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Morera D, Miller BJ. Meta-analysis of a family history of diabetes in schizophrenia. Schizophr Res 2024; 264:90-94. [PMID: 38118263 DOI: 10.1016/j.schres.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 09/28/2023] [Accepted: 12/05/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVE Type 2 diabetes (T2DM) is common in patients with schizophrenia and non-affective psychosis. These patients also have an increased prevalence of a family history of T2DM. We performed a systematic review and meta-analysis of the association between a family history of T2DM and schizophrenia. METHOD We searched electronic databases from inception until July 2022 for studies of a family history of T2DM or gestational diabetes in patients with schizophrenia and controls. We performed random effects meta-analysis, calculating odds ratios (ORs) and 95 % confidence intervals (CI) and meta-regression analyses. RESULTS Nine studies were included, comprising 2953 patients with non-affective psychosis and 4484 controls. Schizophrenia was associated with an over two-fold increased odds of a family history of T2DM or gestational diabetes (OR = 2.18, 95 % CI 1.61-2.96, p < 0.01). In meta-regression analyses, age, sex, study quality score, and year of publication were all unrelated to the association. CONCLUSION We found that patients with schizophrenia had a 2.2-fold increased odds of a family history of T2DM versus controls. This association may be relevant to both the pathophysiology of schizophrenia and the reported increased risk of development of diabetes with antipsychotic treatment.
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Affiliation(s)
- Daley Morera
- Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Brian J Miller
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, United States.
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2
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Protsenko M, Kerkelä M, Miettunen J, Auvinen J, Järvelin MR, Jones PB, Gissler M, Veijola J. Insulin resistance and lipid levels in the middle-aged offspring of parents with severe mental illness. Schizophr Res 2023; 252:271-278. [PMID: 36696701 DOI: 10.1016/j.schres.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/28/2022] [Accepted: 01/07/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Type 2 diabetes and dyslipidemias co-occur frequently with severe mental illnesses (SMI). However, less is known about serum insulin and lipid levels and prevalence of Insulin Resistance (IR) in offspring with familial risk for SMI. METHOD The Northern Finland Birth Cohort 1966 consists of 12,068 mothers, 11,068 fathers, and 12,231 children from the two northernmost provinces in Finland. At age 46 they participated in clinical examination including measurements of glucose, lipids, and IR and answered a questionnaire including information about their nutrition and physical activity. The information on parental SMI was obtained from the Hospital Discharge Register. Parents with SMI were those who had been treated in hospital for any psychiatric disorder during 1969-1982 (ICD-8 codes 290-315). The final study group included 334 (7.3 %) offspring who had a parent with SMI and 4249 (92.7 %) offspring in the comparison group. RESULTS We did not find increased risk for disturbances in lipid levels, insulin levels, or IR levels between the study group (offspring of either parent with SMI) compared with the comparison group. All offspring, especially female offspring of either parent with SMI, had an increased risk for higher glucose levels and waist circumference. The results remained the same after excluding offspring with SMI. CONCLUSION Our findings suggest that offspring of parents with SMI, especially female offspring, have partly increased risk for disturbances in cardiometabolic risk factors. Disturbances in glucose metabolism may have an effect via familial risk of severe mental illness.
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Affiliation(s)
- Maria Protsenko
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Finland.
| | - Martta Kerkelä
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Finland
| | - Jouko Miettunen
- Research Unit of Population Health, University of Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Juha Auvinen
- Research Unit of Population Health, University of Oulu, Finland
| | | | - Peter B Jones
- Department of Psychiatry, University of Cambridge, UK
| | - Mika Gissler
- THL, Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland; University of Turku, Research Centre for Child Psychiatry, Turku, Finland; Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - Juha Veijola
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland; Department of Psychiatry, University Hospital of Oulu, Finland
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Davoren M, O'Reilly K, Mohan D, Kennedy HG. Prospective cohort study of the evaluation of patient benefit from the redevelopment of a complete national forensic mental health service: the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST) protocol. BMJ Open 2022; 12:e058581. [PMID: 35868830 PMCID: PMC9315909 DOI: 10.1136/bmjopen-2021-058581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Secure forensic mental health services are low volume, high cost services. They offer care and treatment to mentally disordered offenders who pose a high risk of serious violence to others. It is therefore incumbent on these services to systematically evaluate the outcomes of the care and treatment they deliver to ensure patient benefit in multiple domains. These should include physical and mental health outcomes, as well as offending related outcomes. The aim of Dundrum Forensic Redevelopment Evaluation Study (D-FOREST) is to complete a structured evaluation study of a complete national forensic mental health service, at the time of redevelopment of the National Forensic Mental Health Service for the Ireland. METHODS AND ANALYSIS D-FOREST is a multisite, prospective observational cohort study. The study uses a combination of baseline and repeated measures, to evaluate patient benefit from admissions to forensic settings. Patients will be rated for physical health, mental health, offending behaviours and other recovery measures relevant to the forensic hospital setting at admission to the hospital and 6 monthly thereafter.Lagged causal model analysis will be used to assess the existence and significance of potential directed relationships between the baseline measures of symptomatology of schizophrenia and violence risk and final outcome namely length of stay. Time intervals including length of stay will be measured by median and 95% CI using Kaplan-Meier and Cox regression analyses and survival analyses. Patient related measures will be rated as changes from baseline using general estimating equations for repeated measures, analysis of variance, analysis of covariance or logistic regression. ETHICS AND DISSEMINATION The study has received approval from the Research Ethics and Effectiveness Committee of the National Forensic Mental Health Service, Ireland. Results will be made available to the funder and to forensic psychiatry researchers via international conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05074732.
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Affiliation(s)
- Mary Davoren
- Dundrum Centre for Forensic Excellence, Trinity College Dublin School of Medicine, Dublin, Ireland
- Health Service Executive, National Forensic Mental Health Service, Dundrum, Ireland
| | - Ken O'Reilly
- Dundrum Centre for Forensic Excellence, Trinity College Dublin School of Medicine, Dublin, Ireland
- Health Service Executive, National Forensic Mental Health Service, Dundrum, Ireland
| | - Damian Mohan
- Dundrum Centre for Forensic Excellence, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Harry G Kennedy
- Dundrum Centre for Forensic Excellence, Trinity College Dublin School of Medicine, Dublin, Ireland
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Zhang L, Lizano P, Guo B, Xu Y, Rubin LH, Hill SK, Alliey-Rodriguez N, Lee AM, Wu B, Keedy SK, Tamminga CA, Pearlson GD, Clementz BA, Keshavan MS, Gershon ES, Sweeney JA, Bishop JR. Inflammation subtypes in psychosis and their relationships with genetic risk for psychiatric and cardiometabolic disorders. Brain Behav Immun Health 2022; 22:100459. [PMID: 35496776 PMCID: PMC9046804 DOI: 10.1016/j.bbih.2022.100459] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 03/31/2022] [Indexed: 02/07/2023] Open
Abstract
Cardiometabolic disorders have known inflammatory implications, and peripheral measures of inflammation and cardiometabolic disorders are common in persons with psychotic disorders. Inflammatory signatures are also related to neurobiological and behavioral changes in psychosis. Relationships between systemic inflammation and cardiometabolic genetic risk in persons with psychosis have not been examined. Thirteen peripheral inflammatory markers and genome-wide genotyping were assessed in 122 participants (n = 86 psychosis, n = 36 healthy controls) of European ancestry. Cluster analyses of inflammatory markers classified higher and lower inflammation subgroups. Single-trait genetic risk scores (GRS) were constructed for each participant using previously reported GWAS summary statistics for the following traits: schizophrenia, bipolar disorder, major depressive disorder, coronary artery disease, type-2 diabetes, low-density lipoprotein, high-density lipoprotein, triglycerides, and waist-to-hip ratio. Genetic correlations across traits were quantified. Principal component (PC) analysis of the cardiometabolic GRSs generated six PC loadings used in regression models to examine associations with inflammation markers. Functional module discovery explored biological mechanisms of the inflammation association of cardiometabolic GRS genes. A subgroup of 38% persons with psychotic disorders was characterized with higher inflammation status. These higher inflammation individuals had lower BACS scores (p = 0.038) compared to those with lower inflammation. The first PC of the cardiometabolic GRS matrix was related to higher inflammation status in persons with psychotic disorders (OR = 2.037, p = 0.001). Two of eight modules within the functional interaction network of cardiometabolic GRS genes were enriched for immune processes. Cardiometabolic genetic risk may predispose some individuals with psychosis to elevated inflammation which adversely impacts cognition associated with illness.
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Affiliation(s)
- Lusi Zhang
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Bin Guo
- Division of Biostatistics, School of Public Health, University of Minnesota, MN, USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA
| | - Leah H. Rubin
- Department of Neurology, Psychiatry, and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - S. Kristian Hill
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Ney Alliey-Rodriguez
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Adam M. Lee
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Baolin Wu
- Division of Biostatistics, School of Public Health, University of Minnesota, MN, USA
| | - Sarah K. Keedy
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Carol A. Tamminga
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Godfrey D. Pearlson
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Department of Neurobiology, School of Medicine, Yale University, New Haven, CT, USA
| | - Brett A. Clementz
- Department of Psychology and Neuroscience, University of Georgia, Athens, GA, USA
| | - Matcheri S. Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Elliot S. Gershon
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - John A. Sweeney
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Jeffrey R. Bishop
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
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5
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Metabolic polygenic risk scores effect on antipsychotic-induced metabolic dysregulation: A longitudinal study in a first episode psychosis cohort. Schizophr Res 2022; 244:101-110. [PMID: 35659654 DOI: 10.1016/j.schres.2022.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 03/18/2022] [Accepted: 05/21/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Metabolic syndrome is a health-threatening condition suffered by approximately one third of schizophrenia patients and largely attributed to antipsychotic medication. Previous evidence reports a common genetic background of psychotic and metabolic disorders. In this study, we aimed to assess the role of polygenic risk scores (PRSs) on the progression of the metabolic profile in a first-episode psychosis (FEP) cohort. METHOD Of the 231 FEP individuals included in the study, 192-220 participants were included in basal analysis and 118-179 in longitudinal 6-month models. Eleven psychopathologic and metabolic PRSs were constructed. Basal and longitudinal PRSs association with metabolic measurements was assessed by statistical analyses. RESULTS No major association of psychopathological PRSs with the metabolic progression was found. However, high risk individuals for depression and cholesterol-related PRSs reported a higher increase of cholesterol levels during the follow-up (FDR ≤ 0.023 for all analyses). Their effect was comparable to other well-established pharmacological and environmental risk factors (explaining at least 1.2% of total variance). CONCLUSION Our findings provide new evidence of the effects of metabolic genetic risk on the development of metabolic dysregulation. The future establishment of genetic profiling tools in clinical procedures could enable practitioners to better personalize antipsychotic treatment selection and dosage.
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Schizophrenia Outside the Brain. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1400:53-63. [DOI: 10.1007/978-3-030-97182-3_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Winterton A, Bettella F, de Lange AMG, Haram M, Steen NE, Westlye LT, Andreassen OA, Quintana DS. Oxytocin-pathway polygenic scores for severe mental disorders and metabolic phenotypes in the UK Biobank. Transl Psychiatry 2021; 11:599. [PMID: 34824196 PMCID: PMC8616952 DOI: 10.1038/s41398-021-01725-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/26/2021] [Accepted: 10/19/2021] [Indexed: 02/07/2023] Open
Abstract
Oxytocin is a neuromodulator and hormone that is typically associated with social cognition and behavior. In light of its purported effects on social cognition and behavior, research has investigated its potential as a treatment for psychiatric illnesses characterized by social dysfunction, such as schizophrenia and bipolar disorder. While the results of these trials have been mixed, more recent evidence suggests that the oxytocin system is also linked with cardiometabolic conditions for which individuals with severe mental disorders are at a higher risk for developing. To investigate whether the oxytocin system has a pleiotropic effect on the etiology of severe mental illness and cardiometabolic conditions, we explored oxytocin's role in the shared genetic liability of schizophrenia, bipolar disorder, type-2 diabetes, and several phenotypes linked with cardiovascular disease and type 2 diabetes risk using a polygenic pathway-specific approach. Analysis of a large sample with about 480,000 individuals (UK Biobank) revealed statistically significant associations across the range of phenotypes analyzed. By comparing these effects to those of polygenic scores calculated from 100 random gene sets, we also demonstrated the specificity of many of these significant results. Altogether, our results suggest that the shared effect of oxytocin-system dysfunction could help partially explain the co-occurrence of social and cardiometabolic dysfunction in severe mental illnesses.
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Affiliation(s)
- Adriano Winterton
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Francesco Bettella
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ann-Marie G de Lange
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Marit Haram
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Nils Eiel Steen
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Lars T Westlye
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Daniel S Quintana
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway.
- Department of Psychology, University of Oslo, Oslo, Norway.
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway.
- NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway.
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8
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Arnaiz JA, Rodrigues-Silva C, Mezquida G, Amoretti S, Cuesta MJ, Fraguas D, Lobo A, González-Pinto A, Díaz-Caneja MC, Corripio I, Vieta E, Baeza I, Mané A, García-Rizo C, Bioque M, Saiz J, Bernardo M, Mas S. The usefulness of Olanzapine plasma concentrations in monitoring treatment efficacy and metabolic disturbances in first-episode psychosis. Psychopharmacology (Berl) 2021; 238:665-676. [PMID: 33230696 DOI: 10.1007/s00213-020-05715-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The role of Olanzapine therapeutic drug monitoring is controversial. The present study explores the associations of Olanzapine plasma concentrations with clinical response and metabolic side effects in first episode psychosis (FEP) after 2 months of treatment. METHODS Forty-seven patients were included. Improvement in clinical symptomatology was assessed using the PANSS. Metabolic assessment included weight, blood pressure, waist circumference, blood glucose, total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides. RESULTS The Olanzapine plasma concentrations after 2 months of treatment were positively correlated with weight gain (r = 0.49, p = 0.003), and a concentration > 23.28 ng/mL was identified as a positive predictor of weight gain (≥ 7%). The Olanzapine concentration to dose (C/D) ratio was positively correlated with the percentage of improvement in the total PANSS (r = 0.46, p = 0.004), and a C/D ratio > 2.12 was identified as a positive predictor of a good response (percentage of improvement > 30%) after 2 months of treatment. We also identified several factors that could alter Olanzapine pharmacokinetics: gender (p = 0.03), diagnosis (p = 0.05), smoking habit (p = 0.05), and co-medications such as valproic acid (p = 0.05) and anxiolytics (p = 0.01). DISCUSSION In conclusion, our results suggest that therapeutic drug monitoring of Olanzapine could be helpful to evaluate therapeutic efficacy and metabolic dysfunction in FEP patients treated with Olanzapine.
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Affiliation(s)
- J A Arnaiz
- Phase I Unit, Clinical Pharmacology Department, Hospital Clinic de Barcelona (HCB), Barcelona, Spain.,Department of Basic Clinical Practice, University of Barcelona (UB), Casanova 143, E-08036, Barcelona, Spain
| | - C Rodrigues-Silva
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Goiás, Goiânia, GO, Brazil
| | - G Mezquida
- Department of Basic Clinical Practice, University of Barcelona (UB), Casanova 143, E-08036, Barcelona, Spain.,Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, HCB, Barcelona, Catalunya, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
| | - S Amoretti
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, HCB, Barcelona, Catalunya, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
| | - M J Cuesta
- Departmentof Psychiatry, Complejo Hospitalario de Navarra, Instituto de Investigaciones Sanitarias de Navarra (IdiSNa), Pamplona, Spain
| | - D Fraguas
- Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos, IdISSC, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Medicine and Psychiatry, Zaragoza University, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - A González-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Hospital Universitario Araba, Servicio de Psiquiatria, UPV/EHU, Bioaraba, Spain
| | - M C Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañon, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - I Corripio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - E Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - I Baeza
- Department of Child and Adolescent Psychiatry and Psychology, Clínic Institute of Neurosciences, Hospital Clínic de Barcelona, 2017SGR881, University of Barcelona, CIBERSAM, IDIBAPS, Barcelona, Spain
| | - A Mané
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Autonomous university of Barcelona (UAB), Barcelona, Spain
| | - C García-Rizo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain.,Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, Barcelona, Spain.,Department of Medicine, Barcelona, UB, Spain
| | - M Bioque
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain.,Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, Barcelona, Spain.,Department of Medicine, Barcelona, UB, Spain
| | - J Saiz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - M Bernardo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain.,Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, Barcelona, Spain.,Department of Medicine, Barcelona, UB, Spain
| | - S Mas
- Department of Basic Clinical Practice, University of Barcelona (UB), Casanova 143, E-08036, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. .,Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain.
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Misiak B, Wiśniewski M, Lis M, Samochowiec J, Stańczykiewicz B. Glucose homeostasis in unaffected first-degree relatives of schizophrenia patients: A systematic review and meta-analysis. Schizophr Res 2020; 223:2-8. [PMID: 32739343 DOI: 10.1016/j.schres.2020.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/28/2020] [Accepted: 07/19/2020] [Indexed: 12/15/2022]
Abstract
It has been proposed that type 2 diabetes and schizophrenia-spectrum disorders share overlapping genetic backgrounds. Therefore, we aimed to perform a systematic review and meta-analysis of studies comparing fasting levels of glucose and insulin, the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), glucose levels during the oral glucose tolerance test (OGTT) and the levels of glycated hemoglobin (HbA1c) in unaffected first-degree relatives of patients with schizophrenia and controls. Online searches covered the publication period from database inception until May 8th 2020. Meta-analyses were performed using random-effects models with Hedges' g as the effect size estimate. Out of 2556 records identified, 12 studies representing 672 relatives of schizophrenia patients and 6446 controls were found to be eligible. There were no significant differences in fasting levels of glucose (g = 0.54, 95%CI = -0.26 to 1.35, p = 0.188) and insulin (g = 0.07, 95%CI = -0.14 to 0.29, p = 0.491), HOMA-IR (g = 0.12, 95%CI = -0.19 to 0.43, p = 0.433), and the levels of HbA1c (g = 0.38, 95%CI = -0.02 to 0.77, p = 0.061) between relatives of schizophrenia patients and controls. Two studies demonstrated significantly higher 2-hour glucose levels during OGTT in relatives of patients with schizophrenia (g = 0.90, 95%CI = 0.49 to 1.31, p < 0.001). Our findings do not support the hypothesis that familial liability to psychosis is related to altered fasting parameters of glucose homeostasis. However, this population might show impaired glucose tolerance. More studies are needed to confirm these observations.
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Affiliation(s)
- Błażej Misiak
- Department of Genetics, Wroclaw Medical University, Marcinkowskiego 1 Street, 50-368 Wroclaw, Poland.
| | - Michał Wiśniewski
- First Department of Psychiatry, Institute of Psychiatry & Neurology, Sobieskiego 9 Street, 02-957 Warsaw, Poland
| | - Michał Lis
- Clinical Department of Internal Diseases, Endocrinology and Diabetology, The Central Clinical Hospital of the Ministry of the Interior in Warsaw, Wołoska 137 Street, 02-507 Warsaw, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-460 Szczecin, Poland
| | - Bartłomiej Stańczykiewicz
- Department of Nervous System Diseases, Wroclaw Medical University, Bartla 5 Street, 51-618 Wroclaw, Poland
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10
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Ertekin H, Uysal S, Aydın M, İlhan B, Ertekin YH. Correlation between vaspin and PANSS scores in schizophrenia patients with obesity. Int J Psychiatry Med 2020; 55:264-280. [PMID: 32050814 DOI: 10.1177/0091217420905463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Metabolic abnormalities such as diabetes, dyslipidemia, abdominal obesity, metabolic syndrome, and abnormal levels of plasma adipokines have been observed in patients with schizophrenia. This study aimed to investigate the differences and correlations of plasma vaspin levels with metabolic parameters in patients with schizophrenia and to compare with healthy controls. METHOD We measured plasma levels of vaspin and metabolic parameters of 100 patients with schizophrenia and 95 healthy controls. Patients with schizophrenia were evaluated with the Positive and Negative Syndrome Scale (PANSS) and The Global Assessment of Functioning. RESULTS Mean levels of body mass index, waist circumference, triglyceride, and low-density lipoprotein cholesterol of the patients were statistically higher than those of the healthy controls (p = 0.002, p < 0.001, p = 0.03, and p = 0.002, respectively). Plasma levels of vaspin were 0.96 ± 0.73 ng/ml in patients with schizophrenia and 0.29 ± 0.15 ng/ml in the healthy controls (p < 0.001). Plasma vaspin levels were statistically higher in patients with schizophrenia than healthy controls both in groups with and without metabolic syndrome and obesity (p < 0.001). Plasma vaspin levels showed a positive correlation with triglyceride in patients with schizophrenia (r = 0.26, p = 0.007). There were positive correlations between vaspin and PANSS scores in schizophrenia patients with obesity (PANSS Positive: r = 0.42, p = 0.01; PANSS Negative: r = 0.42, p = 0.01; PANSS General: r = 0.43, p = 0.01; PANSS Total: r = 0.47, p = 0.006). CONCLUSIONS Our study showed a significant relationship and positive correlation between vaspin and PANSS scores in schizophrenia patients with obesity. Vaspin may play an important role in the metabolic processes of patients with schizophrenia.
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Affiliation(s)
- Hülya Ertekin
- Department of Psychiatry, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Sema Uysal
- Department of Biochemistry, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Memduha Aydın
- Department of Psychiatry, Selcuk University, Konya, Turkey
| | - Bilge İlhan
- Department of Psychiatry, Health Sciences University, Konya, Turkey
| | - Yusuf Haydar Ertekin
- Department of Family Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
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11
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Tosato S, Bonetto C, Tomassi S, Zanardini R, Faravelli C, Bruschi C, D'Agostino A, Minelli A, Scocco P, Lasalvia A, Furlato K, Imbesi M, Preti A, Ruggeri M, Gennarelli M, Bocchio-Chiavetto L. Childhood trauma and glucose metabolism in patients with first-episode psychosis. Psychoneuroendocrinology 2020; 113:104536. [PMID: 31864124 DOI: 10.1016/j.psyneuen.2019.104536] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/29/2019] [Accepted: 11/29/2019] [Indexed: 01/23/2023]
Abstract
Although the associations between first-episode psychosis (FEP) and metabolic abnormalities on one side, and childhood trauma (CT) and risk of developing psychosis on the other are both well established, evidence on the relationship between CT and metabolic dysregulation in terms of abnormal glucose metabolism is very limited. We tested whether, already at illness onset, FEP patients with a history of CT show dysregulation of a broad range of glucose metabolism markers. In particular, in 148 FEP patients we evaluated serum concentrations of c-peptide, insulin, plasminogen-activator-inhibitor-1 (PAI-1), resistin, visfatin, glucagon, glucagon-like peptide-1 (GLP-1), gastric-inhibitor-peptide (GIP), leptin, and ghrelin. We also assessed CT with the Childhood Experience of Care and Abuse Questionnaire, and stressful life events (SLEs) with a semi-structured interview. Psychopathology, cannabis and tobacco habits, Body Mass Index (BMI) were recorded. Serum concentrations of markers were analyzed from peripheral blood. Ninety-five patients (56 % males, mean age 29.5) reported CT. Multivariate models showed that CT is associated only with the concentrations of c-peptide and insulin after adjusting for age, sex, BMI and SLEs. FEP patients who had experienced CT showed higher c-peptide and insulin serum concentrations. Our study reports that CT might be associated with the metabolic abnormalities in the first stage of psychosis, suggesting that a thorough anamnestic evaluation at psychosis onset that would include the history of CT could be helpful for clinicians in order to implement early programmes of healthy lifestyle education and to guide choice of therapeutic interventions for trauma.
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Affiliation(s)
- Sarah Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
| | - Chiara Bonetto
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simona Tomassi
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberta Zanardini
- IRCCS Istituto Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy
| | - Carlo Faravelli
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Alessandra Minelli
- IRCCS Istituto Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy; Department of Molecular and Translational Medicine, Division of Biology and Genetics, University of Brescia, Brescia, Italy
| | - Paolo Scocco
- Department of Mental Health, Azienda ULSS 6 Euganea, Padua, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Karin Furlato
- Department of Mental Health, Azienda USL Bolzano, Italy
| | | | - Antonio Preti
- Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Massimo Gennarelli
- IRCCS Istituto Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy; Department of Molecular and Translational Medicine, Division of Biology and Genetics, University of Brescia, Brescia, Italy
| | | | - Luisella Bocchio-Chiavetto
- IRCCS Istituto Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy; Faculty of Psychology, eCampus University, Novedrate (Como), Italy
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12
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Chung J, Miller BJ. Meta-analysis of comorbid diabetes and family history of diabetes in non-affective psychosis. Schizophr Res 2020; 216:41-47. [PMID: 31806529 DOI: 10.1016/j.schres.2019.10.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Schizophrenia and other non-affective psychoses (NAP) are associated with an increased prevalence of both type 2 diabetes (DM2) as well as a family history of DM2. We performed a systematic review and meta-analysis of the association between comorbid DM2 and a family history of DM2 in patients with NAP. METHOD We searched major electronic databases from inception until August 2018 for studies of comorbid DM2 in patients with non-affective psychosis and family history of DM2 status. Random effects meta-analysis calculating odds ratios (ORs) and 95% confidence intervals (CI) and meta-regression analyses were performed. RESULTS Ten studies met the inclusion criteria. Across these studies, there were 804 patients with non-affective psychosis and comorbid DM2, and 2976 patients with non-affective psychosis without this comorbidity. A family history of DM2 was associated with an over four-fold increased odds of comorbid DM2 in patients with NAP (OR = 4.3, 95% CI 2.9-6.4, p<0.001). In; meta-regression analyses older age, but not sex, BMI, geographic region, study quality, or year; of publication moderated the association between comorbid DM2 and family history of DM2. CONCLUSION We found that a family history of DM2 was associated with an over four-fold increased odds of comorbid DM2 in patients with NAP. This association may be due to shared environmental or genetic risk factors, or gene-environment interactions. Given the increased risk of incident diabetes with antipsychotic treatment, screening for a family history of DM2 is germane to the clinical care of patients with NAP.
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Affiliation(s)
- Jim Chung
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, United States
| | - Brian J Miller
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, United States.
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13
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Kucukgoncu S, Kosir U, Zhou E, Sullivan E, Srihari VH, Tek C. Glucose metabolism dysregulation at the onset of mental illness is not limited to first episode psychosis: A systematic review and meta-analysis. Early Interv Psychiatry 2019; 13:1021-1031. [PMID: 30277314 PMCID: PMC6445792 DOI: 10.1111/eip.12749] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 05/16/2018] [Accepted: 09/09/2018] [Indexed: 12/15/2022]
Abstract
AIM To compare the differences of glucose metabolism outcomes between treatment-naïve, patients with first episode psychosis (FEP) and mood disorders. METHODS We conducted a systematic review and meta-analysis of glucose intolerance in treatment-naïve, first episode patients with severe mental illnesses (SMIs). RESULTS We identified 31 eligible studies. Compared to healthy controls, FEP group have higher insulin and insulin resistance levels, and both groups have higher glucose tolerance test results. No significant differences were found in glucose metabolism outcomes between FEP and mood disorder groups. CONCLUSIONS Our results highlight impaired glucose metabolism at the onset of SMIs, suggesting both patients with psychosis and mood disorders are high-risk groups for diabetes development.
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Affiliation(s)
- Suat Kucukgoncu
- Yale University Department of Psychiatry, Connecticut Mental Health Hospital, New Haven, Connecticut
| | - Urska Kosir
- Yale University Department of Psychiatry, Connecticut Mental Health Hospital, New Haven, Connecticut
| | - Elton Zhou
- Yale University Department of Psychiatry, Connecticut Mental Health Hospital, New Haven, Connecticut
| | - Erin Sullivan
- Yale University Department of Psychiatry, Connecticut Mental Health Hospital, New Haven, Connecticut
| | - Vinod H Srihari
- Yale University Department of Psychiatry, Connecticut Mental Health Hospital, New Haven, Connecticut
| | - Cenk Tek
- Yale University Department of Psychiatry, Connecticut Mental Health Hospital, New Haven, Connecticut
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14
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Abstract
BACKGROUND Research suggests an association between metabolic disorders, such as type 2 diabetes mellitus (T2DM), and schizophrenia. However, the risk of metabolic disorders in the unaffected siblings of patients with schizophrenia remains unclear. METHODS Using the Taiwan National Health Insurance Research Database, 3135 unaffected siblings of schizophrenia probands and 12,540 age-/sex-matched control subjects were included and followed up to the end of 2011. Individuals who developed metabolic disorders during the follow-up period were identified. RESULTS The unaffected siblings of schizophrenia probands had a higher prevalence of T2DM (3.4% vs. 2.6%, p = 0.010) than the controls. Logistic regression analyses with the adjustment of demographic data revealed that the unaffected siblings of patients with schizophrenia were more likely to develop T2DM (odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.10-1.75) later in life compared with the control group. Moreover, only female siblings of schizophrenia probands had an increased risk of hypertension (OR: 1.47, 95% CI: 1.07-2.01) during the follow-up compared with the controls.DiscussionThe unaffected siblings, especially sisters, of schizophrenia probands had a higher prevalence of T2DM and hypertension compared with the controls. Our study revealed a familial link between schizophrenia and T2DM in a large sample. Additional studies are required to investigate the shared pathophysiology of schizophrenia and T2DM.
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15
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Tsao WY, Hsu JW, Huang KL, Bai YM, Su TP, Li CT, Tsai SJ, Lin WC, Chen TJ, Pan TL, Chen MH. Risk of cardiometabolic diseases among siblings of patients with bipolar disorder. J Affect Disord 2019; 253:171-175. [PMID: 31035218 DOI: 10.1016/j.jad.2019.04.094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/16/2019] [Accepted: 04/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cardiometabolic diseases are suggested to be associated with bipolar disorder. However, the risk of metabolic disorders in unaffected siblings of patients with bipolar disorder remains unclear. METHODS From the Taiwan National Health Insurance Research Database, 7,225 unaffected siblings of bipolar probands and 28,900 age-/sex-/income-/residence-matched control individuals were included and followed until the end of 2011. Individuals who developed metabolic disorders during the follow-up period were identified. RESULTS The unaffected siblings of bipolar probands had a higher prevalence of dyslipidemia (5.4% vs. 4.5%, p = 0.001), younger age at diagnosis of type 2 diabetes mellitus (34.81 vs. 37.22, p = 0.024), and higher prevalence of any stroke (1.5% vs. 1.1%, p = 0.007) than the controls. Moreover, only male siblings of bipolar probands had an increased risk of dyslipidemia (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.10-1.48) and higher rates of any stroke (OR: 1.38, 95% CI: 1.02-1.85) and ischemic stroke (OR: 2.43, 95% CI: 1.60-3.70) during the follow-up compared with the controls. DISCUSSION Unaffected siblings of bipolar patients, particularly brothers, had a higher prevalence of dyslipidemia and ischemic stroke compared with the controls. The result suggests the familial association between cardiometabolic diseases and bipolar disorder. Further research may be necessary to identify this shared etiology between the disorders.
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Affiliation(s)
- Wen-Yen Tsao
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Chen Lin
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Tai-Long Pan
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan; Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
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16
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Cadenhead KS, Minichino A, Kelsven S, Addington J, Bearden C, Cannon TD, Cornblatt BA, Mathalon D, McGlashan TH, Perkins DO, Seidman LJ, Tsuang M, Walker EF, Woods SW, Yao J. Metabolic abnormalities and low dietary Omega 3 are associated with symptom severity and worse functioning prior to the onset of psychosis: Findings from the North American Prodrome Longitudinal Studies Consortium. Schizophr Res 2019; 204:96-103. [PMID: 30249470 PMCID: PMC6402991 DOI: 10.1016/j.schres.2018.09.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/16/2018] [Accepted: 09/17/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Patients with schizophrenia have a high prevalence of metabolic disorders and cardiovascular mortality. It is possible that a vulnerability to metabolic abnormalities is associated with risk for psychosis, symptoms and functionality. In this study, we evaluate demographic information, cardiometabolic indices, symptoms and functioning in an antipsychotic free cohort at Clinical High Risk (CHR) for psychosis from the NAPLS Omega 3 fatty acid clinical trial. METHOD Subjects received physical exams and metabolic monitoring prior to randomization into the Omega 3 versus Placebo trial. Anthropometrical measures, vital signs, glucose, and lipids were assessed along with symptoms, functioning, dietary Omega 3 fatty acids, erythrocyte polyunsaturated fatty acid content and a measure of lipid peroxidation (TBARS, Thiobarbituric acid-reactive substances). RESULTS The sample included 113 CHR subjects (42.1% female; 17.5% Latino) ages 12-29. The mean BMI was 24.3 with a trend toward higher BMI and a higher incidence of metabolic syndrome in Latino subjects; 36% of the sample was obese/overweight; 37.6% met criteria for prehypertension/hypertension; 4.2% met criteria for prediabetes/diabetes; 9.6% showed evidence of insulin resistance and 44.7% had dyslipidemia. The TBARS was elevated at 9.8 μM ± 6.1 (normal 1.86-3.94 μM). Metabolic parameters and a diet low in Omega 3 rich foods were significantly associated with prodromal symptoms and poor functioning. CONCLUSIONS CHR subjects show a high percentage of metabolic abnormalities prior to exposure to antipsychotic medication. These findings reinforce that early detection of metabolic disturbances and food insecurity is crucial since these factors are modifiable with the potential for significant gains in terms of quality of life, physical and mental health.
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Affiliation(s)
| | | | - Skylar Kelsven
- University of California San Diego, La Jolla, CA,San Diego State University/University of California-San Diego Joint Doctoral Program in Clinical
Psychology
| | - Jean Addington
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Barbara A. Cornblatt
- The Zucker Hillside Hospital, New York, NY; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York;
The Feinstein Institute for Medical Research, Manhasset, New York
| | - Dan Mathalon
- University of California San Francisco, San Francisco, CA
| | | | | | | | - Ming Tsuang
- University of California San Diego, La Jolla, CA
| | | | | | - Jeff Yao
- VA Pittsburgh Healthcare System and University of Pittsburg School of Medicine, Pittsburgh, PA
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17
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Tumiel E, Wichniak A, Jarema M, Lew-Starowicz M. Nonpharmacological Interventions for the Treatment of Cardiometabolic Risk Factors in People With Schizophrenia-A Systematic Review. Front Psychiatry 2019; 10:566. [PMID: 31481903 PMCID: PMC6709656 DOI: 10.3389/fpsyt.2019.00566] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/19/2019] [Indexed: 01/05/2023] Open
Abstract
Background: People suffering from schizophrenia are notably vulnerable to cardiometabolic risk factors (CMRF), such as obesity, high blood pressure, hyperglycemia and insulin resistance, high serum triglycerides, and low serum high-density lipoprotein (HDL), which are related to increased mortality and decreased quality of life. The increased risk of "metabolic syndrome" (MS) is related to low physical activity, an unhealthy diet, and side effects of antipsychotic drugs. Nonpharmacological interventions seem to be important in the prevention and therapy of MS. Aim: This paper provides an overview of published studies and a critical analysis of pilot programs involving nonpharmacological measures aimed at prevention and treatment of CMRF in patients with schizophrenia. Material and Method: We searched the PubMed, PsycARTICLES, and Cochrane Library databases to identify clinical trials. We included full-text studies that met the following criteria: age > 18 years, a diagnosis of schizophrenia or schizoaffective disorder, and monitored parameters associated with MS. Results: All 1,555 references were evaluated for inclusion in the review, and 20 met the inclusion criteria. Nonpharmacological interventions led to improvement in physical health and showed a promising potential for implementation in treatment programs dedicated to this particular group of patients. However, a critical analysis revealed limitations, which have implications for the direction of future research. Conclusions: Patients suffering from schizophrenia can benefit from nonpharmacological interventions aimed at counteracting CMRF, improving either metabolic parameters, cardiovascular fitness, or their health perception. Notwithstanding, to achieve long-term effects, future studies should comprise appropriate follow-up procedures.
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Affiliation(s)
- Ewa Tumiel
- III Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Adam Wichniak
- III Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Marek Jarema
- III Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Michał Lew-Starowicz
- III Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland.,Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw, Poland
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18
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Accelerated aging in schizophrenia and related disorders: Future research. Schizophr Res 2018; 196:4-8. [PMID: 28689755 DOI: 10.1016/j.schres.2017.06.034] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 01/17/2023]
Abstract
Several lines of evidence suggest schizophrenia is a segmental progeria, that is, some but not all aspects of accelerated aging may be present. However, the evidence has not been consistent. Problems with matching and confounding may account for some of these discrepancies. Given the etiopathophysiological heterogeneity of schizophrenia, it is possible that only a specific pathophysiological group within schizophrenia is associated with progeroid features, while others are not, or that one group is associated with a particular segment of aging features, while other progeroid features are found in another pathophysiological subgroup. In the aging research field, significant progress has been made in identifying the molecular pathways that confer aging: epigenetic changes, inflammation, proteostasis, adult stem cell function, metabolic changes, and adaptation to stress, and macromolecular damage. In addition to replication and clarification of existing kinds of evidence, examining these aging pathways would improve our understanding of progeria in schizophrenia.
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19
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Duarte JMN, Xin L. Magnetic Resonance Spectroscopy in Schizophrenia: Evidence for Glutamatergic Dysfunction and Impaired Energy Metabolism. Neurochem Res 2018; 44:102-116. [PMID: 29616444 PMCID: PMC6345729 DOI: 10.1007/s11064-018-2521-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 01/03/2023]
Abstract
In the past couple of decades, major efforts were made to increase reliability of metabolic assessments by magnetic resonance methods. Magnetic resonance spectroscopy (MRS) has been valuable for providing in vivo evidence and investigating biomarkers in neuropsychiatric disorders, namely schizophrenia. Alterations of glutamate and glutamine levels in brains of schizophrenia patients relative to healthy subjects are generally interpreted as markers of glutamatergic dysfunction. However, only a small fraction of MRS-detectable glutamate is involved in neurotransmission. Here we review and discuss brain metabolic processes that involve glutamate and that are likely to be implicated in neuropsychiatric disorders.
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Affiliation(s)
- João M N Duarte
- Department of Experimental Medical Science, Faculty of Medicine, Lund University, BMC C11, Sölvegatan 19, 221 84, Lund, Sweden. .,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.
| | - Lijing Xin
- Animal Imaging and Technology Core (AIT), Center for Biomedical Imaging (CIBM), Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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20
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Atbasoglu EC, Gumus-Akay G, Guloksuz S, Saka MC, Ucok A, Alptekin K, Gullu S, van Os J. Higher schizotypy predicts better metabolic profile in unaffected siblings of patients with schizophrenia. Psychopharmacology (Berl) 2018; 235:1029-1039. [PMID: 29306964 DOI: 10.1007/s00213-017-4818-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/20/2017] [Indexed: 12/19/2022]
Abstract
RATIONALE Type 2 diabetes (T2D) is more frequent in schizophrenia (Sz) than in the general population. This association is partly accounted for by shared susceptibility genetic variants. OBJECTIVE We tested the hypotheses that a genetic predisposition to Sz would be associated with higher likelihood of insulin resistance (IR), and that IR would be predicted by subthreshold psychosis phenotypes. METHODS Unaffected siblings of Sz patients (n = 101) were compared with a nonclinical sample (n = 305) in terms of IR, schizotypy (SzTy), and a behavioural experiment of "jumping to conclusions". The measures, respectively, were the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Structured Interview for Schizotypy-Revised (SIS-R), and the Beads Task (BT). The likelihood of IR was examined in multiple regression models that included sociodemographic, metabolic, and cognitive parameters alongside group status, SIS-R scores, and BT performance. RESULTS Insulin resistance was less frequent in siblings (31.7%) compared to controls (43.3%) (p < 0.05), and negatively associated with SzTy, as compared among the tertile groups for the latter (p < 0.001). The regression model that examined all relevant parameters included the tSzTy tertiles, TG and HDL-C levels, and BMI, as significant predictors of IR. Lack of IR was predicted by the highest as compared to the lowest SzTy tertile [OR (95%CI): 0.43 (0.21-0.85), p = 0.015]. CONCLUSION Higher dopaminergic activity may contribute to both schizotypal features and a favourable metabolic profile in the same individual. This is compatible with dopamine's regulatory role in glucose metabolism via indirect central actions and a direct action on pancreatic insulin secretion. The relationship between dopaminergic activity and metabolic profile in Sz must be examined in longitudinal studies with younger unaffected siblings.
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Affiliation(s)
- E Cem Atbasoglu
- Faculty of Medicine, Department of Psychiatry, Ankara University, Ankara, Turkey.
| | | | - Sinan Guloksuz
- Maastricht University Medical Centre, Maastricht, Netherlands
| | - Meram Can Saka
- Faculty of Medicine, Department of Psychiatry, Ankara University, Ankara, Turkey
| | - Alp Ucok
- Istanbul Faculty of Medicine, Department of Psychiatry, Istanbul University, Istanbul, Turkey
| | - Koksal Alptekin
- Faculty of Medicine, Department of Psychiatry, Dokuz Eylul University, İzmir, Turkey
| | - Sevim Gullu
- Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Ankara University, Ankara, Turkey
| | - Jim van Os
- Maastricht University Medical Centre, Maastricht, Netherlands.,Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, Netherlands.,King's College London, Department of Psychosis Studies, Institute of Psychiatry, London, UK
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21
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Comorbidity of chronic somatic diseases in patients with psychotic disorders and their influence on 4-year outcomes of integrated care treatment (ACCESS II study). Schizophr Res 2018; 193:377-383. [PMID: 28778554 DOI: 10.1016/j.schres.2017.07.036] [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] [Received: 01/12/2017] [Revised: 07/10/2017] [Accepted: 07/15/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND People with psychotic disorders fulfilling criteria of a severe and persistent mental illness (SPMI) display a high risk of somatic comorbidity (SC). METHODS ACCESS II is a prospective, long-term study examining the effectiveness of Integrated Care for people with psychotic disorders fulfilling SPMI criteria. Chronic comorbid somatic disorders were systematically assessed according to ICD-10-GM criteria. Patients treated for ≥4years in ACCESS were categorized as early psychosis (treatment: ≤2years) or non-early psychosis (treatment: >2years) patients. RESULTS Of 187 patients treated in ACCESS for ≥4years (mean age=41.8years, males=44.4%), 145 (77.5%) had SC, (mean=2.1±2.1). Overall, 55 different diseases from 15 different ICD-10-GM disease areas were identified. Prevalence of ≥1 SC (p=0.09) and specific types of SC (p=0.08-1.00) did not differ between early and non-early psychosis patients, but non-early psychosis patients had a higher mean number of SC (2.3±2.2 vs. 1.3±1.3, p=0.002). SC patients had higher rates of comorbid mental disorders (93% vs. 81%, p=0.002), specifically posttraumatic stress disorder (23% vs. 7%, p=0.002), and suicide attempts (43% vs. 19%, p<0.001). At the 4-year endpoint, both patients with and without comorbidity displayed major improvements in psychopathology, severity of illness, functioning, quality of life and satisfaction with care. CONCLUSIONS SC is frequent in patients with severe psychotic disorders, even in the early psychosis phase. The magnitude of the problem underlines the need for regular screening, comprehensive assessment, preventive pharmacotherapy, and targeted SC management.
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22
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Ho CSH, Zhang MWB, Mak A, Ho RCM. Metabolic syndrome in psychiatry: advances in understanding and management. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.113.011619] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
SummaryMetabolic syndrome comprises a number of cardiovascular risk factors that increase morbidity and mortality. The increase in incidence of the syndrome among psychiatric patients has been unanimously demonstrated in recent studies and it has become one of the greatest challenges in psychiatric practice. Besides the use of psychotropic drugs, factors such as genetic polymorphisms, inflammation, endocrinopathies and unhealthy lifestyle contribute to the association between metabolic syndrome and a number of psychiatric disorders. In this article, we review the current diagnostic criteria for metabolic syndrome and propose clinically useful guidelines for psychiatrists to identify and monitor patients who may have the syndrome. We also outline the relationship between metabolic syndrome and individual psychiatric disorders, and discuss advances in pharmacological treatment for the syndrome, such as metformin.LEARNING OBJECTIVES•Be familiar with the definition of metabolic syndrome and its parameters of measurement.•Appreciate how individual psychiatric disorders contribute to metabolic syndrome and vice versa.•Develop a framework for the prevention, screening and management of metabolic syndrome in psychiatric patients.
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23
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Zuccoli GS, Saia-Cereda VM, Nascimento JM, Martins-de-Souza D. The Energy Metabolism Dysfunction in Psychiatric Disorders Postmortem Brains: Focus on Proteomic Evidence. Front Neurosci 2017; 11:493. [PMID: 28936160 PMCID: PMC5594406 DOI: 10.3389/fnins.2017.00493] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/22/2017] [Indexed: 12/27/2022] Open
Abstract
Psychiatric disorders represent a great medical and social challenge and people suffering from these conditions face many impairments regarding personal and professional life. In addition, a mental disorder will manifest itself in approximately one quarter of the world's population at some period of their life. Dysfunction in energy metabolism is one of the most consistent scientific findings associated with these disorders. With this is mind, this review compiled data on disturbances in energy metabolism found by proteomic analyses of postmortem brains collected from patients affected by the most prevalent psychiatric disorders: schizophrenia (SCZ), bipolar disorder (BPD), and major depressive disorder (MDD). We searched in the PubMed database to gather the studies and compiled all the differentially expressed proteins reported in each work. SCZ studies revealed 92 differentially expressed proteins related to energy metabolism, while 95 proteins were discovered in BPD, and 41 proteins in MDD. With the compiled data, it was possible to determine which proteins related to energy metabolism were found to be altered in all the disorders as well as which ones were altered exclusively in one of them. In conclusion, the information gathered in this work could contribute to a better understanding of the impaired metabolic mechanisms and hopefully bring insights into the underlying neuropathology of psychiatric disorders.
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Affiliation(s)
- Giuliana S Zuccoli
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of CampinasCampinas, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e TecnologicoSão Paulo, Brazil
| | - Verônica M Saia-Cereda
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of CampinasCampinas, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e TecnologicoSão Paulo, Brazil
| | - Juliana M Nascimento
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of CampinasCampinas, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e TecnologicoSão Paulo, Brazil
| | - Daniel Martins-de-Souza
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of CampinasCampinas, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e TecnologicoSão Paulo, Brazil
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24
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Yang X, Sun L, Zhao A, Hu X, Qing Y, Jiang J, Yang C, Xu T, Wang P, Liu J, Zhang J, He L, Jia W, Wan C. Serum fatty acid patterns in patients with schizophrenia: a targeted metabonomics study. Transl Psychiatry 2017; 7:e1176. [PMID: 28742081 PMCID: PMC5538128 DOI: 10.1038/tp.2017.152] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/25/2017] [Accepted: 06/07/2017] [Indexed: 12/21/2022] Open
Abstract
Previous studies have indicated that schizophrenia is linked to abnormal lipid metabolism. Free fatty acids (FFAs) in peripheral blood can reflect the status of lipid metabolism in human body. The purpose of this study was to scan the FFA pattern and elucidate the characteristics of lipid metabolic abnormality in schizophrenia patients. One hundred and ten patients with schizophrenia (SCZs) and 109 healthy controls (HCs) were included in the study and divided into a discovery set and a validation set. Forty-seven serum FFAs were detected by UPLC-QTOF-MS and 39 of them were absolutely quantified by establishing standard curves. Monounsaturated fatty acids (MUFAs) and ω-6 polyunsaturated fatty acids (ω-6 PUFAs) were significantly increased in SCZs compared with HCs. Desaturation from saturated fatty acids to MUFAs and β-oxidation were enhanced, as estimated by the ratios of products to precursors. These results suggest that lipolysis and β-oxidation are upregulated in SCZ, presumably resulting from insufficient brain energy supply.
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Affiliation(s)
- X Yang
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Key Laboratory of Translational Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
| | - L Sun
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Key Laboratory of Translational Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
| | - A Zhao
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - X Hu
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Key Laboratory of Translational Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
| | - Y Qing
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Key Laboratory of Translational Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
| | - J Jiang
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Key Laboratory of Translational Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
| | - C Yang
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Key Laboratory of Translational Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
| | - T Xu
- Discipline of Neuroscience, Department of Anatomy, Histology and Embryology, Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - P Wang
- The Fourth People’s Hospital of Wuhu, Wuhu, China
| | - J Liu
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - J Zhang
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Key Laboratory of Translational Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
| | - L He
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Key Laboratory of Translational Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
| | - W Jia
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China,Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China E-mail:
| | - C Wan
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Key Laboratory of Translational Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China,Collaborative Innovation Center of Genetics and Development, Shanghai, China,Bio-X Institutes, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China. E-mail:
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25
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Association of the type 2 diabetes mellitus susceptibility gene (IGF2BP2) with schizophrenia in an Egyptian sample. MIDDLE EAST CURRENT PSYCHIATRY 2017. [DOI: 10.1097/01.xme.0000513071.88010.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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26
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Quintana DS, Dieset I, Elvsåshagen T, Westlye LT, Andreassen OA. Oxytocin system dysfunction as a common mechanism underlying metabolic syndrome and psychiatric symptoms in schizophrenia and bipolar disorders. Front Neuroendocrinol 2017; 45:1-10. [PMID: 28049009 DOI: 10.1016/j.yfrne.2016.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/14/2016] [Accepted: 12/29/2016] [Indexed: 12/24/2022]
Abstract
There is growing interest in using intranasal oxytocin (OT) to treat social dysfunction in schizophrenia and bipolar disorders (i.e., psychotic disorders). While OT treatment results have been mixed, emerging evidence suggests that OT system dysfunction may also play a role in the etiology of metabolic syndrome (MetS), which appears in one-third of individuals with psychotic disorders and associated with increased mortality. Here we examine the evidence for a potential role of the OT system in the shared risk for MetS and psychotic disorders, and its prospects for ameliorating MetS. Using several studies to demonstrate the overlapping neurobiological profiles of metabolic risk factors and psychiatric symptoms, we show that OT system dysfunction may be one common mechanism underlying MetS and psychotic disorders. Given the critical need to better understand metabolic dysregulation in these disorders, future OT trials assessing behavioural and cognitive outcomes should additionally include metabolic risk factor parameters.
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Affiliation(s)
- Daniel S Quintana
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway.
| | - Ingrid Dieset
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway
| | - Torbjørn Elvsåshagen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway; Department of Neurology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars T Westlye
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway
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27
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Meta-analysis of glucose tolerance, insulin, and insulin resistance in antipsychotic-naïve patients with nonaffective psychosis. Schizophr Res 2017; 179:57-63. [PMID: 27743650 PMCID: PMC5564201 DOI: 10.1016/j.schres.2016.09.026] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Some studies have suggested that antipsychotic-naïve patients with nonaffective psychosis (NAP) have glucose intolerance. AIMS To conduct a systematic review and meta-analysis of fasting glucose (FG), two hour values in the oral glucose tolerance test (2HG), fasting insulin concentration (INS), and insulin resistance (IR). METHOD We identified possibly relevant studies, then selected studies, following usual guidelines, with two authors reviewing the manuscripts. We required studies to include subjects with nonaffective psychosis and control subjects. RESULTS There were 911 patients and 870 control subjects in the analysis of FG; their average ages were respectively 28.7 and 29.5years. Significant differences were found for all four variables, with effect size estimates ranging from 0.21 to 0.58. CONCLUSIONS As a group, at the time of first clinical contact for psychosis, people with NAP have a slight increase in FG, which most of them maintain in the normal range despite a small increase in IR by secreting additional INS. When faced with a physiological challenge such as a glucose tolerance test or antipsychotics, they are no longer able to maintain a normal glucose concentration.
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28
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Castillo RI, Rojo LE, Henriquez-Henriquez M, Silva H, Maturana A, Villar MJ, Fuentes M, Gaspar PA. From Molecules to the Clinic: Linking Schizophrenia and Metabolic Syndrome through Sphingolipids Metabolism. Front Neurosci 2016; 10:488. [PMID: 27877101 PMCID: PMC5100552 DOI: 10.3389/fnins.2016.00488] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 10/12/2016] [Indexed: 12/12/2022] Open
Abstract
Metabolic syndrome (MS) is a prevalent and severe comorbidity observed in schizophrenia (SZ). The exact nature of this association is controversial and very often accredited to the effects of psychotropic medications and disease-induced life-style modifications, such as inactive lifestyle, poor dietary choices, and smoking. However, drug therapy and disease-induced lifestyle factors are likely not the only factors contributing to the observed converging nature of these conditions, since an increased prevalence of MS is also observed in first episode and drug-naïve psychosis populations. MS and SZ share common intrinsic susceptibility factors and etiopathogenic mechanisms, which may change the way we approach clinical management of SZ patients. Among the most relevant common pathogenic pathways of SZ and MS are alterations in the sphingolipids (SLs) metabolism and SLs homeostasis. SLs have important structural functions as they participate in the formation of membrane “lipid rafts.” SLs also play physiological roles in cell differentiation, proliferation, and inflammatory processes, which might be part of MS/SZ common pathophysiological processes. In this article we review a plausible mechanism to explain the link between MS and SZ through a disruption in SL homeostasis. Additionally, we provide insights on how this hypothesis can lead to the developing of new diagnostic/therapeutic technologies for SZ patients.
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Affiliation(s)
- Rolando I Castillo
- Translational Psychiatry Laboratory, Clínica Psiquiátrica Universitaria, Hospital Clínico Universidad de Chile Santiago, Chile
| | - Leonel E Rojo
- Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile Santiago, Chile
| | - Marcela Henriquez-Henriquez
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de ChileSantiago, Chile; Department of Pediatrics, Institute of Human Nutrition, College of Physicians and Surgeons, Columbia UniversityNew York, NY, USA; Department of Pathology and Cell Biology, Columbia UniversityNew York, NY, USA
| | - Hernán Silva
- Translational Psychiatry Laboratory, Clínica Psiquiátrica Universitaria, Hospital Clínico Universidad de ChileSantiago, Chile; Facultad de Medicina, Biomedical Neuroscience Institute, Universidad de ChileSantiago, Chile
| | - Alejandro Maturana
- Translational Psychiatry Laboratory, Clínica Psiquiátrica Universitaria, Hospital Clínico Universidad de Chile Santiago, Chile
| | - María J Villar
- Translational Psychiatry Laboratory, Clínica Psiquiátrica Universitaria, Hospital Clínico Universidad de Chile Santiago, Chile
| | - Manuel Fuentes
- Departamento de Psiquiatría, Clínica Alemana Santiago, Chile
| | - Pablo A Gaspar
- Translational Psychiatry Laboratory, Clínica Psiquiátrica Universitaria, Hospital Clínico Universidad de ChileSantiago, Chile; Facultad de Medicina, Biomedical Neuroscience Institute, Universidad de ChileSantiago, Chile; Departamento de Psiquiatría, Clínica AlemanaSantiago, Chile
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29
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Chen DC, Du XD, Yin GZ, Yang KB, Nie Y, Wang N, Li YL, Xiu MH, He SC, Yang FD, Cho RY, Kosten TR, Soares JC, Zhao JP, Zhang XY. Impaired glucose tolerance in first-episode drug-naïve patients with schizophrenia: relationships with clinical phenotypes and cognitive deficits. Psychol Med 2016; 46:3219-3230. [PMID: 27604840 DOI: 10.1017/s0033291716001902] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Schizophrenia patients have a higher prevalence of type 2 diabetes mellitus with impaired glucose tolerance (IGT) than normals. We examined the relationship between IGT and clinical phenotypes or cognitive deficits in first-episode, drug-naïve (FEDN) Han Chinese patients with schizophrenia. METHOD A total of 175 in-patients were compared with 31 healthy controls on anthropometric measures and fasting plasma levels of glucose, insulin and lipids. They were also compared using a 75 g oral glucose tolerance test and the homeostasis model assessment of insulin resistance (HOMA-IR). Neurocognitive functioning was assessed using the MATRICS Consensus Cognitive Battery (MCCB). Patient psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS). RESULTS Of the patients, 24.5% had IGT compared with none of the controls, and they also had significantly higher levels of fasting blood glucose and 2-h glucose after an oral glucose load, and were more insulin resistant. Compared with those patients with normal glucose tolerance, the IGT patients were older, had a later age of onset, higher waist or hip circumference and body mass index, higher levels of low-density lipoprotein and triglycerides and higher insulin resistance. Furthermore, IGT patients had higher PANSS total and negative symptom subscale scores, but no greater cognitive impairment except on the emotional intelligence index of the MCCB. CONCLUSIONS IGT occurs with greater frequency in FEDN schizophrenia, and shows association with demographic and anthropometric parameters, as well as with clinical symptoms but minimally with cognitive impairment during the early course of the disorder.
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Affiliation(s)
- D C Chen
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
| | - X D Du
- Suzhou Psychiatric Hospital,Suzhou,Jiangsu Province,People's Republic of China
| | - G Z Yin
- Suzhou Psychiatric Hospital,Suzhou,Jiangsu Province,People's Republic of China
| | - K B Yang
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
| | - Y Nie
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
| | - N Wang
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
| | - Y L Li
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
| | - M H Xiu
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
| | - S C He
- Department of Psychology,Peking University,Beijing,People's Republic of China
| | - F D Yang
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
| | - R Y Cho
- Department of Psychiatry and Behavioral Sciences,The University of Texas Health Science Center at Houston,Houston, TX,USA
| | - T R Kosten
- Department of Psychiatry and Behavioral Sciences,Baylor College of Medicine,Houston, TX,USA
| | - J C Soares
- Department of Psychiatry and Behavioral Sciences,The University of Texas Health Science Center at Houston,Houston, TX,USA
| | - J P Zhao
- Mental Health Institute of the Second Xiangya Hospital, Central South University,Changsha,People's Republic of China
| | - X Y Zhang
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
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30
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Parental type 2 diabetes in patients with non-affective psychosis. Schizophr Res 2016; 175:223-225. [PMID: 27156239 PMCID: PMC4958496 DOI: 10.1016/j.schres.2016.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/18/2016] [Accepted: 04/21/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE People with schizophrenia have an increased risk of diabetes that may be independent of antipsychotics. Previous studies have explored the prevalence of a family history of type 2 diabetes (DM2) in schizophrenia. We hypothesized that parental DM2 is increased in probands with non-affective psychosis (NAP) compared to controls, and parental DM2 predicts comorbid diabetes in NAP, after controlling for potential confounders. METHOD N=217 patients with NAP and N=67 controls were interviewed for a history of parental DM2. NAP was investigated as a predictor of parental DM2 in binary logistic regression models, controlling for age, sex, race, smoking, body mass index, socioeconomic status, and parental psychiatric history. RESULTS There was an increased prevalence of DM2 in the mother (30.0% vs 13.8%, p=0.013) and in either the mother or father (44.5% vs 24.6%, p=0.006) in patients with NAP versus controls. After accounting for potential confounders, NAP was associated with significant increased odds of parental DM2 (OR=2.80, 95% CI 1.08-7.23, p=0.034). Parental DM2 was also associated with increased odds of comorbid DM2 in NAP (OR=3.67, 95% CI 1.58-8.56, p=0.003). CONCLUSIONS We replicated an association of an increased prevalence of parental DM2 in patients with NAP. Parental DM2 was also an independent predictor of comorbid DM2 in these patients. These associations may be due to shared environmental or genetic risk factors, or gene by environment interactions. Given risks of incident diabetes with antipsychotic treatment, screening for parental DM2 status is germane to the clinical care of patients with NAP.
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31
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Foley DL, Mackinnon A, Morgan VA, Watts GF, Castle DJ, Waterreus A, Galletly CA. Common familial risk factors for schizophrenia and diabetes mellitus. Aust N Z J Psychiatry 2016. [PMID: 26209325 DOI: 10.1177/0004867415595715] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The co-occurrence of type 2 diabetes and psychosis is an important form of medical comorbidity within individuals, but no large-scale study has evaluated comorbidity within families. The aim of this study was to determine whether there is evidence for familial comorbidity between type 2 diabetes and psychosis. METHOD Data were analysed from an observational study of a nationally representative sample of 1642 people with psychosis who were in contact with psychiatric services at the time of survey (The 2010 Australian National Survey of Psychosis). Participants were aged 18-64 years and met World Health Organization's International Classification of Diseases, 10th Revision diagnostic criteria for a psychotic disorder (857 with schizophrenia, 319 with bipolar disorder with psychotic features, 293 with schizoaffective disorder, 81 with depressive psychosis and 92 with delusional disorder or other non-organic psychoses). Logistic regression was used to estimate the association between a family history of diabetes and a family history of schizophrenia. RESULTS A positive family history of diabetes was associated with a positive family history of schizophrenia in those with a psychotic disorder (odds ratio = 1.35, p = 0.01, adjusted for age and gender). The association was different in those with an affective versus non-affective psychosis (odds ratio = 0.613, p = 0.019, adjusted for age and gender) and was significant only in those with a non-affective psychosis, specifically schizophrenia (odds ratio = 1.58, p = 0.005, adjusted for age and sex). Adjustment for demographic factors in those with schizophrenia slightly strengthened the association (odds ratio = 1.74, p = 0.001, adjusted for age, gender, diagnosis, ethnicity, education, employment, income and marital status). CONCLUSION Elevated risk for type 2 diabetes in people with schizophrenia is not simply a consequence of antipsychotic medication; type 2 diabetes and schizophrenia share familial risk factors.
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Affiliation(s)
- Debra L Foley
- Orygen - The National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Mackinnon
- Orygen - The National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, University of Western Australia, WA, Australia
| | - Gerald F Watts
- Lipid Disorders Clinic, Metabolic Research Centre and Department of Cardiology, Royal Perth Hospital Unit, School of Medicine and Pharmacology, The University of Western Australia, WA, Australia
| | - David J Castle
- St. Vincent's Hospital, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Anna Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, University of Western Australia, WA, Australia
| | - Cherrie A Galletly
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia Ramsay Health Care (SA) Mental Health, Adelaide, SA, Australia Northern Adelaide Local Health Network SA Australia, Adelaide, SA, Australia
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32
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Gragnoli C, Reeves GM, Reazer J, Postolache TT. Dopamine-prolactin pathway potentially contributes to the schizophrenia and type 2 diabetes comorbidity. Transl Psychiatry 2016; 6:e785. [PMID: 27093067 PMCID: PMC4872408 DOI: 10.1038/tp.2016.50] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 02/15/2016] [Accepted: 02/19/2016] [Indexed: 01/10/2023] Open
Abstract
Schizophrenia (SCZ) and type 2 diabetes (T2D) are clinically associated, and common knowledge attributes this association to side effects of antipsychotic treatment. However, even drug-naive patients with SCZ are at increased risk for T2D. Dopamine dysfunction has a central role in SCZ. It is well-known that dopamine constitutively inhibits prolactin (PRL) secretion via the dopamine receptor 2 (DR2D). If dopamine is increased or if dopamine receptors hyperfunction, PRL may be reduced. During the first SCZ episode, low PRL levels are associated with worse symptoms. PRL is essential in human and social bonding, as well as it is implicated in glucose homeostasis. Dopamine dysfunction, beyond contributing to SCZ symptoms, may lead to altered appetite and T2D. To our knowledge, there are no studies of the genetics of the SCZ-T2D comorbidity focusing jointly on the dopamine and PRL pathway in the attempt to capture molecular heterogeneity correlated to possible disease manifestation heterogeneity. In this dopamine-PRL pathway-focused-hypothesis-driven review on the association of SCZ with T2D, we report a specific revision of what it is known about PRL and dopamine in relation to what we theorize is one of the missing links between the two disorders. We suggest that new studies are necessary to establish the genetic role of PRL and dopamine pathway in SCZ-T2D comorbidity.
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Affiliation(s)
- C Gragnoli
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA,Molecular Biology Laboratory, Bios Biotech Multi-Diagnostic Health Center, Rome, Italy,Division of Endocrinology, Diabetes, and Metabolism, University of Florida College of Medicine, 653-1 West 8th Street, Learning Resource Center, L14, Jacksonville, FL 32209, USA. E-mail:
| | - G M Reeves
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - J Reazer
- Borland Health Sciences Library, University of Florida, Jacksonville, FL, USA
| | - T T Postolache
- Rocky Mountain Mental Illness Research Education and Clinical Center, Denver, CO, USA,Veterans Integrated Service Network 5 MIRECC, Baltimore, MD, USA,Department of Psychiatry, University of Maryland, Baltimore, MD, USA
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Enez Darcin A, Yalcin Cavus S, Dilbaz N, Kaya H, Dogan E. Metabolic syndrome in drug-naïve and drug-free patients with schizophrenia and in their siblings. Schizophr Res 2015; 166:201-6. [PMID: 26004686 DOI: 10.1016/j.schres.2015.05.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 04/16/2015] [Accepted: 05/04/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We tested the hypothesis that metabolic disturbances in people with schizophrenia exist as a part of the schizophrenic syndrome, even when the antipsychotic drug effect is eliminated. We aimed to determine the prevalence of metabolic syndrome among patients with schizophrenia who were antipsychotic drug-naive or drug-free and their siblings for comparison with healthy controls. METHODS One-hundred-two patients with schizophrenia (drug-naïve or drug-free), 64 siblings and 70 age-matched healthy subjects were recruited for this case-control study. Metabolic syndrome was assessed based on Adult Treatment Panel (ATP) III, adapted ATP III and International Diabetes Federation criteria. Student's t-tests, chi-squared tests, Kruskal-Wallis tests and Bonferroni corrections were used as appropriate. RESULTS The diagnoses of metabolic syndrome and metabolic disturbances as a subsyndromal state were found to be significantly more frequent in patients and their siblings than in the controls. Low levels of high-density lipoprotein cholesterol and disturbances in blood pressure put the patient group at risk for metabolic syndrome even before they were exposed to antipsychotic drugs. CONCLUSIONS Although antipsychotic drugs have consistently been related to disturbances of glucose and lipid metabolism in patients with schizophrenia, this study showed that patients with schizophrenia and their siblings are already at a high risk for metabolic syndrome independent of any antipsychotic effects. These individuals should be monitored regularly following a diagnosis of schizophrenia.
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Caravaggio F, Hahn M, Nakajima S, Gerretsen P, Remington G, Graff-Guerrero A. Reduced insulin-receptor mediated modulation of striatal dopamine release by basal insulin as a possible contributing factor to hyperdopaminergia in schizophrenia. Med Hypotheses 2015; 85:391-6. [PMID: 26118462 DOI: 10.1016/j.mehy.2015.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 05/22/2015] [Accepted: 06/17/2015] [Indexed: 12/23/2022]
Abstract
Schizophrenia is a severe and chronic neuropsychiatric disorder which affects 1% of the world population. Using the brain imaging technique positron emission tomography (PET) it has been demonstrated that persons with schizophrenia have greater dopamine transmission in the striatum compared to healthy controls. However, little progress has been made as to elucidating other biological mechanisms which may account for this hyperdopaminergic state in this disease. Studies in animals have demonstrated that insulin receptors are expressed on midbrain dopamine neurons, and that insulin from the periphery acts on these receptors to modify dopamine transmission in the striatum. This is pertinent given that several lines of evidence suggest that insulin receptor functioning may be abnormal in the brains of persons with schizophrenia. Post-mortem studies have shown that persons with schizophrenia have less than half the number of cortical insulin receptors compared to healthy persons. Moreover, these post-mortem findings are unlikely due to the effects of antipsychotic treatment; studies in cell lines and animals suggest antipsychotics enhance insulin receptor functioning. Further, hyperinsulinemia - even prior to antipsychotic use - seems to be related to less psychotic symptoms in patients with schizophrenia. Collectively, these data suggest that midbrain insulin receptor functioning may be abnormal in persons with schizophrenia, resulting in reduced insulin-mediated regulation of dopamine transmission in the striatum. Such a deficit may account for the hyperdopaminergic state observed in these patients and would help guide the development of novel treatment strategies. We hypothesize that, (i) insulin receptor expression and/or function is reduced in midbrain dopamine neurons in persons with schizophrenia, (ii) basal insulin should reduce dopaminergic transmission in the striatum via these receptors, and (iii) this modulation of dopaminergic transmission by basal insulin is reduced in the brains of persons with schizophrenia.
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Affiliation(s)
- Fernando Caravaggio
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, University of Toronto, 2374 Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Margaret Hahn
- Institute of Medical Science, University of Toronto, 2374 Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Shinichiro Nakajima
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Philip Gerretsen
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, University of Toronto, 2374 Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Gary Remington
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, University of Toronto, 2374 Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Ariel Graff-Guerrero
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, University of Toronto, 2374 Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
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Mothi SS, Tandon N, Padmanabhan J, Mathew IT, Clementz B, Tamminga C, Pearlson G, Sweeney J, Keshavan MS. Increased cardiometabolic dysfunction in first-degree relatives of patients with psychotic disorders. Schizophr Res 2015; 165:103-7. [PMID: 25900543 PMCID: PMC5436498 DOI: 10.1016/j.schres.2015.03.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/27/2015] [Accepted: 03/29/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Elevated prevalence of comorbid cardio-vascular and metabolic dysfunction (CMD) is consistently reported in patients with severe psychotic disorders such as schizophrenia (SZ), schizoaffective (SZA) and bipolar disorder (BP-P). Since both psychosis and CMD are substantively heritable in nature, we attempted to investigate the occurrence of CMD disorders in first-degree relatives of probands with psychosis. METHODS Our sample included 861 probands with a diagnosis of SZ (n=354), SZA (n=212) and BP-P (n=295), 776 first-degree relatives of probands and 416 healthy controls. Logistic regression was used to compare prevalence of any CMD disorders (diabetes, hypertension, hyperlipidemia or coronary artery disease) across groups. Post hoc tests of independence checked for CMD prevalence across psychosis diagnosis (SZ, SZA and BP-P), both in relatives of probands and within probands themselves. RESULTS After controlling for potential confounders, first-degree relatives with (p<0.001) and without (p=0.03) Axis I non-psychotic or Axis- II cluster disorders were at a significant risk for CMD compared to controls. No significant difference (p=0.42) was observed in prevalence of CMD between relatives of SZ, SZA and BP-P, or between psychosis diagnoses for probands (p=0.25). DISCUSSION Prevalence of CMD was increased in the first-degree relatives of psychosis subjects. This finding suggests the possibility of overlapping genetic contributions to CMD and psychosis. Increased somatic disease burden in relatives of psychotic disorder probands points to need for early detection and preventive efforts in this population.
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Affiliation(s)
- Suraj Sarvode Mothi
- Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Psychiatry, Harvard Medical School-Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Neeraj Tandon
- Psychiatry, Harvard Medical School-Beth Israel Deaconess Medical Center, Boston, MA, USA; Baylor College of Medicine, Texas Medical Center, Houston, TX, USA
| | - Jaya Padmanabhan
- Psychiatry, Harvard Medical School-Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ian T Mathew
- Psychiatry, Harvard Medical School-Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brett Clementz
- Department of Psychology, Bio-Imaging Research Center, University of Georgia, Athens, GA, USA; Department of Neuroscience, Bio-Imaging Research Center, University of Georgia, Athens, GA, USA
| | | | - Godfrey Pearlson
- Olin Neuropsychiatry Research Center, Hartford, CT, USA; Department of Psychiatry and Neurobiology, Yale University, New Haven, CT, USA
| | - John Sweeney
- Department of Neuroscience, Bio-Imaging Research Center, University of Georgia, Athens, GA, USA
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Kirkpatrick B, Miller B, García-Rizo C, Fernandez-Egea E. Schizophrenia: a systemic disorder. ACTA ACUST UNITED AC 2015; 8:73-9. [PMID: 23518782 DOI: 10.3371/csrp.kimi.031513] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The concept of schizophrenia that is most widely taught is that it is a disorder in which psychotic symptoms are the main problem, and a dysregulation of dopamine signaling is the main feature of pathophysiology. However, this concept limits clinical assessment, the treatments offered to patients, research, and the development of therapeutics. A more appropriate conceptual model is that: 1) schizophrenia is not a psychotic disorder, but a disorder of essentially every brain function in which psychosis is present; 2) it is not a brain disease, but a disorder with impairments throughout the body; 3) for many patients, neuropsychiatric problems other than psychosis contribute more to impairment in function and quality of life than does psychosis; and, 4) some conditions that are considered to be comorbid are integral parts of the illness. In conclusion, students, patients, and family members should be taught this model, along with its implications for assessment, research, and therapeutics.
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Affiliation(s)
- Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno, NV
| | - Brian Miller
- Department of Psychiatry and Health Behavior, Georgia Health Sciences University, Augusta, GA
| | - Clemente García-Rizo
- Schizophrenia Program, Department of Psychiatry, Neuroscience Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Emilio Fernandez-Egea
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, Good Outcome Schizophrenia Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK, Huntingdon, UK
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Caravaggio F, Borlido C, Hahn M, Feng Z, Fervaha G, Gerretsen P, Nakajima S, Plitman E, Chung JK, Iwata Y, Wilson A, Remington G, Graff-Guerrero A. Reduced insulin sensitivity is related to less endogenous dopamine at D2/3 receptors in the ventral striatum of healthy nonobese humans. Int J Neuropsychopharmacol 2015; 18:pyv014. [PMID: 25716779 PMCID: PMC4540108 DOI: 10.1093/ijnp/pyv014] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 02/04/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Food addiction is a debated topic in neuroscience. Evidence suggests diabetes is related to reduced basal dopamine levels in the nucleus accumbens, similar to persons with drug addiction. It is unknown whether insulin sensitivity is related to endogenous dopamine levels in the ventral striatum of humans. We examined this using the agonist dopamine D2/3 receptor radiotracer [(11)C]-(+)-PHNO and an acute dopamine depletion challenge. In a separate sample of healthy persons, we examined whether dopamine depletion could alter insulin sensitivity. METHODS Insulin sensitivity was estimated for each subject from fasting plasma glucose and insulin using the Homeostasis Model Assessment II. Eleven healthy nonobese and nondiabetic persons (3 female) provided a baseline [(11)C]-(+)-PHNO scan, 9 of which provided a scan under dopamine depletion, allowing estimates of endogenous dopamine at dopamine D2/3 receptor. Dopamine depletion was achieved via alpha-methyl-para-tyrosine (64mg/kg, P.O.). In 25 healthy persons (9 female), fasting plasma and glucose was acquired before and after dopamine depletion. RESULTS Endogenous dopamine at ventral striatum dopamine D2/3 receptor was positively correlated with insulin sensitivity (r(7)=.84, P=.005) and negatively correlated with insulin levels (r(7)=-.85, P=.004). Glucose levels were not correlated with endogenous dopamine at ventral striatum dopamine D2/3 receptor (r(7)=-.49, P=.18). Consistently, acute dopamine depletion in healthy persons significantly decreased insulin sensitivity (t(24)=2.82, P=.01), increased insulin levels (t(24)=-2.62, P=.01), and did not change glucose levels (t(24)=-0.93, P=.36). CONCLUSION In healthy individuals, diminished insulin sensitivity is related to less endogenous dopamine at dopamine D2/3 receptor in the ventral striatum. Moreover, acute dopamine depletion reduces insulin sensitivity. These findings may have important implications for neuropsychiatric populations with metabolic abnormalities.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Ariel Graff-Guerrero
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (Mr Caravaggio, Ms Borlido, Ms Feng, Dr Gerretsen, Dr Nakajima, Mr Plitman, Mr Chung, Dr Iwata, Dr Wilson, Dr Remington, and Dr Graff-Guerrero); Institute of Medical Science (Mr Caravaggio, Dr Hahn, Mr Fervaha, Dr Gerretsen, Mr Plitman, Mr Chung, Dr Wilson, Dr Remington, and Dr Graff-Guerrero), and Department of Psychiatry (Drs Hahn, Gerretsen, Nakajima, Iwata, Wilson, Remington, and Graff-Guerrero), University of Toronto, Toronto, Ontario, Canada.
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Behavioural and molecular endophenotypes in psychotic disorders reveal heritable abnormalities in glutamatergic neurotransmission. Transl Psychiatry 2015; 5:e540. [PMID: 25826115 PMCID: PMC4429170 DOI: 10.1038/tp.2015.26] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 01/02/2015] [Accepted: 01/20/2015] [Indexed: 02/02/2023] Open
Abstract
Psychotic disorders such as schizophrenia are biologically complex and carry huge population morbidity due to their prevalence, persistence and associated disability. Defined by features such as delusions and hallucinations, they involve cognitive dysfunction and neurotransmitter dysregulations that appear mostly to involve the dopaminergic and glutamatergic systems. A number of genetic and environmental factors are associated with these disorders but it has been difficult to identify the biological pathways underlying the principal symptoms. The endophenotype concept of stable, heritable traits that form a mechanistic link between genes and an overt expression of the disorder has potential to reduce the complexity of psychiatric phenotypes. In this study, we used a genetically sensitive design with individuals with a first episode of psychosis, their non-affected first-degree relatives and non-related healthy controls. Metabolomic analysis was combined with neurocognitive assessment to identify multilevel endophenotypic patterns: one concerned reaction times during the performance of cognitive and emotional tests that have previously been associated with the glutamate neurotransmission system, the other involved metabolites involved directly and indirectly in the co-activation of the N-methyl-D-aspartate receptor, a major receptor of the glutamate system. These cognitive and metabolic endophenotypes may comprise a single construct, such that genetically mediated dysfunction in the glutamate system may be responsible for delays in response to cognitive and emotional functions in psychotic disorders. This focus on glutamatergic neurotransmission should guide drug discovery and experimental medicine programmes in schizophrenia and related disorders.
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Schwarz E, Steiner J, Guest PC, Bogerts B, Bahn S. Investigation of molecular serum profiles associated with predisposition to antipsychotic-induced weight gain. World J Biol Psychiatry 2015; 16:22-30. [PMID: 24001020 DOI: 10.3109/15622975.2013.817685] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Metabolic disturbances are major adverse side effects in the treatment of schizophrenia patients with antipsychotics. A substantial proportion of patients discontinue treatment with second-generation antipsychotics due to weight gain. The objective of this study was to investigate molecular factors predisposing patients to the development of such metabolic disturbances. METHODS We investigated whether serum molecules measured before treatment initiation were associated with subsequent weight gain following a 6-week treatment with antipsychotics. The concentrations of 191 molecules were measured longitudinally in serum from 77 schizophrenia patients using multiplex immunoassays. RESULTS This showed that the levels of 10 serum molecules at T0 were significantly associated with ΔBMI, which included interleukin-6 receptor, epidermal growth factor and thyroid stimulating hormone. CONCLUSIONS Our results suggest that patients who experience antipsychotic-induced weight gain have specific molecular alterations already prior to treatment. Further studies are required to validate and evaluate current findings in the context of response and side-effect development. This may ultimately lead to molecular tests that can aid in the selection of antipsychotic treatments.
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Affiliation(s)
- Emanuel Schwarz
- Department of Chemical Engineering and Biotechnology, University of Cambridge , Cambridge , UK
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Mitochondrial dysfunction in schizophrenia: an evolutionary perspective. Hum Genet 2014; 134:13-21. [PMID: 25312050 DOI: 10.1007/s00439-014-1491-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022]
Abstract
Schizophrenia (SCZ) is a severe psychiatric illness with a lifetime prevalence of 0.4 %. A disturbance of energy metabolism has been suggested as part of the etiopathogenesis of the disorder. Several lines of evidence have proposed a connection between etiopathogenesis of SCZ and human brain evolution, which was characterized by an increase in the energy requirement, demanding a co-evolution of the mitochondrial system. Mitochondria are key players in brain energy homeostasis and multiple lines of evidence suggest that the system is disrupted in SCZ. In this review, we will describe the current knowledge on pathways/system involved in the human brain evolution as well as the main theories regarding the evolutionary origin of SCZ. We will furthermore discuss the role of mitochondria in the context of brain energy metabolism and its role in the etiopathogenesis of SCZ. Understanding SCZ in the context of human brain evolution opens a new perspective to elucidate pathophysiological mechanisms involved in the origin and/or portions of the complex symptomatology of this severe mental disorder.
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Li YK, Hui CLM, Lee EHM, Chang WC, Chan SKW, Leung CM, Chen EYH. Coupling physical exercise with dietary glucose supplement for treating cognitive impairment in schizophrenia: a theoretical model and future directions. Early Interv Psychiatry 2014; 8:209-20. [PMID: 24224943 DOI: 10.1111/eip.12109] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/10/2013] [Indexed: 01/09/2023]
Abstract
AIMS Metabolic dysregulation may disrupt the complex neuroprotective mechanisms essential for brain health. Recent studies have pointed out the possible aetiological role of metabolic dysregulation in the onset of schizophrenia and the associated cognitive impairment. In this paper, we aimed to generate a theoretical model of how a combination of physical exercise and dietary glucose supplement may help to alleviate cognitive impairment in schizophrenia. METHODS Literature on metabolic dysregulation, especially insulin resistance, in relation to the onset of schizophrenia and the associated cognitive impairment is reviewed. The cognitive enhancement effects of physical exercise and dietary glucose supplement are then summarised. Finally, we propose a theoretical model based on the concerted effects of physical exercise and glucose supplement. RESULTS In general, the joint action of physical exercise and dietary glucose supplement could up-regulate glucose and insulin transport into the brain, as well as augmenting the release of insulin growth factor-1 and brain-derived neurotrophic factor. Physical exercise and glucose supplement could enhance energy supply and neuroplasticity in brain, subsequently leading to potential cognitive enhancement in schizophrenia. However, glucose supplement is not suitable for patients with abnormal metabolic profile. CONCLUSIONS The combination of physical exercise and glucose supplement has potential therapeutic values in treating cognitive impairment in schizophrenia. Further research is necessary to investigate the optimal patterns of exercise and doses of glucose for treating cognitive impairment in schizophrenia.
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Affiliation(s)
- Yuet-Keung Li
- Department of Psychiatry, University of Hong Kong, Hong Kong
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Steiner J, Bernstein HG, Schiltz K, Müller UJ, Westphal S, Drexhage HA, Bogerts B. Immune system and glucose metabolism interaction in schizophrenia: a chicken-egg dilemma. Prog Neuropsychopharmacol Biol Psychiatry 2014; 48:287-94. [PMID: 23085507 DOI: 10.1016/j.pnpbp.2012.09.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 09/15/2012] [Accepted: 09/22/2012] [Indexed: 12/15/2022]
Abstract
Impaired glucose metabolism and the development of metabolic syndrome contribute to a reduction in the average life expectancy of individuals with schizophrenia. It is unclear whether this association simply reflects an unhealthy lifestyle or whether weight gain and impaired glucose tolerance in patients with schizophrenia are directly attributable to the side effects of atypical antipsychotic medications or disease-inherent derangements. In addition, numerous previous studies have highlighted alterations in the immune system of patients with schizophrenia. Increased concentrations of interleukin (IL)-1, IL-6, and transforming growth factor-beta (TGF-β) appear to be state markers, whereas IL-12, interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), and soluble IL-2 receptor (sIL-2R) appear to be trait markers of schizophrenia. Moreover, the mononuclear phagocyte system (MPS) and microglial activation are involved in the early course of the disease. This review illustrates a "chicken-egg dilemma", as it is currently unclear whether impaired cerebral glucose utilization leads to secondary disturbances in peripheral glucose metabolism, an increased risk of cardiovascular complications, and accompanying pro-inflammatory changes in patients with schizophrenia or whether immune mechanisms may be involved in the initial pathogenesis of schizophrenia, which leads to disturbances in glucose metabolism such as metabolic syndrome. Alternatively, shared underlying factors may be responsible for the co-occurrence of immune system and glucose metabolism disturbances in schizophrenia.
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Affiliation(s)
- Johann Steiner
- Department of Psychiatry, University of Magdeburg, Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany.
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van der Leeuw C, Marcelis M, Peeters SCT, Verbeek MM, Menheere PPCA, de Haan L, van Os J, van Beveren NJM. Replicated evidence of absence of association between serum S100B and (risk of) psychotic disorder. PLoS One 2013; 8:e82535. [PMID: 24358202 PMCID: PMC3866164 DOI: 10.1371/journal.pone.0082535] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 10/24/2013] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND S100B is a potential marker of neurological and psychiatric illness. In schizophrenia, increased S100B levels, as well as associations with acute positive and persisting negative symptoms, have been reported. It remains unclear whether S100B elevation, which possibly reflects glial dysfunction, is the consequence of disease or compensatory processes, or whether it is an indicator of familial risk. METHODS Serum samples were acquired from two large independent family samples (n = 348 and n = 254) in the Netherlands comprising patients with psychotic disorder (n = 140 and n = 82), non-psychotic siblings of patients with psychotic disorder (n = 125 and n = 94) and controls (n = 83 and n = 78). S100B was analyzed with a Liaison automated chemiluminescence system. Associations between familial risk of psychotic disorder and S100B were examined. RESULTS Results showed that S100B levels in patients (P) and siblings (S) were not significantly different from controls (C) (dataset 1: P vs. C: B = 0.004, 95% CI -0.005 to 0.013, p = 0.351; S vs. C: B = 0.000, 95% CI -0.009 to 0.008, p = 0.926; and dataset 2: P vs. C: B = 0.008, 95% CI -0.011 to 0.028, p = 0.410; S vs. C: B = 0.002, 95% CI -0.016 to 0.021, p = 0.797). In patients, negative symptoms were positively associated with S100B (B = 0.001, 95% CI 0.000 to 0.002, p = 0.005) in one of the datasets, however with failure of replication in the other. There was no significant association between S100B and positive symptoms or present use or type of antipsychotic medication. CONCLUSIONS S100B is neither an intermediate phenotype, nor a trait marker for psychotic illness.
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Affiliation(s)
- Christine van der Leeuw
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- * E-mail:
| | - Sanne C. T. Peeters
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marcel M. Verbeek
- Departments of Neurology and Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Paul P. C. A. Menheere
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lieuwe de Haan
- Deparment of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
| | - Nico J. M. van Beveren
- Departments of Psychiatry and Neuroscience, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department “Nieuwe Kennis”, Delta Centre for Mental Health Care, Rotterdam, The Netherlands
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Wu X, Huang Z, Wu R, Zhong Z, Wei Q, Wang H, Diao F, Wang J, Zheng L, Zhao J, Zhang J. The comparison of glycometabolism parameters and lipid profiles between drug-naïve, first-episode schizophrenia patients and healthy controls. Schizophr Res 2013; 150:157-62. [PMID: 23998954 DOI: 10.1016/j.schres.2013.07.051] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 07/18/2013] [Accepted: 07/28/2013] [Indexed: 11/26/2022]
Abstract
To compare the difference in body mass index (BMI), waist-to-hip ratio (WHR), and glucose and lipid metabolism parameters between drug-naïve, first-episode schizophrenia patients and healthy controls matched for age, ethnicity and gender, we conducted a test including BMI, WHR, and fasting glucose and lipid metabolism parameters in both 70 drug-naïve, first-episode schizophrenia patients, having not a single day of cumulative exposure to antipsychotic medications and 44 normal healthy controls at baseline. Student's t tests (two tailed) were conducted to examine between group differences. We found that drug-naïve first-episode schizophrenia patients had higher insulin, insulin resistance and C-peptide levels, and had lower total cholesterol (TC), high density lipoprotein cholesterol (HDL-c) and apolipoproteinA1 levels. Simultaneously, drug-naïve, first-episode schizophrenia patients show a potential tendency of WHR enlargement, although there were no statistically significant differences between groups (mean=0.82, SD=0.06, for the patients versus mean=0.79, SD=0.06, for the health subjects). These results suggest that drug-naïve, first-episode schizophrenia patients do differ from healthy controls in their fasting glycometabolism parameters and lipid profiles, including fasting plasma levels of insulin, C-peptide, TC, HDL-c, and apolipoproteinA1, and patients are more insulin resistant before the onset of antipsychotic medication treatment.
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Affiliation(s)
- Xiaoli Wu
- Mental Health Institute of The Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan 410011, PR China; Psychiatry Department, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, PR China
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Harris LW, Guest PC, Wayland MT, Umrania Y, Krishnamurthy D, Rahmoune H, Bahn S. Schizophrenia: metabolic aspects of aetiology, diagnosis and future treatment strategies. Psychoneuroendocrinology 2013; 38:752-66. [PMID: 23084727 DOI: 10.1016/j.psyneuen.2012.09.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 09/12/2012] [Accepted: 09/12/2012] [Indexed: 10/27/2022]
Abstract
Despite decades of research, the pathophysiology and aetiology of schizophrenia remains incompletely understood. The disorder is frequently accompanied by metabolic symptoms including dyslipidaemia, hyperinsulinaemia, type 2 diabetes and obesity. These symptoms are a common side effect of currently available antipsychotic medications. However, reports of metabolic dysfunction in schizophrenia predate the antipsychotic era and have also been observed in first onset patients prior to antipsychotic treatment. Here, we review the evidence for abnormalities in metabolism in schizophrenia patients, both in the central nervous system and periphery. Molecular analysis of post mortem brain tissue has pointed towards alterations in glucose metabolism and insulin signalling pathways, and blood-based molecular profiling analyses have demonstrated hyperinsulinaemia and abnormalities in secretion of insulin and co-released factors at first presentation of symptoms. Nonetheless, such features are not observed for all subjects with the disorder and not all individuals with such abnormalities suffer the symptoms of schizophrenia. One interpretation of these data is the presence of an underlying metabolic vulnerability in a subset of individuals which interacts with environmental or genetic factors to produce the overt symptoms of the disorder. Further investigation of metabolic aspects of schizophrenia may prove critical for diagnosis, improvement of existing treatment based on patient stratification/personalised medicine strategies and development of novel antipsychotic agents.
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Affiliation(s)
- Laura W Harris
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Tennis Court Road, Cambridge, United Kingdom.
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Chaggar PS, Shaw SM, Williams SG. Effect of Antipsychotic Medications on Glucose and Lipid Levels. J Clin Pharmacol 2013; 51:631-8. [DOI: 10.1177/0091270010368678] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Papanastasiou E. The prevalence and mechanisms of metabolic syndrome in schizophrenia: a review. Ther Adv Psychopharmacol 2013; 3:33-51. [PMID: 23983991 PMCID: PMC3736963 DOI: 10.1177/2045125312464385] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Metabolic syndrome (MetS), a constellation of central obesity, hypertension, dyslipidaemia and glucose intolerance, is highly prevalent in individuals with schizophrenia and conveys significant cardiovascular risk and mortality. Associated risk factors are female sex, some ethnic groups, advanced age, long duration of illness, smoking and exposure to antipsychotic agents. The prevalence of MetS varies across countries and psychiatric populations, and its development can be very rapid. Regular monitoring of all features of MetS is the cornerstone of its early detection and management. Future research needs to focus more on genetic determinants of MetS in the context of schizophrenic illness. This review aims to update the reader with the latest knowledge about the prevalence of MetS in schizophrenia and what might be the underlying pathophysiological mechanisms.
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Affiliation(s)
- Evangelos Papanastasiou
- CSI Lab, Department of Psychosis Studies, Institute of Psychiatry, KCL, De Crespigny Park, PO63, Denmark Hill, Camberwell, London SE5 8AF, UK
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The prevalence of diabetes mellitus is increased in relatives of patients with a non-affective psychotic disorder. Schizophr Res 2013; 143:354-7. [PMID: 23245702 DOI: 10.1016/j.schres.2012.11.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 10/31/2012] [Accepted: 11/01/2012] [Indexed: 11/22/2022]
Abstract
Patients with schizophrenia are more likely to develop diabetes mellitus (DM) compared to the general population. In relatives, however, an increased rate of DM has not consistently been reported. In this study, we compared DM rates in 1740 unaffected first- and second-/third-degree relatives of patients with a non-affective psychotic disorder to 1271 control subjects, by administering the Family Interview for Genetic Studies (FIGS). The prevalence of DM (6.1%) was increased in the relatives of patients as compared to the relatives of the healthy subjects (3.6%, OR=1.6, p=0.007). Our findings support the hypothesis of a familial, possibly genetic, link between DM and non-affective psychotic disorders.
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Abstract
The metabolic syndrome (MetS) is an increasingly prevalent condition in people with schizophrenia. It remains highly prevalent in the general population in developed countries, but recently health promotion campaigns and greater awareness of the high associated mortality rates have resulted in improvements in the rates of cardiovascular risk factors. This is not the case for people with schizophrenia who continue to have more than twice the rates of MetS and significantly higher mortality rates than the general population. Various behavioural and pharmacological interventions have been used to improve conditions that are linked to MetS, mainly smoking and obesity. This review aims to provide an update of the latest knowledge about the behavioural, pharmacological and other interventions that might help to combat this life-threatening problem in people with schizophrenia.
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Affiliation(s)
- Evangelos Papanastasiou
- CSI Lab, Department of Psychosis Studies, Institute of Psychiatry, KCL, De Crespigny Park, PO63, Denmark Hill, London SE5 8AF, UK
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Genetic correlates of medical comorbidity associated with schizophrenia and treatment with antipsychotics. Curr Opin Psychiatry 2012; 25:381-90. [PMID: 22842659 DOI: 10.1097/yco.0b013e3283568537] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW High comorbidity rates for various medical conditions have been documented in schizophrenia, being explained by factors either inherent to the disease or associated with antipsychotic treatment. The aim of this study is to review the genetic factors contributing to medical comorbidity in schizophrenia. RECENT FINDINGS Based on clinical genetic studies in schizophrenia, comorbid impaired glucose tolerance/type 2 diabetes mellitus, most autoimmune disorders and cardiac autonomic dysregulation have the strongest evidence for familial predisposition. Similarly, of antipsychotic-induced adverse drug reactions, tardive dyskinesia, neuroleptic malignant syndrome, and antipsychotic-induced weight gain have some evidence for familial clustering. On the molecular genetic level, schizophrenia seems to share specific genes with type 2 diabetes mellitus and with autoimmune disorders. Various genes have been proposed to account for the reduced incidence of rheumatoid arthritis and cancer in schizophrenic patients and their relatives. Many pharmacogenetic association studies have pinpointed numerous, though often contradictory or poorly replicated, genes of modest effect size for tardive dyskinesia, neuroleptic malignant syndrome, clozapine-induced agranulocytosis, hyperprolactinaemia, antipsychotic-induced weight gain, and antipsychotic-induced QT prolongation. SUMMARY Unravelling the genetic underpinnings of medical comorbidity associated with schizophrenia and its treatment is expected to highlight new pathogenetic pathways in both schizophrenia and comorbid medical conditions, and introduce personalized treatment strategies for schizophrenia patients.
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