explain positive symptoms and provides a unified explanation for the following experimental findings in schizophrenia, most of which have been shown to correlate with positive symptoms: aberrant learning for neutral cues (assessed with behavioral and autonomic responses), and aberrant, increased activation of the ventral striatum, midbrain, and other limbic regions for neutral cues, neutral outcomes, and neutral prediction errors. Taken together, then, these two disturbances explain many findings in schizophrenia. We review evidence supporting their co-occurrence and consider their differential implications for the treatment of positive and negative symptoms.
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Affiliation(s)
- Tiago V Maia
- Institute for Molecular Medicine, School of Medicine, University of Lisbon, Lisbon, Portugal.
| | - Michael J Frank
- Department of Cognitive, Linguistic and Psychological Sciences, the Department of Psychiatry and Human Behavior, and the Brown Institute for Brain Science, Brown University, Providence, Rhode Island
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Attari A, Mojdeh A, Khalifeh Soltani FAS, Najarzadegan MR. Aspirin Inclusion in Antipsychotic Treatment on Severity of Symptoms in Schizophrenia: A Randimized Clinical Trial. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2016. [DOI: 10.17795/ijpbs-5848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Ramsay RR. Molecular aspects of monoamine oxidase B. Prog Neuropsychopharmacol Biol Psychiatry 2016; 69:81-9. [PMID: 26891670 DOI: 10.1016/j.pnpbp.2016.02.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/06/2016] [Accepted: 02/11/2016] [Indexed: 02/07/2023]
Abstract
Monoamine oxidases (MAO) influence the monoamine levels in brain by virtue of their role in neurotransmitter breakdown. MAO B is the predominant form in glial cells and in platelets. MAO B structure, function and kinetics are described as a background for the effect of alterations in its activity on behavior. The need to inhibit MAO B to combat decreased brain amines continues to drive the search for new drugs. Reversible and irreversible inhibitors are now designed using data-mining, computational screening, docking and molecular dynamics. Multi-target ligands designed to combat the elevated activity of MAO B in Alzheimer's and Parkinson's Diseases incorporate MAO inhibition (usually irreversible) as well as iron chelation, antioxidant or neuroprotective properties. The main focus of drug design is the catalytic activity of MAO, but the imidazoline I2 site in the entrance cavity of MAO B is also a pharmacological target. Endogenous regulation of MAO B expression is discussed briefly in light of new studies measuring mRNA, protein, or activity in healthy and degenerative samples, including the effect of DNA methylation on the expression. Overall, this review focuses on examples of recent research on the molecular aspects of the expression, activity, and inhibition of MAO B.
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Affiliation(s)
- Rona R Ramsay
- Biomedical Sciences Research Complex, University of St Andrews, North Haugh, St Andrews KY16 9ST, United Kingdom.
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Jung SI, Woo J, Kim YT, Kwak SG. Validation of the Korean-Version of the Clinical Assessment Interview for Negative Symptoms of Schizophrenia (CAINS). J Korean Med Sci 2016; 31:1114-20. [PMID: 27366011 PMCID: PMC4901005 DOI: 10.3346/jkms.2016.31.7.1114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/04/2016] [Indexed: 12/05/2022] Open
Abstract
The Clinical Assessment Interview for Negative Symptoms (CAINS) was developed to overcome the limitations of existing instruments and reflect the current view of negative symptoms. The aim of the present study was to evaluate the reliability and validity of the Korean version of the Clinical Assessment Interview for Negative Symptoms (K-CAINS). Inpatients (n = 49) and outpatients (n = 70) with schizophrenia were recruited from three institutions. The confirmative factor analysis, test-retest reliability, inter-rater reliability, convergent validity, and discriminant validity were assessed. The study group consisted of 71 males (59.7%) and 48 females (40.3%). Their mean age was 42.15 years (SD = 12.2). The K-CAINS was confirmed to be divided into two subscales of 9 items related to "motivation/pleasure" and 4 items related to "expression" in concordance with the original version of the CAINS. The results showed that the K-CAINS had a good inter-rater reliability (ICC = 0.84-0.94), test-retest reliability (r = 0.90, P < 0.001). Convergent validity was proven by demonstrating a significant correlation with the Positive and Negative Syndrome Scale (PANSS) negative subscale, and the Scale for the Assessment of Negative Symptoms (SANS). Discriminant validity was proven by the lack of a significant correlation with the PANSS positive subscale, the Korean version of the Beck depression inventory (BDI), the Korean version of the Calgary depression scale for schizophrenia (K-CDSS), and the Modified Simpson Angus scale (MSAS). The K-CAINS could be a reliable and valid tool to assess the negative symptoms of Korean schizophrenia patients.
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Affiliation(s)
- Sung Il Jung
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jungmin Woo
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Yang-Tae Kim
- Department of Psychiatry, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, Catholic University of Daegu School of Medicine, Daegu, Korea
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Synaptic and cellular changes induced by the schizophrenia susceptibility gene G72 are rescued by N-acetylcysteine treatment. Transl Psychiatry 2016; 6:e807. [PMID: 27163208 PMCID: PMC5070069 DOI: 10.1038/tp.2016.74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/19/2016] [Accepted: 03/20/2016] [Indexed: 12/15/2022] Open
Abstract
Genetic studies have linked the primate-specific gene locus G72 to the development of schizophrenia and bipolar disorder. Transgenic mice carrying the entire gene locus express G72 mRNA in dentate gyrus (DG) and entorhinal cortex, causing altered electrophysiological properties of their connections. These transgenic mice exhibit behavioral alterations related to psychiatric diseases, including cognitive deficits that can be reversed by treatment with N-acetylcysteine, which was also found to be effective in human patients. Here, we show that G72 transgenic mice have larger excitatory synapses with an increased amount of N-methyl-d-aspartate (NMDA) receptors in the molecular layer of DG, compared with wild-type littermates. Furthermore, transgenic animals have lower number of dentate granule cells with a parallel, but an even stronger decrease in the number of excitatory synapses in the molecular layer. Importantly, we also show that treatment with N-acetylcysteine can effectively normalize all these changes in transgenic animals, resulting in a state similar to wild-type mice. Our results show that G72 transcripts induce robust alterations in the glutamatergic system at the synaptic level that can be rescued with N-acetylcysteine treatment.
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Pero JE, Rossi MA, Kelly MJ, Lehman HGF, Layton ME, Garbaccio RM, O’Brien JA, Magliaro BC, Uslaner J, Huszar SL, Fillgrove KL, Tang C, Kuo Y, Joyce LA, Sherer E, Jacobson MA. Optimization of Novel Aza-benzimidazolone mGluR2 PAMs with Respect to LLE and PK Properties and Mitigation of CYP TDI. ACS Med Chem Lett 2016; 7:312-7. [PMID: 26985321 PMCID: PMC4789683 DOI: 10.1021/acsmedchemlett.5b00459] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/09/2016] [Indexed: 01/01/2023] Open
Abstract
Investigation of a novel amino-aza-benzimidazolone structural class of positive allosteric modulators (PAMs) of metabotropic glutamate receptor 2 (mGluR2) identified [2.2.2]-bicyclic amine 12 as an intriguing lead structure due to its promising physicochemical properties and lipophilic ligand efficiency (LLE). Further optimization led to chiral amide 18, which exhibited strong in vitro activity and attractive pharmacokinetic (PK) properties. Hypothesis-driven target design identified compound 21 as a potent, highly selective, orally bioavailable mGluR2 PAM, which addressed a CYP time-dependent inhibition (TDI) liability of 18, while maintaining excellent drug-like properties with robust in vivo activity in a clinically validated model of antipsychotic potential.
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Affiliation(s)
- Joseph E. Pero
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Michael A. Rossi
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Michael J. Kelly
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Hannah
D. G. F. Lehman
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Mark E. Layton
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Robert M. Garbaccio
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Julie A. O’Brien
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Brian C. Magliaro
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Jason
M. Uslaner
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Sarah L. Huszar
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Kerry L. Fillgrove
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Cuyue Tang
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Yuhsin Kuo
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Leo A. Joyce
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Edward
C. Sherer
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Marlene A. Jacobson
- Departments
of Medicinal Chemistry, In Vitro Sciences, Psychiatry Research, Central Pharmacology, Drug Metabolism, Process and Analytical
Chemistry, and Structural Chemistry, Merck Research Laboratories, P.O. Box 4, Sumneytown Pike, West Point, Pennsylvania 19486, United States
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39
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Holm-Hansen S, Low JK, Zieba J, Gjedde A, Bergersen LH, Karl T. Behavioural effects of high fat diet in a mutant mouse model for the schizophrenia risk gene neuregulin 1. GENES BRAIN AND BEHAVIOR 2016; 15:295-304. [PMID: 26707035 DOI: 10.1111/gbb.12267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 11/29/2022]
Abstract
Schizophrenia patients are often obese or overweight and poor dietary choices appear to be a factor in this phenomenon. Poor diet has been found to have complex consequences for the mental state of patients. Thus, this study investigated whether an unhealthy diet [i.e. high fat diet (HFD)] impacts on the behaviour of a genetic mouse model for the schizophrenia risk gene neuregulin 1 (i.e. transmembrane domain Nrg1 mutant mice: Nrg1 HET). Female Nrg1 HET and wild-type-like littermates (WT) were fed with either HFD or a control chow diet. The mice were tested for baseline (e.g. anxiety) and schizophrenia-relevant behaviours after 7 weeks of diet exposure. HFD increased body weight and impaired glucose tolerance in all mice. Only Nrg1 females on HFD displayed a hyper-locomotive phenotype as locomotion-suppressive effects of HFD were only evident in WT mice. HFD also induced an anxiety-like response and increased freezing in the context and the cued version of the fear conditioning task. Importantly, CHOW-fed Nrg1 females displayed impaired social recognition memory, which was absent in HFD-fed mutants. Sensorimotor gating deficits of Nrg1 females were not affected by diet. In summary, HFD had complex effects on the behavioural phenotype of test mice and attenuated particular cognitive deficits of Nrg1 mutant females. This topic requires further investigations thereby also considering other dietary factors of relevance for schizophrenia as well as interactive effects of diet with medication and sex.
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Affiliation(s)
- S Holm-Hansen
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Brain and Muscle Energy Group, Electron Microscopy Laboratory, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - J K Low
- Neuroscience Research Australia, Sydney, Australia.,Schizophrenia Research Institute, Randwick, Australia
| | - J Zieba
- Neuroscience Research Australia, Sydney, Australia.,Schizophrenia Research Institute, Randwick, Australia
| | - A Gjedde
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - L H Bergersen
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Brain and Muscle Energy Group, Electron Microscopy Laboratory, Institute of Oral Biology, University of Oslo, Oslo, Norway.,Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - T Karl
- Neuroscience Research Australia, Sydney, Australia.,Schizophrenia Research Institute, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Sydney, Australia
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40
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Gur RC, Gur RE. Social cognition as an RDoC domain. Am J Med Genet B Neuropsychiatr Genet 2016; 171B:132-41. [PMID: 26607670 PMCID: PMC4843508 DOI: 10.1002/ajmg.b.32394] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 10/07/2015] [Indexed: 01/09/2023]
Abstract
While the bulk of research into neural substrates of behavior and psychopathology has focused on cognitive, memory and executive functions, there has been a recent surge of interest in emotion processing and social cognition, manifested in designating Social Cognition as a major RDoC domain. We describe the origins of this field's influence on cognitive neuroscience and highlight the most salient findings leading to the characterization of the "social brain" and the establishments of parameters that quantify normative and aberrant behaviors. Such parameters of behavior and neurobiology are required for a potentially successful RDoC construct, especially if heritability is established, because of the need to link with genomic systems. We proceed to illustrate how a social cognition measure can be used within the RDoC framework by presenting a task of facial emotion identification. We show that performance is sensitive to normative individual differences related to age and sex and to deficits associated with schizophrenia and other psychotic disorders. Neuroimaging studies with this task demonstrate that it recruits limbic and frontal regulatory activation in healthy samples as well as abnormalities in psychiatric populations. Evidence for its heritability was documented in genomic family studies and in patients with the 22q11.2 deletion syndrome. Measures that meet such criteria can help build translational bridges between cellular molecular mechanisms and behavior that elucidate aberrations related to psychopathology. Such links will transcend current diagnostic classifications and ultimately lead to a mechanistically based diagnostic nomenclature. Establishing such bridges will provide the elements necessary for early detection and scientifically grounded intervention.
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Affiliation(s)
- Ruben C. Gur
- Brain Behavior Laboratory, Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raquel E. Gur
- Brain Behavior Laboratory, Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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41
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Lodovighi MA, Palomba A, Belzeaux R, Adida M, Azorin JM. Symptômes négatifs de la schizophrénie : nouvelles approches pharmacologiques. Encephale 2015; 41:6S41-9. [DOI: 10.1016/s0013-7006(16)30010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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43
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Dlabac-de Lange JJ, Liemburg EJ, Bais L, Renken RJ, Knegtering H, Aleman A. Effect of rTMS on brain activation in schizophrenia with negative symptoms: A proof-of-principle study. Schizophr Res 2015; 168:475-82. [PMID: 26187147 DOI: 10.1016/j.schres.2015.06.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/03/2015] [Accepted: 06/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Prefrontal cortical dysfunction is frequently reported in schizophrenia and is thought to underlie negative symptoms of schizophrenia. Repetitive Transcranial Magnetic Stimulation (rTMS) can modulate neuronal activity and has been shown to improve negative symptoms in patients with schizophrenia, but the underlying neural mechanism is unknown. OBJECTIVE To examine whether 3weeks of 10Hz rTMS treatment of the bilateral dorsolateral prefrontal cortex (DLPFC) would improve frontal brain activation in patients with negative symptoms of schizophrenia, as measured by functional magnetic resonance imaging (fMRI) during the Tower of London (ToL) task. METHODS 24 patients with the diagnosis of schizophrenia with moderate to severe negative symptoms (Positive and Negative Syndrome Scale (PANSS) negative subscale≥15) participated. Patients were randomized to a 3-week (15day) course of active or sham rTMS. All patients performed the ToL task during fMRI scanning both pre-treatment and post-treatment. Differences in brain activation between the two groups were compared non-parametrically. RESULTS After rTMS treatment, brain activity in the active group increased in the right DLPFC and the right medial frontal gyrus as compared to the sham group. In addition, the groups significantly differed with regard to activation change in the left posterior cingulate, with decreased activation in the active and increased activation in the sham group. CONCLUSIONS Treatment with rTMS over the DLPFC may have the potential for increasing task-related activation in frontal areas in patients with schizophrenia. Effects of different rTMS parameters and fMRI tasks targeting relevant brain circuitry deserve further investigation. TRIAL REGISTRATION Nederlands Trial Register, registration number: NTR1261.
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Affiliation(s)
- Jozarni J Dlabac-de Lange
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Neuroscience and BCN Neuroimaging Center, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands.
| | - Edith J Liemburg
- University of Groningen, University Medical Center Groningen, Department of Neuroscience and BCN Neuroimaging Center, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands
| | - Leonie Bais
- University of Groningen, University Medical Center Groningen, Department of Neuroscience and BCN Neuroimaging Center, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands; Lentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG Groningen, The Netherlands
| | - Remco J Renken
- University of Groningen, University Medical Center Groningen, Department of Neuroscience and BCN Neuroimaging Center, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands
| | - Henderikus Knegtering
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Neuroscience and BCN Neuroimaging Center, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands; Lentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG Groningen, The Netherlands
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Department of Neuroscience and BCN Neuroimaging Center, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Psychology, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
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44
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Negative symptoms in schizophrenia show association with amygdala volumes and neural activation during affective processing. Acta Neuropsychiatr 2015; 27:213-20. [PMID: 25777814 DOI: 10.1017/neu.2015.11] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Negative symptoms in schizophrenia have been associated with structural and functional alterations of the amygdala. We hypothesised that there would be between-group differences in amygdala volume and neural activation patterns during processing of affective stimuli among patients with schizophrenia and healthy controls. We further hypothesised correlations between neuroimaging metrics and clinical ratings of negative symptoms in patients with schizophrenia. METHODS We used structural and functional magnetic resonance imaging to assess volume and neural activation of the amygdala in 28 patients with schizophrenia and 28 healthy controls. RESULTS We found no between-group differences in amygdala volume or neural activation. However, we found a significant negative correlation between emotional blunting and neural activation in the left amygdala during processing of positive affect. We also found a significant negative correlation between stereotyped thinking and the volume of right amygdala. CONCLUSION Our findings implicate the amygdala in a subgroup of negative symptoms in schizophrenia that are characterised by reduced expression with blunted affect and stereotyped thinking.
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45
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Fusar-Poli P, Papanastasiou E, Stahl D, Rocchetti M, Carpenter W, Shergill S, McGuire P. Treatments of Negative Symptoms in Schizophrenia: Meta-Analysis of 168 Randomized Placebo-Controlled Trials. Schizophr Bull 2015; 41:892-9. [PMID: 25528757 PMCID: PMC4466178 DOI: 10.1093/schbul/sbu170] [Citation(s) in RCA: 420] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Existing treatments for schizophrenia can improve positive symptoms, but it is unclear if they have any impact on negative symptoms. This meta-analysis was conducted to assess the efficacy of available treatments for negative symptoms in schizophrenia. METHODS All randomized-controlled trials of interventions for negative symptoms in schizophrenia until December 2013 were retrieved; 168 unique and independent placebo-controlled trials were used. Negative symptom scores at baseline and follow-up, duration of illness, doses of medication, type of interventions, and sample demographics were extracted. Heterogeneity was addressed with the I (2) and Q statistic. Standardized mean difference in values of the Negative Symptom Rating Scale used in each study was calculated as the main outcome measure. RESULTS 6503 patients in the treatment arm and 5815 patients in the placebo arm were included. No evidence of publication biases found. Most treatments reduced negative symptoms at follow-up relative to placebo: second-generation antipsychotics: -0.579 (-0.755 to -0.404); antidepressants: -0.349 (-0.551 to -0.146); combinations of pharmacological agents: -0.518 (-0.757 to -0.279); glutamatergic medications: -0.289 (-0.478 to -0.1); psychological interventions: -0.396 (-0.563 to -0.229). No significant effect was found for first-generation antipsychotics: -0.531 (-1.104 to 0.041) and brain stimulation: -0.228 (-0.775 to 0.319). Effects of most treatments were not clinically meaningful as measured on Clinical Global Impression Severity Scale. CONCLUSIONS AND RELEVANCE Although some statistically significant effects on negative symptoms were evident, none reached the threshold for clinically significant improvement.
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Affiliation(s)
- Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK; OASIS team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Evangelos Papanastasiou
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK;
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Matteo Rocchetti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - William Carpenter
- Department of Psychiatry and Pharmacology, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Sukhwinder Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK; OASIS team, South London and the Maudsley NHS Foundation Trust, London, UK
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46
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Chang WC, Chan GHK, Jim OTT, Lau ESK, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Optimal duration of an early intervention programme for first-episode psychosis: randomised controlled trial. Br J Psychiatry 2015; 206:492-500. [PMID: 25657355 DOI: 10.1192/bjp.bp.114.150144] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 08/06/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Numerous early intervention services targeting young people with psychosis have been established, based on the premise that reducing treatment delay and providing intensive treatment in the initial phase of psychosis can improve long-term outcome. AIMS To establish the effect of extending a specialised early intervention treatment for first-episode psychosis by 1 year. METHOD A randomised, single-blind controlled trial (NCT01202357) compared a 1-year extension of specialised early intervention with step-down care in patients who had all received a 2-year intensive early intervention programme for first-episode psychosis. RESULTS Patients receiving an additional year of specialised intervention had better outcomes in functioning, negative and depressive symptoms and treatment default rate than those managed by step-down psychiatric care. CONCLUSIONS Extending the period of specialised early intervention is clinically desirable but may not be feasible in lower-income countries.
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Affiliation(s)
- Wing Chung Chang
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
| | - Gloria Hoi Kei Chan
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
| | - Olivia Tsz Ting Jim
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
| | - Emily Sin Kei Lau
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
| | - Christy Lai Ming Hui
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
| | - Sherry Kit Wa Chan
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
| | - Edwin Ho Ming Lee
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
| | - Eric Yu Hai Chen
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
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47
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Dlabac-de Lange JJ, Bais L, van Es FD, Visser BGJ, Reinink E, Bakker B, van den Heuvel ER, Aleman A, Knegtering H. Efficacy of bilateral repetitive transcranial magnetic stimulation for negative symptoms of schizophrenia: results of a multicenter double-blind randomized controlled trial. Psychol Med 2015; 45:1263-1275. [PMID: 25354751 DOI: 10.1017/s0033291714002360] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Few studies have investigated the efficacy of repetitive transcranial magnetic stimulation (rTMS) treatment for negative symptoms of schizophrenia, reporting inconsistent results. We aimed to investigate whether 10 Hz stimulation of the bilateral dorsolateral prefrontal cortex during 3 weeks enhances treatment effects. METHOD A multicenter double-blind randomized controlled trial was performed in 32 patients with schizophrenia or schizo-affective disorder, and moderate to severe negative symptoms [Positive and Negative Syndrome Scale (PANSS) negative subscale ⩾15]. Patients were randomized to a 3-week course of active or sham rTMS. Primary outcome was severity of negative symptoms as measured with the Scale for the Assessment of Negative Symptoms (SANS) and the PANSS negative symptom score. Secondary outcome measures included cognition, insight, quality of life and mood. Subjects were followed up at 4 weeks and at 3 months. For analysis of the data a mixed-effects linear model was used. RESULTS A significant improvement of the SANS in the active group compared with sham up to 3 months follow-up (p = 0.03) was found. The PANSS negative symptom scores did not show a significant change (p = 0.19). Of the cognitive tests, only one showed a significant improvement after rTMS as compared with sham. Finally, a significant change of insight was found with better scores in the treatment group. CONCLUSIONS Bilateral 10 Hz prefrontal rTMS reduced negative symptoms, as measured with the SANS. More studies are needed to investigate optimal parameters for rTMS, the cognitive effects and the neural basis.
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Affiliation(s)
- J J Dlabac-de Lange
- University of Groningen,University Medical Center Groningen,Department of Psychiatry,Hanzeplein 1,Groningen,The Netherlands
| | - L Bais
- University of Groningen,University Medical Center Groningen,Department of Neuroscience and BCN Neuroimaging Center,Antonius Deusinglaan 2,Groningen,The Netherlands
| | - F D van Es
- University of Groningen,University Medical Center Groningen,Department of Psychiatry,Hanzeplein 1,Groningen,The Netherlands
| | - B G J Visser
- University of Groningen,University Medical Center Groningen,Department of Psychiatry,Hanzeplein 1,Groningen,The Netherlands
| | - E Reinink
- Lentis Research,Center for Mental Health,Hereweg 80,Groningen,The Netherlands
| | - B Bakker
- Lentis Research,Center for Mental Health,Hereweg 80,Groningen,The Netherlands
| | - E R van den Heuvel
- University of Groningen,University Medical Center Groningen,Department of Epidemiology,Hanzeplein 1,Groningen,The Netherlands
| | - A Aleman
- University of Groningen,University Medical Center Groningen,Department of Neuroscience and BCN Neuroimaging Center,Antonius Deusinglaan 2,Groningen,The Netherlands
| | - H Knegtering
- University of Groningen,University Medical Center Groningen,Department of Psychiatry,Hanzeplein 1,Groningen,The Netherlands
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Abstract
The glutamate and dopamine hypotheses are leading theories of the pathoaetiology of schizophrenia. Both were initially based on indirect evidence from pharmacological studies supported by post-mortem findings, but have since been substantially advanced by new lines of evidence from in vivo imaging studies. This review provides an update on the latest findings on dopamine and glutamate abnormalities in schizophrenia, focusing on in vivo neuroimaging studies in patients and clinical high-risk groups, and considers their implications for understanding the biology and treatment of schizophrenia. These findings have refined both the dopamine and glutamate hypotheses, enabling greater anatomical and functional specificity, and have been complemented by preclinical evidence showing how the risk factors for schizophrenia impact on the dopamine and glutamate systems. The implications of this new evidence for understanding the development and treatment of schizophrenia are considered, and the gaps in current knowledge highlighted. Finally, the evidence for an integrated model of the interactions between the glutamate and dopamine systems is reviewed, and future directions discussed.
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Affiliation(s)
- Oliver Howes
- Psychiatric Imaging, MRC Clinical Sciences Centre, Hammersmith Hospital, London, UK Institute of Psychiatry, King's College London, London, UK
| | - Rob McCutcheon
- Psychiatric Imaging, MRC Clinical Sciences Centre, Hammersmith Hospital, London, UK Institute of Psychiatry, King's College London, London, UK
| | - James Stone
- Psychiatric Imaging, MRC Clinical Sciences Centre, Hammersmith Hospital, London, UK Institute of Psychiatry, King's College London, London, UK
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49
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Joseph B, Narayanaswamy JC, Venkatasubramanian G. Insight in schizophrenia: relationship to positive, negative and neurocognitive dimensions. Indian J Psychol Med 2015; 37:5-11. [PMID: 25722504 PMCID: PMC4341311 DOI: 10.4103/0253-7176.150797] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Impairment of insight is considered as the hallmark of schizophrenia. Substantial proportion of patients with schizophrenia has either poor or absent insight. Insight is a multidimensional and dynamic construct which appears to have intricate links with other symptom dimensions of the psychotic illness. A better appreciation of the association that insight shares with other symptom clusters in psychosis could help us in gaining knowledge about aetiology, prognosis and treatment-related facets of the disorder. This is likely to have critical implications in the understanding and therapeutics of schizophrenia.
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Affiliation(s)
- Boban Joseph
- Department of Psychiatric Social Work, Schizophrenia Clinic, Translational Psychiatry Laboratory, Bangalore, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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50
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Andrade C, Kisely S, Monteiro I, Rao S. Antipsychotic augmentation with modafinil or armodafinil for negative symptoms of schizophrenia: systematic review and meta-analysis of randomized controlled trials. J Psychiatr Res 2015; 60:14-21. [PMID: 25306261 DOI: 10.1016/j.jpsychires.2014.09.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/18/2014] [Accepted: 09/12/2014] [Indexed: 12/14/2022]
Abstract
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) of modafinil or armodafinil (ar/mod) augmentation in schizophrenia. We searched PubMed, clinical trial registries, reference lists, and other sources for parallel group, placebo-controlled RCTs. Our primary outcome variable was the effect of ar/mod on negative symptom outcomes. Eight RCTs (pooled N = 372; median duration, 8 weeks) met our selection criteria. Ar/mod (200 mg/day) significantly attenuated negative symptom ratings (6 RCTs; N = 322; standardized mean difference [SMD], -0.26; 95% CI, -0.48 to -0.04). This finding remained similar in all but one sensitivity analysis - when the only RCT in acutely ill patients was excluded, the outcome was no longer statistically significant (SMD, -0.17; 95% CI, -0.51 to 0.06). The absolute advantage for ar/mod was small: just 0.27 points on the PANSS-N (6 RCTs). Ar/mod attenuated total psychopathology ratings (7 RCTs; N = 342; SMD, -0.23; 95% CI, -0.45 to -0.02) but did not influence positive symptom ratings (5 RCTs; N = 302; mean difference, -0.58; 95% CI, -1.71 to 0.55). Although data were limited, cognition, fatigue, daytime drowsiness, adverse events, and drop out rates did not differ significantly between ar/mod and placebo groups. Fixed and random effects models yielded similar results. There was no heterogeneity in all but one analysis. Publication bias could not be tested. We conclude that ar/mod (200 mg/day) is safe and well tolerated in the short-term treatment of schizophrenia. Ar/mod reduces negative symptoms with a small effect size; the absolute advantage is also small, and the advantage disappears when chronically ill patients or those with high negative symptom burden are treated. Ar/mod does not benefit or worsen other symptom dimensions in schizophrenia.
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Affiliation(s)
- Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore 560 029, India.
| | - Steve Kisely
- School of Medicine, The University of Queensland, Level 4, Building 1, Princess Alexandra Hospital, Ipswich Road, Woolloongabba QLD 4102, Australia
| | - Ingrid Monteiro
- National Institute of Mental Health and Neurosciences, Bangalore 560 029, India
| | - Sanjay Rao
- Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS B3H 2E2, Canada
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