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Holmberg C, Torgerson J, Gremyr A. Elevated pulse pressure and its associations with demographic and clinical parameters in a clinically representative sample of outpatients with psychotic disorders. BJPsych Open 2022; 8:e79. [PMID: 35388791 PMCID: PMC9059612 DOI: 10.1192/bjo.2022.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Elevated pulse pressure is associated with metabolic and neurocognitive diseases. Preliminary small-scale studies among patients with psychotic disorders have indicated that these patients had an increased pulse pressure compared with controls. However, it is unclear whether and how these associations are manifested among larger heterogenous samples of patients with psychotic disorders. We examined elevated pulse pressure and its associations with demographic and clinical characteristics in a clinically representative sample of outpatients with psychotic disorders (n = 1289). In a subsample (n = 343), we also examined associations with six domains of functioning. Controlling for age and cardiovascular disease, body mass index (BMI) and employment status independently predicted the odds ratio of having elevated pulse pressure. Elevated pulse pressure was also primarily associated with the physical domains of functioning. Outpatients with psychotic disorders that have high BMI and are unemployed thus seem to be at increased risk for elevated pulse pressure and should therefore be particularly considered for blood pressure screenings.
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Affiliation(s)
- Christopher Holmberg
- Department of Psychotic Disorders, Sahlgrenska University Hospital, and Department of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Jarl Torgerson
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Gremyr
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, and Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
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Tan XW, Chan CYW, Lum AWM, Lee ES, Mok YM, Fung DSS, Tor PC. Association of cardiovascular metabolic risk factor measurements with psychiatric readmission among in-hospital patients with severe mental illness: a retrospective study. BMC Psychiatry 2022; 22:43. [PMID: 35042498 PMCID: PMC8767705 DOI: 10.1186/s12888-022-03704-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with severe mental illness (SMI) and comorbid physical conditions were often associated with higher risks of mortality and hospital readmission. In this study, we aim to examine the association of cardiovascular metabolic risk factor measurements with risks of psychiatric readmissions among in-hospital patients with severe mental illness (SMI). METHODS We collected the longitudinal information of laboratory investigations, blood pressure and body mass index (BMI) among in-hospital patients who had been diagnosed with schizophrenia, major depression disorder or bipolar disorder and with comorbid diagnosis of hypertension, hyperlipidemia or diabetes from Jan 2014 to Jan 2019. The primary outcome was time to first psychiatric readmission. Cox proportional hazard model was utilized to calculate the hazard risks (HR) of cardiovascular metabolic risk factors with psychiatric readmission. RESULTS A total of 5,256 patients were included in the analysis. Compared to patients with normal blood parameters, patients with aberrant tests of high-density dyslipidemia (HDL) and diastolic blood pressure (DBP) during in-hospitalization period were associated with higher risks to first psychiatric readmission [ HR (Hazard Ratio), 1.37 95% Confidence interval (CI), 1.03-1.83 for HDL and HR, 1.32 (95% CI, 1.04-1.67])for DBP]. Compared to patients with optimal monitoring, patients with suboptimal monitoring of blood lipids and blood pressure during in-hospitalization period or recommended window period of cardiovascular disease (CVD) risk management were associated with higher risks to first psychiatric readmission. CONCLUSIONS Aberrant cardiovascular metabolic blood test and blood pressure and missing measurements among in-hospital patients with SMI were associated with increased risks of psychiatric readmissions. This calls for more active screening and monitoring of CVD risk factors for those in-hospital patients in need.
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Affiliation(s)
- Xiao Wei Tan
- Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Christopher Yi Wen Chan
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Alvin Wai Mum Lum
- grid.414752.10000 0004 0469 9592Medical Care Service, Institute of Mental Health, Singapore, 539747 Singapore
| | - Eng Sing Lee
- grid.466910.c0000 0004 0451 6215Clinical Research Unit, National Healthcare Group Polyclinics, Singapore, 138543 Singapore ,grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technology University of Singapore, Singapore, 308232 Singapore
| | - Yee Ming Mok
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Graduate Medical School, Singapore, 169857 Singapore
| | - Daniel Shuen Sheng Fung
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore ,grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technology University of Singapore, Singapore, 308232 Singapore
| | - Phern Chern Tor
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Graduate Medical School, Singapore, 169857 Singapore
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Correlations between age, biomedical variables, and cognition in patients with schizophrenia. Schizophr Res Cogn 2020; 22:100182. [PMID: 32577406 PMCID: PMC7303996 DOI: 10.1016/j.scog.2020.100182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To illustrate the influence of clinical variables on cognition performance in patients with schizophrenia (SCZ). Methods Using the 66nao Brain Training device (a novel measurement tool), the cognitive performance of 99 patients with SCZ was evaluated. Patients were diagnosed by the ICD-10 diagnostic criteria for SCZ, and their age were 16–68 years old. Furthermore, we explored the relationship between age, biomedical variables and specific cognitive domains in patients with SCZ. Patients were divided into two groups: various of cognitive domains impairment group and non-impairment group according to the norm scores. All data were analyzed using RStudio Version 1.0.44 (RStudio, Inc.) Results Patients with SCZ had obvious cognitive impairment in total and five subdomains of cognitive function. We found that 1) SCZ patients with impaired cognitive total score experienced significant older age and longer illness duration compared with those with normal cognitive total score. 2) SCZ patients with impaired memory experienced significant older age compared with those with normal memory. 3) SCZ patients with impaired attention showed significant lower serum triglyceride (TG) level compared with those with normal attention. 4) SCZ patients with impaired flexibility performed significant longer illness duration compared with those with normal flexibility. 5) SCZ patients with impaired cognitive agility performed significant older age, longer duration, and higher systolic blood pressure (SBP) compared with those with normal cognitive agility. 6) The age, illness duration and SBP in patients with impaired time perception were marginally different from those of subjects with normal time perception. Conclusion There are five dimensions (memory, attention, flexibility, cognitive agility, and time perception) of cognitive dysfunction in SCZ patients. Age, illness duration, TG, and SBP might play vital roles in various subdomains of the cognitive deficits respectively in patients with SCZ.
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Silverstein SM, Fradkin SI, Demmin DL. Schizophrenia and the retina: Towards a 2020 perspective. Schizophr Res 2020; 219:84-94. [PMID: 31708400 PMCID: PMC7202990 DOI: 10.1016/j.schres.2019.09.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Differences between people with schizophrenia and psychiatrically healthy controls have been consistently demonstrated on measures of retinal function such as electroretinography (ERG), and measures of retinal structure such as optical coherence tomography (OCT). Since our 2015 review of this literature, multiple new studies have been published using these techniques. At the same time, the accumulation of data has highlighted the "fault lines" in these fields, suggesting methodological considerations that need greater attention in future studies. METHODS We reviewed studies of ERG and OCT in schizophrenia, as well as data from studies whose findings are relevant to interpreting these papers, such as those on effects of the following on ERG and OCT data: comorbid medical conditions that are over-represented in schizophrenia, smoking, antipsychotic medication, substance abuse, sex and gender, obesity, attention, motivation, and influences of brain activity on retinal function. RESULTS Recent ERG and OCT studies continue to support the hypothesis of retinal structural and functional abnormalities in schizophrenia, and suggest that these are relevant to understanding broader aspects of pathophysiology, neurodevelopment, and neurodegeneration in this disorder. However, there are differences in findings which suggest that the effects of multiple variables on ERG and OCT data need further clarification. CONCLUSIONS The retina, as the only component of the CNS that can be imaged directly in live humans, has potential to clarify important aspects of schizophrenia. With greater attention to specific methodological issues, the true potential of ERG and OCT as biomarkers for important clinical phenomena in schizophrenia should become apparent.
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Affiliation(s)
- Steven M Silverstein
- Rutgers University Behavioral Health Care, United States; Rutgers University, Robert Wood Johnson Medical School, Departments of Psychiatry and Ophthalmology, United States.
| | | | - Docia L Demmin
- Rutgers University, Department of Psychology, United States.
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Abstract
BACKGROUND Differences between people with schizophrenia and psychiatrically healthy controls have been consistently demonstrated on measures of retinal function such as electroretinography (ERG), and measures of retinal structure such as optical coherence tomography (OCT). Since our 2015 review of this literature, multiple new studies have been published using these techniques. At the same time, the accumulation of data has highlighted the "fault lines" in these fields, suggesting methodological considerations that need greater attention in future studies. METHODS We reviewed studies of ERG and OCT in schizophrenia, as well as data from studies whose findings are relevant to interpreting these papers, such as those on effects of the following on ERG and OCT data: comorbid medical conditions that are over-represented in schizophrenia, smoking, antipsychotic medication, substance abuse, sex and gender, obesity, attention, motivation, and influences of brain activity on retinal function. RESULTS Recent ERG and OCT studies continue to support the hypothesis of retinal structural and functional abnormalities in schizophrenia, and suggest that these are relevant to understanding broader aspects of pathophysiology, neurodevelopment, and neurodegeneration in this disorder. However, there are differences in findings which suggest that the effects of multiple variables on ERG and OCT data need further clarification. CONCLUSIONS The retina, as the only component of the CNS that can be imaged directly in live humans, has potential to clarify important aspects of schizophrenia. With greater attention to specific methodological issues, the true potential of ERG and OCT as biomarkers for important clinical phenomena in schizophrenia should become apparent.
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Grover S, R P, Sahoo S, Gopal S, Nehra R, Ganesh A, Raghavan V, Sankaranarayan A. Relationship of metabolic syndrome and neurocognitive deficits in patients with schizophrenia. Psychiatry Res 2019; 278:56-64. [PMID: 31146142 DOI: 10.1016/j.psychres.2019.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 01/23/2023]
Abstract
This study aimed to evaluate the association of the metabolic syndrome (MS) and its components with neurocognition among patients with schizophrenia. 121 patients with schizophrenia from an outpatient service of two psychiatric centers were assessed on a neurocognitive battery and by metabolic measures. More than half (56.2%) of the patients fulfilled the consensus criteria for MS. After controlling/adjusting for various covariates (age, education in years, duration of illness, age of onset, Positive and Negative Symptom scale score and presence of smoking status), it was found that compared to patients without MS, those with MS had significantly poorer performance "in the cognitive domains" of cognitive processing and selective attention (Stroop effect percentile; p value 0.002; effect size-0.45) and auditory and verbal memory (AVLT; p value <0.001; effect size 0.68). Patients with a higher number of abnormal parameters of MS had poorer functioning in the domains of cognitive processing and selective attention, auditory and verbal memory, and executive tasks. To conclude, this two center study suggests that MS has a negative impact on neurocognition in patients with schizophrenia. There is a need to identify and monitor metabolic abnormalities among patients with schizophrenia to minimize the negative effect of metabolic parameters on neurocognition.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
| | - Padmavati R
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | | | - Ritu Nehra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Arthi Ganesh
- Schizophrenia Research Foundation (SCARF), Chennai, India
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VGF has Roles in the Pathogenesis of Major Depressive Disorder and Schizophrenia: Evidence from Transgenic Mouse Models. Cell Mol Neurobiol 2019; 39:721-727. [PMID: 31037515 DOI: 10.1007/s10571-019-00681-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/25/2019] [Indexed: 12/22/2022]
Abstract
Mental disorders, such as major depressive disorder and schizophrenia, are complex multigenetic conditions, but focused studies of single genes might reveal genes involved in the pathogenesis of mental disorders, including major depressive disorder and schizophrenia. Several candidate genes have been identified using transgenic mice. VGF nerve growth factor inducible (VGF) is a neuropeptide expression of which is induced by nerve growth factor (NGF). VGF is robustly and exclusively synthesized in neuronal and neuroendocrine cells. In central nervous system (CNS), VGF is extensively expressed especially in the cerebral cortex, hippocampus, and hypothalamus. VGF has many roles in the CNS, such as promotion of synaptic plasticity, neurogenesis, and neurite outgrowth. In clinical studies, altered expression and genetic mutations of VGF have been reported in patients with major depressive disorder and schizophrenia. On this basis, studies using transgenic mice to overexpress or knockout VGF have been performed to investigate the roles of upregulation or downregulation of VGF. In this review, we will discuss studies of the roles of VGF using transgenic mice and its relevance to pathologies in major depressive disorder and schizophrenia.
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Moody G, Miller BJ. Total and differential white blood cell counts and hemodynamic parameters in first-episode psychosis. Psychiatry Res 2018; 260:307-312. [PMID: 29223800 DOI: 10.1016/j.psychres.2017.11.086] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
Abstract
There is evidence for blood inflammatory abnormalities in patients with first-episode psychosis (FEP). The monocyte- and neutrophil-to-lymphocyte ratios (MLR; NLR) are markers of inflammation and endothelial dysfunction, and predictors of cardiovascular disease, the leading cause of death in schizophrenia. We investigated relationships between white blood cell (WBC) counts and hemodynamic parameters associated with cardiovascular disease risk in 25 subjects age 18-50 hospitalized for FEP and 44 controls. Subjects had a blood draw, vital signs, and medical history. Patients with FEP had significantly higher NLR, MLR, pulse pressure, and rate pressure product (RPP) than controls (p < 0.05 for each), after controlling for potential confounders. In linear regression analyses, higher monocytes were a significant predictor of higher pulse pressure (p = 0.033) and higher MLR predicted RPP at the trend level (p = 0.051) in FEP, after controlling for potential confounders. To our knowledge, ours is the first report of increased RPP, a measure of myocardial workload, in FEP. We also replicated findings of increased NLR, MLR and pulse pressure in FEP. Our findings underscore that measurement of routine vital signs and blood total and differential WBC counts are germane to the clinical care of patients with psychosis as markers of cardiovascular disease risk.
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Affiliation(s)
- Grant Moody
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Brian J Miller
- Department of Psychiatry and Health Behavior, Augusta University, 997 Saint Sebastian Way, Augusta, GA 30912, USA.
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