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Zhou C, Tang X, Yu M, Zhang H, Zhang X, Gao J, Zhang X, Chen J. Convergent and divergent genes expression profiles associated with brain-wide functional connectome dysfunction in deficit and non-deficit schizophrenia. Transl Psychiatry 2024; 14:124. [PMID: 38413564 PMCID: PMC10899251 DOI: 10.1038/s41398-024-02827-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 02/29/2024] Open
Abstract
Deficit schizophrenia (DS) is a subtype of schizophrenia characterized by the primary and persistent negative symptoms. Previous studies have identified differences in brain functions between DS and non-deficit schizophrenia (NDS) patients. However, the genetic regulation features underlying these abnormal changes are still unknown. This study aimed to detect the altered patterns of functional connectivity (FC) in DS and NDS and investigate the gene expression profiles underlying these abnormal FC. The study recruited 82 DS patients, 96 NDS patients, and 124 healthy controls (CN). Voxel-based unbiased brain-wide association study was performed to reveal altered patterns of FC in DS and NDS patients. Machine learning techniques were used to access the utility of altered FC for diseases diagnosis. Weighted gene co-expression network analysis (WGCNA) was employed to explore the associations between altered FC and gene expression of 6 donated brains. Enrichment analysis was conducted to identify the genetic profiles, and the spatio-temporal expression patterns of the key genes were further explored. Comparing to CN, 23 and 20 brain regions with altered FC were identified in DS and NDS patients. The altered FC among these regions showed significant correlations with the SDS scores and exhibited high efficiency in disease classification. WGCNA revealed associations between DS/NDS-related gene expression and altered FC. Additionally, 22 overlapped genes, including 12 positive regulation genes and 10 negative regulation genes, were found between NDS and DS. Enrichment analyses demonstrated relationships between identified genes and significant pathways related to cellular response, neuro regulation, receptor binding, and channel activity. Spatial and temporal gene expression profiles of SCN1B showed the lowest expression at the initiation of embryonic development, while DPYSL3 exhibited rapid increased in the fetal. The present study revealed different altered patterns of FC in DS and NDS patients and highlighted the potential value of FC in disease classification. The associations between gene expression and neuroimaging provided insights into specific and common genetic regulation underlying these brain functional changes in DS and NDS, suggesting a potential genetic-imaging pathogenesis of schizophrenia.
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Affiliation(s)
- Chao Zhou
- Department of Geriatric Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaowei Tang
- Department of Psychiatry, Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Miao Yu
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hongying Zhang
- Department of Radiology, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xiaobin Zhang
- Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ju Gao
- Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Jiu Chen
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, Jiangsu, China.
- Medical Imaging Center, the Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
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2
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Lv X, Hou YS, Zhang ZH, Yue WH. OXTR polymorphisms associated with severity and treatment responses of schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:7. [PMID: 38184684 PMCID: PMC10851696 DOI: 10.1038/s41537-023-00413-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/13/2023] [Indexed: 01/08/2024]
Abstract
The mechanisms generating specific symptoms of schizophrenia remain unclear and genetic research makes it possible to explore these issues at a fundamental level. Taking into account the associations between the oxytocin system and social functions, which are apparently impaired in schizophrenia patients, we hypothesized that the oxytocin receptor gene (OXTR) might be associated with schizophrenia symptoms in both severity and responses to antipsychotics and did this exploratory positional study. A total of 2363 patients with schizophrenia (1181 males and 1182 females) included in our study were randomly allocated to seven antipsychotic treatment groups and received antipsychotic monotherapy for 6 weeks. Their blood DNA was genotyped for OXTR polymorphisms. Their symptom severity was assessed by Positive and Negative Syndrome Scale (PANSS), and the scores were transformed into seven factors (positive, disorganized, negative symptoms apathy/avolition, negative symptoms deficit of expression, hostility, anxiety and depression). Percentage changes in PANSS scores from baseline to week 6 were calculated to quantify antipsychotic responses. We found that OXTR polymorphisms were nominally associated with the severity of overall symptoms (rs237899, β = 1.669, p = 0.019), hostility symptoms (rs237899, β = 0.427, p = 0.044) and anxiety symptoms (rs13316193, β = -0.197, p = 0.038). As for treatment responses, OXTR polymorphisms were nominally associated with the improvement in negative symptoms apathy/avolition (rs2268490, β = 2.235, p = 0.0499). No association between severity or response to treatment and OXTR polymorphisms was found with statistical correction for multiplicity. Overall, our results highlighted the possibility of nominally significant associations of the OXTR gene with the severity and improvement in schizophrenia symptoms. Given the exploratory nature of this study, these associations are indicative of the role of the OXTR gene in the pathology of schizophrenia and may contribute to further elucidate the mechanism of specific symptoms of schizophrenia and to exploit antipsychotics more effective to specific symptoms.
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Affiliation(s)
- Xue Lv
- The First Affiliated Hospital of Xinxiang Medical College, 453100, Xinxiang, Henan, China
| | - Yue-Sen Hou
- The First Affiliated Hospital of Xinxiang Medical College, 453100, Xinxiang, Henan, China
- Henan Key Laboratory of Neurorestoratology, 453199, Xinxiang, Henan, China
- Henan Engineering Research Center of Physical Diagnostics and Treatment Technology for the Mental and Neurological Diseases, 453005, Xinxiang, Henan, China
| | - Zhao-Hui Zhang
- The First Affiliated Hospital of Xinxiang Medical College, 453100, Xinxiang, Henan, China.
| | - Wei-Hua Yue
- Peking University Sixth Hospital, Peking University Institute of Mental Health, 100191, Beijing, China.
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Gao J, Jiang R, Tang X, Chen J, Yu M, Zhou C, Wang X, Zhang H, Huang C, Yang Y, Zhang X, Cui Z, Zhang X. A neuromarker for deficit syndrome in schizophrenia from a combination of structural and functional magnetic resonance imaging. CNS Neurosci Ther 2023; 29:3774-3785. [PMID: 37288482 PMCID: PMC10651988 DOI: 10.1111/cns.14297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023] Open
Abstract
AIM Deficit schizophrenia (DS), defined by primary and enduring negative symptoms, has been proposed as a promising homogeneous subtype of schizophrenia. It has been demonstrated that unimodal neuroimaging characteristics of DS were different from non-deficit schizophrenia (NDS), however, whether multimodal-based neuroimaging features could identify deficit syndrome remains to be determined. METHODS Functional and structural multimodal magnetic resonance imaging of DS, NDS and healthy controls were scanned. Voxel-based features of gray matter volume, fractional amplitude of low-frequency fluctuations, and regional homogeneity were extracted. The support vector machine classification models were constructed using these features separately and jointly. The most discriminative features were defined as the first 10% of features with the greatest weights. Moreover, relevance vector regression was applied to explore the predictive values of these top-weighted features in predicting negative symptoms. RESULTS The multimodal classifier achieved a higher accuracy (75.48%) compared with the single modal model in distinguishing DS from NDS. The most predictive brain regions were mainly located in the default mode and visual networks, exhibiting differences between functional and structural features. Further, the identified discriminative features significantly predicted scores of diminished expressivity factor in DS but not NDS. CONCLUSIONS The present study demonstrated that local properties of brain regions extracted from multimodal imaging data could distinguish DS from NDS with a machine learning-based approach and confirmed the relationship between distinctive features and the negative symptoms subdomain. These findings may improve the identification of potential neuroimaging signatures and improve the clinical assessment of the deficit syndrome.
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Affiliation(s)
- Ju Gao
- Institute of Mental HealthSuzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow UniversitySuzhouChina
- Department of Geriatric PsychiatryNanjing Brain Hospital Affiliated to Nanjing Medical UniversityNanjingChina
| | - Rongtao Jiang
- Department of Radiology & Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Xiaowei Tang
- Department of PsychiatryWutaishan Hospital of YangzhouYangzhouChina
| | - Jiu Chen
- Department of Geriatric PsychiatryNanjing Brain Hospital Affiliated to Nanjing Medical UniversityNanjingChina
| | - Miao Yu
- Department of Geriatric PsychiatryNanjing Brain Hospital Affiliated to Nanjing Medical UniversityNanjingChina
| | - Chao Zhou
- Department of Geriatric PsychiatryNanjing Brain Hospital Affiliated to Nanjing Medical UniversityNanjingChina
| | - Xiang Wang
- Medical Psychological Institute of the Second Xiangya HospitalChangshaChina
| | - Hongying Zhang
- Department of RadiologySubei People's Hospital of Jiangsu ProvinceYangzhouChina
| | - Chengbing Huang
- Department of Geriatric PsychiatryNanjing Brain Hospital Affiliated to Nanjing Medical UniversityNanjingChina
- Department of PsychiatryHuai'an No. 3 People's HospitalHuai'anChina
| | - Yong Yang
- Institute of Mental HealthSuzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow UniversitySuzhouChina
| | - Xiaobin Zhang
- Institute of Mental HealthSuzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow UniversitySuzhouChina
| | - Zaixu Cui
- Chinese Institute for Brain ResearchBeijingChina
| | - Xiangrong Zhang
- Department of Geriatric PsychiatryNanjing Brain Hospital Affiliated to Nanjing Medical UniversityNanjingChina
- Department of PsychiatryThe Affiliated Xuzhou Oriental Hospital of Xuzhou Medical UniversityXuzhouChina
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4
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Wang Z, Ling Y, Wang Y, Zhu T, Gao J, Tang X, Yu M, Zhou C, Xu Y, Zhang X, Zhang X, Fang X. The Role of Two Factors of Negative Symptoms and Cognition on Social Functioning in Male Patients with Schizophrenia: A Mediator Model. Brain Sci 2023; 13:brainsci13020187. [PMID: 36831730 PMCID: PMC9953813 DOI: 10.3390/brainsci13020187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE This study aims to compare the cognitive function and social functioning in male patients with deficit syndrome (DS) and non-DS, and to explore whether cognitive function serves as a mediator in the relationship between the two factors of negative symptoms (motivation and pleasure (MAP) and expressivity (EXP) deficits, and social functioning in schizophrenia patients. METHODS One hundred and fifty-six male patients with schizophrenia and 109 age- and education-matched normal controls were enrolled in the current study. The Chinese version of a Schedule for Deficit Syndrome (SDS) was used for DS and non-DS categorization. The Brief Psychiatric Rating Scale (BPRS) and the Brief Negative Symptoms Scale (BNSS) were used to assess psychotic and negative symptoms in patients. The Social-Adaptive Functioning Evaluation (SAFE) was adopted to evaluate patients' social functioning, and a battery of classical neurocognitive tests was used to assess cognition, including sustained vigilance/attention, cognitive flexibility, ideation fluency, and visuospatial memory. RESULTS We found that male patients with DS performed worse in all four cognitive domains and social functioning compared to non-DS patients. Both total negative symptoms and its two factors were significantly associated with all four domains of cognition and social functioning in male patients. Interestingly, our results indicate that only cognitive flexibility mediates the relationship between negative symptoms and social functioning in schizophrenia patients, but there were no differences between EXP and MAP negative factors in this model. CONCLUSION Our findings suggest that DS patients may represent a unique clinical subgroup of schizophrenia, and the integrated interventions targeting both negative symptoms and cognition, especially cognitive flexibility, may optimally improve functional outcomes in schizophrenia patients.
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Affiliation(s)
- Zixu Wang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yuru Ling
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yu Wang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Tingting Zhu
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ju Gao
- Suzhou Guangji Hospital, Medical College of Soochow University, Suzhou 215008, China
| | - Xiaowei Tang
- Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou 225003, China
| | - Miao Yu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Chao Zhou
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yanmin Xu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan 430012, China
| | - Xiaobin Zhang
- Suzhou Guangji Hospital, Medical College of Soochow University, Suzhou 215008, China
- Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou 225003, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou 221004, China
- Correspondence: (X.Z.); (X.F.); Tel.: +86-025-82296259 (X.Z.); +86-025-82296099 (X.F.)
| | - Xinyu Fang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
- Correspondence: (X.Z.); (X.F.); Tel.: +86-025-82296259 (X.Z.); +86-025-82296099 (X.F.)
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5
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Quattrone D, Reininghaus U, Richards AL, Tripoli G, Ferraro L, Quattrone A, Marino P, Rodriguez V, Spinazzola E, Gayer-Anderson C, Jongsma HE, Jones PB, La Cascia C, La Barbera D, Tarricone I, Bonora E, Tosato S, Lasalvia A, Szöke A, Arango C, Bernardo M, Bobes J, Del Ben CM, Menezes PR, Llorca PM, Santos JL, Sanjuán J, Arrojo M, Tortelli A, Velthorst E, Berendsen S, de Haan L, Rutten BPF, Lynskey MT, Freeman TP, Kirkbride JB, Sham PC, O’Donovan MC, Cardno AG, Vassos E, van Os J, Morgan C, Murray RM, Lewis CM, Di Forti M. The continuity of effect of schizophrenia polygenic risk score and patterns of cannabis use on transdiagnostic symptom dimensions at first-episode psychosis: findings from the EU-GEI study. Transl Psychiatry 2021; 11:423. [PMID: 34376640 PMCID: PMC8355107 DOI: 10.1038/s41398-021-01526-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/16/2021] [Accepted: 06/30/2021] [Indexed: 12/22/2022] Open
Abstract
Diagnostic categories do not completely reflect the heterogeneous expression of psychosis. Using data from the EU-GEI study, we evaluated the impact of schizophrenia polygenic risk score (SZ-PRS) and patterns of cannabis use on the transdiagnostic expression of psychosis. We analysed first-episode psychosis patients (FEP) and controls, generating transdiagnostic dimensions of psychotic symptoms and experiences using item response bi-factor modelling. Linear regression was used to test the associations between these dimensions and SZ-PRS, as well as the combined effect of SZ-PRS and cannabis use on the dimensions of positive psychotic symptoms and experiences. We found associations between SZ-PRS and (1) both negative (B = 0.18; 95%CI 0.03-0.33) and positive (B = 0.19; 95%CI 0.03-0.35) symptom dimensions in 617 FEP patients, regardless of their categorical diagnosis; and (2) all the psychotic experience dimensions in 979 controls. We did not observe associations between SZ-PRS and the general and affective dimensions in FEP. Daily and current cannabis use were associated with the positive dimensions in FEP (B = 0.31; 95%CI 0.11-0.52) and in controls (B = 0.26; 95%CI 0.06-0.46), over and above SZ-PRS. We provide evidence that genetic liability to schizophrenia and cannabis use map onto transdiagnostic symptom dimensions, supporting the validity and utility of the dimensional representation of psychosis. In our sample, genetic liability to schizophrenia correlated with more severe psychosis presentation, and cannabis use conferred risk to positive symptomatology beyond the genetic risk. Our findings support the hypothesis that psychotic experiences in the general population have similar genetic substrates as clinical disorders.
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Affiliation(s)
- Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AF, London, UK. .,National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK. .,Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, 68159, Germany.
| | - Ulrich Reininghaus
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, 68159 Germany ,grid.13097.3c0000 0001 2322 6764Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK ,grid.412966.e0000 0004 0480 1382Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Alex L. Richards
- grid.5600.30000 0001 0807 5670Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, CF24 4HQ UK
| | - Giada Tripoli
- grid.10776.370000 0004 1762 5517Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129 Palermo, Italy
| | - Laura Ferraro
- grid.10776.370000 0004 1762 5517Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129 Palermo, Italy
| | - Andrea Quattrone
- National Health Care System, Villa Betania Psychological Institute, 89100 Reggio Calabria, Italy
| | - Paolo Marino
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Victoria Rodriguez
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Edoardo Spinazzola
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Charlotte Gayer-Anderson
- grid.13097.3c0000 0001 2322 6764Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Hannah E. Jongsma
- grid.83440.3b0000000121901201Psylife Group, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK ,grid.4494.d0000 0000 9558 4598Centre for Transcultural Psychiatry “Veldzicht” Balkbrug, the Netherlands, VR Mental Health Group, University Center for Psychiatry, Univerisity Medical Centre Groningen, Groningen, The Netherlands
| | - Peter B. Jones
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ UK ,grid.450563.10000 0004 0412 9303CAMEO Early Intervention Service, Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, CB21 5EF UK
| | - Caterina La Cascia
- National Health Care System, Villa Betania Psychological Institute, 89100 Reggio Calabria, Italy
| | - Daniele La Barbera
- National Health Care System, Villa Betania Psychological Institute, 89100 Reggio Calabria, Italy
| | - Ilaria Tarricone
- grid.6292.f0000 0004 1757 1758Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40126 Bologna, Italy
| | - Elena Bonora
- grid.6292.f0000 0004 1757 1758Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40126 Bologna, Italy
| | - Sarah Tosato
- grid.5611.30000 0004 1763 1124Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Antonio Lasalvia
- grid.5611.30000 0004 1763 1124Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Andrei Szöke
- grid.7429.80000000121866389INSERM, U955, Equipe 15, 51 Avenue de Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Celso Arango
- grid.4795.f0000 0001 2157 7667Child and Adolescent Psychiatry Department, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Miquel Bernardo
- grid.5841.80000 0004 1937 0247Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Department of Medicine, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Julio Bobes
- grid.10863.3c0000 0001 2164 6351Faculty of Medicine and Health Sciences - Psychiatry, Universidad de Oviedo, ISPA, INEUROPA. CIBERSAM, Oviedo, Spain
| | - Cristina Marta Del Ben
- grid.11899.380000 0004 1937 0722Neuroscience and Behavior Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Paulo Rossi Menezes
- grid.11899.380000 0004 1937 0722Department of Preventative Medicine, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
| | - Pierre-Michel Llorca
- grid.494717.80000000115480420University Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, F-63000 Clermont-Ferrand, France
| | - Jose Luis Santos
- grid.413507.40000 0004 1765 7383Department of Psychiatry, Servicio de Psiquiatría Hospital “Virgen de la Luz,”, Cuenca, Spain
| | - Julio Sanjuán
- grid.5338.d0000 0001 2173 938XDepartment of Psychiatry, School of Medicine, Universidad de Valencia, Centro de Investigación Biomédica en Red de Salud Mental, Valencia, Spain
| | - Manuel Arrojo
- grid.411048.80000 0000 8816 6945Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago, Spain
| | | | - Eva Velthorst
- grid.7177.60000000084992262Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands ,grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Steven Berendsen
- grid.7177.60000000084992262Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Lieuwe de Haan
- grid.7177.60000000084992262Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Bart P. F. Rutten
- grid.412966.e0000 0004 0480 1382Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Michael T. Lynskey
- grid.13097.3c0000 0001 2322 6764National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 4 Windsor Walk, London, SE5 8BB UK
| | - Tom P. Freeman
- grid.13097.3c0000 0001 2322 6764National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 4 Windsor Walk, London, SE5 8BB UK ,grid.7340.00000 0001 2162 1699Department of Psychology, University of Bath, 10 West, Bath, BA2 7AY UK
| | - James B. Kirkbride
- grid.83440.3b0000000121901201Psylife Group, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Pak C. Sham
- grid.194645.b0000000121742757Department of Psychiatry, the University of Hong Kong, Pok Fu Lam, Hong Kong ,grid.194645.b0000000121742757Centre for Genomic Sciences, Li KaShing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Michael C. O’Donovan
- grid.5600.30000 0001 0807 5670Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, CF24 4HQ UK
| | - Alastair G. Cardno
- grid.9909.90000 0004 1936 8403Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9NL UK
| | - Evangelos Vassos
- grid.13097.3c0000 0001 2322 6764Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF, London, UK ,grid.13097.3c0000 0001 2322 6764National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King’s College London, London, UK
| | - Jim van Os
- grid.412966.e0000 0004 0480 1382Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands ,grid.7692.a0000000090126352Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Craig Morgan
- grid.13097.3c0000 0001 2322 6764Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Robin M. Murray
- grid.10776.370000 0004 1762 5517Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129 Palermo, Italy ,grid.13097.3c0000 0001 2322 6764National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King’s College London, London, UK
| | - Cathryn M. Lewis
- grid.13097.3c0000 0001 2322 6764Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF, London, UK ,grid.13097.3c0000 0001 2322 6764National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King’s College London, London, UK
| | - Marta Di Forti
- grid.13097.3c0000 0001 2322 6764Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF, London, UK ,grid.13097.3c0000 0001 2322 6764National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King’s College London, London, UK
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Lyngstad SH, Bettella F, Aminoff SR, Athanasiu L, Andreassen OA, Faerden A, Melle I. Associations between schizophrenia polygenic risk and apathy in schizophrenia spectrum disorders and healthy controls. Acta Psychiatr Scand 2020; 141:452-464. [PMID: 32091622 DOI: 10.1111/acps.13167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Apathy is a central predictor of a poor functional outcome in schizophrenia. Schizophrenia polygenic risk scores (PRSs) are used to detect genetic associations to key clinical phenotypes in schizophrenia. We explored the associations between schizophrenia PRS and apathy levels in schizophrenia spectrum disorders (n = 281) and matched healthy controls (n = 298), and further how schizophrenia PRS contributed in predicting apathy when added to premorbid and clinical factors in the patient sample. METHOD Schizophrenia PRSs were computed for each participant. Apathy was assessed with the Apathy Evaluation Scale. Bivariate correlation analyses were used to investigate associations between schizophrenia PRS and apathy, and between apathy and premorbid and clinical factors. Multiple hierarchical regression analyses were employed to evaluate the contributions of clinical variables and schizophrenia PRS to apathy levels. RESULTS We found no significant associations between schizophrenia PRS and apathy in patients and healthy controls. Several premorbid and clinical characteristics significantly predicted apathy in patients, but schizophrenia PRS did not. CONCLUSION Since the PRSs are based on common genetic variants, our results do not preclude associations to other types of genetic factors. The results could also indicate that environmentally based biological or psychological factors contribute to apathy levels in schizophrenia.
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Affiliation(s)
- S H Lyngstad
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - F Bettella
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - S R Aminoff
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - L Athanasiu
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - O A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - A Faerden
- Division of Mental Health and Addiction, Department of Acute Psychiatry, Oslo University Hospital, Oslo, Norway
| | - I Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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7
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Liu J, He J, Cheng M, Cao H, Zhang X. Prevalence, Sociodemographic, and Clinical Correlates of Older Chinese Patients With Deficit Schizophrenia. J Geriatr Psychiatry Neurol 2019; 32:298-303. [PMID: 31480981 DOI: 10.1177/0891988719870321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE No study has investigated the frequency and risk factors for deficit schizophrenia (DS) in Chinese Han population. We investigated the prevalence of DS among community-dwelling older Chinese patients with schizophrenia and examined the sociodemographic and clinical correlates of DS in this population. METHODS A total of 326 community-dwelling older patients with schizophrenia were recruited in this cross-sectional study. Deficit schizophrenia was confirmed using the Chinese version of the Schedule for the Deficit Syndrome. Data pertaining to sociodemographic and clinical characteristics were collected. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS). RESULTS The prevalence of DS in the study population was 26.7% (31.2% among male patients and 21.6% among female patients with schizophrenia). Patients with DS had significantly higher current smoking rate, hospitalizations, PANSS negative score, PANSS total score, and had earlier age at onset than patients with non-deficit schizophrenia (N-DS). The N-DS patients had higher PANSS positive scores and a greater proportion of married patients. Multiple logistic regression analysis indicated that negative PANSS score (odds ratio [OR] = 1.10, 95% confidence interval [CI] = 1.04-1.16, P < .001), male sex (OR = 1.71, 95% CI = 1.53-1.91, P = .037), age at onset (OR = 0.88, 95% CI = 0.82-0.94, P = .035), and current smoking (OR = 1.37, 95% CI = 1.15-1.63, P = .041) were independently associated with DS. CONCLUSION Deficit schizophrenia is relatively common among older community-dwelling Chinese patients with schizophrenia. High negative symptom scores, male sex, early onset, and smoking were independent correlates for DS.
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Affiliation(s)
- Junjun Liu
- 1 Department of Psychiatry, Nanjing Meishan Hospital, Nanjing, Jiangsu Province, China
| | - Jinfeng He
- 2 Department of Gastroenterology, Nanjing Meishan Hospital, Nanjing, Jiangsu Province, China
| | - Min Cheng
- 3 Department of Pharmacy, Nanjing Meishan Hospital, Nanjing, Jiangsu Province, China
| | - Hui Cao
- 4 Yuhuatai District Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Xiangrong Zhang
- 5 Department of Clinical Psychology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
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8
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Zhou C, Yu M, Tang X, Wang X, Zhang X, Zhang X, Chen J. Convergent and divergent altered patterns of default mode network in deficit and non-deficit schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:427-434. [PMID: 30367960 DOI: 10.1016/j.pnpbp.2018.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Previous studies suggested likely mechanisms underlying the dysfunction of the default mode network (DMN) in schizophrenia. However, altered patterns of the intrinsic activity of the DMN in both deficit schizophrenia (DS) and non-deficit schizophrenia (NDS) patients, as well as the neurocognitive relationships among them, remain unknown. This study explores the resting-state characteristics of the DMN activity in both DS and NDS patients, and further investigates correlations with neurocognitive features. METHODS Demographic, resting-state functional MRI, and neurocognitive data were collected in 37 DS and 38 NDS patients, as well as in 38 matched healthy control subjects (HCs). Independent component analysis was conducted to investigate the characteristics of DMN activity and to further distinguish between common and specific altered regions. In addition, partial correlation analysis was conducted to examine associations between the activity of altered regions and neurocognitive assessments. RESULTS Overlapping altered brain activity was observed in both DS and NDS patients in the left middle frontal gyrus (MFG), the left angular gyrus (ANG), and the calcarine sulcus (CAL) region. Furthermore, compared to HCs, DS patients showed less activity in the right inferior temporal gyrus, the right para-hippocampal gyrus / hippocampus (PHP / HIP), and the left precuneus (PCUN), while they showed increased activity in the posterior cingulate cortex (PCC). Notably, NDS patients showed less activity in the bilateral middle occipital gyrus. Correlation analysis indicated that, in the DS group, both Trail Making Test (TMT)-B and spatial processing scores were positively associated with the activities of the left PCUN and the right PHP / HIP, while the Stroop color scores were negatively associated with PCC activity. In the NDS group, the TMT-B scores were associated with activities of the left MFG and CAL regions, while the scores of the Wechsler adult intelligence scale (Chinese revision) were negatively associated with CAL region activity. CONCLUSION The present study demonstrates convergent and divergent altered patterns of the DMN in both DS and NDS patients. Importantly, the specific altered regions of the DMN in DS patients may be associated with extensive deficient neurocognition, indicating novel insights into the pathogenesis of cognitive impairment in schizophrenia.
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Affiliation(s)
- Chao Zhou
- Department of Geriatric Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Miao Yu
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiaowei Tang
- Department of Geriatric Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China; Department of Psychiatry, Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu 225003, China
| | - Xiang Wang
- Medical Psychological Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Xiaobin Zhang
- Department of Psychiatry, Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu 225003, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| | - Jiu Chen
- Institute of Neuropsychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Institute of Brain Functional Imaging, Nanjing Medical University, Nanjing, Jiangsu, 210029, China.
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9
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Ahmed AO, Strauss GP, Buchanan RW, Kirkpatrick B, Carpenter WT. Schizophrenia heterogeneity revisited: Clinical, cognitive, and psychosocial correlates of statistically-derived negative symptoms subgroups. J Psychiatr Res 2018; 97:8-15. [PMID: 29156414 DOI: 10.1016/j.jpsychires.2017.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 11/07/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
Abstract
Traditional efforts to delineate the clinical heterogeneity of schizophrenia have been unsuccessful because of the absence of a valid, stable, and meaningful subtyping scheme. A clinically-informed nosology supported by multivariate statistical classification methods may provide a better approach for classifying schizophrenia. The goals of the current study were to 1) use multivariate classification methods to validate a clinical subtyping scheme based on the profile of negative symptoms; and 2) following validation to contrast the statistically-derived subgroups to ascertain distinguishing demographic, clinical, cognitive, and functional characteristics. In the current study, 706 people with schizophrenia completed measures of positive and negative symptoms, premorbid adjustment, cognition, and psychosocial functioning. Latent class analysis served to identify the number of negative symptom subgroups in schizophrenia. Next, statistical classification methods-Bayes Theorem and the Base Rate Classification Technique-were used to assign participants into the identified subgroups. Subgroups were compared on external validation variables not used in the classification process via logistic regression and discriminant function analysis. Latent class analysis supported a three-class model of schizophrenia that included deficit, persistent, and transient negative symptom subgroups. Posthoc comparisons showed that demographic characteristics, positive symptoms, premorbid adjustment, and cognitive profiles can distinguish the schizophrenia subgroups with moderate accuracy. The deficit subgroup had the greatest impairments in psychosocial functioning and quality of life variables. Findings suggest that schizophrenia encapsulates qualitatively distinct negative symptom subgroups that differ in their demographic, symptomatic, neuropsychological, and functional profiles. Schizophrenia heterogeneity reflects a combination of non-arbitrary subgroups and severity-based differences in negative symptoms.
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Affiliation(s)
| | | | - Robert W Buchanan
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, USA
| | - Brian Kirkpatrick
- Department of Psychiatry, University of Nevada School of Medicine, USA
| | - William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, USA
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10
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Whitwell S, Bramham J, Moriarty J. Simple schizophrenia or disorganisation syndrome? A case report and review of the literature. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.11.6.398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Simple schizophrenia is a sometimes controversial diagnosis. Here we review the concept with particular reference to its history in diagnostic systems. Using an illustrative real case of a 25-year-old man, we show that there is a need to retain this diagnostic category, which may fit better within proposed dimensional (psychomotor poverty, disorganisation and reality distortion) rather than categorical classifications of schizophrenia. Symptoms of the disorder may be better revealed by functional assessment than by relying on descriptive psychopathology.
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11
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Dickinson D, Pratt DN, Giangrande EJ, Grunnagle M, Orel J, Weinberger DR, Callicott JH, Berman KF. Attacking Heterogeneity in Schizophrenia by Deriving Clinical Subgroups From Widely Available Symptom Data. Schizophr Bull 2018; 44:101-113. [PMID: 28369611 PMCID: PMC5768050 DOI: 10.1093/schbul/sbx039] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Previous research has identified (1) a "deficit" subtype of schizophrenia characterized by enduring negative symptoms and diminished emotionality and (2) a "distress" subtype associated with high emotionality-including anxiety, depression, and stress sensitivity. Individuals in deficit and distress categories differ sharply in development, clinical course and behavior, and show distinct biological markers, perhaps signaling different etiologies. We tested whether deficit and distress subtypes would emerge from a simple but novel data-driven subgrouping analysis, based on Positive and Negative Syndrome Scale (PANSS) negative and distress symptom dimensions, and whether subgrouping was informative regarding other facets of behavior and brain function. PANSS data, and other assessments, were available for 549 people with schizophrenia diagnoses. Negative and distress symptom composite scores were used as indicators in 2-step cluster analyses, which divided the sample into low symptom (n = 301), distress (n = 121), and deficit (n = 127) subgroups. Relative to the low-symptom group, the deficit and distress subgroups had comparably higher total PANSS symptoms (Ps < .001) and were similarly functionally impaired (eg, global functioning [GAF] Ps < .001), but showed markedly different patterns on symptom, cognitive and personality variables, among others. Initial analyses of functional magnetic resonance imaging (fMRI) data from a 182-participant subset of the full sample also suggested distinct patterns of neural recruitment during working memory. The field seeks more neuroscience-based systems for classifying psychiatric conditions, but these are inescapably behavioral disorders. More effective parsing of clinical and behavioral traits could identify homogeneous target groups for further neural system and molecular studies, helping to integrate clinical and neuroscience approaches.
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Affiliation(s)
- Dwight Dickinson
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD,To whom correspondence should be addressed; 10 Center Drive, Building 10, Room 3c-115, Bethesda, MD 20814, US; tel: 301-451-2123, fax: 301-480-7795, e-mail:
| | - Danielle N Pratt
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Evan J Giangrande
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - MeiLin Grunnagle
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Jennifer Orel
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Daniel R Weinberger
- The Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD
| | - Joseph H Callicott
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Karen F Berman
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
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12
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Yu M, Dai Z, Tang X, Wang X, Zhang X, Sha W, Yao S, Shu N, Wang X, Yang J, Zhang X, Zhang X, He Y, Zhang Z. Convergence and Divergence of Brain Network Dysfunction in Deficit and Non-deficit Schizophrenia. Schizophr Bull 2017; 43:1315-1328. [PMID: 29036672 PMCID: PMC5737538 DOI: 10.1093/schbul/sbx014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Deficit schizophrenia (DS), characterized by primary and enduring negative symptoms, has been considered as a pathophysiologically distinct schizophrenic subgroup. Neuroimaging characteristics of DS, especially functional brain network architecture, remain largely unknown. Resting-state functional magnetic resonance imaging and graph theory approaches were employed to investigate the topological organization of whole-brain functional networks of 114 male participants including 33 DS, 41 non-deficit schizophrenia (NDS) and 40 healthy controls (HCs). At the whole-brain level, both the NDS and DS group exhibited lower local efficiency (Eloc) than the HC group, implying the reduction of local specialization of brain information processing (reduced functional segregation). The DS, but not NDS group, exhibited enhanced parallel information transfer (enhanced functional integration) as determined by smaller characteristic path length (Lp) and higher global efficiency (Eglob). The Lp and Eglob presented significant correlations with Brief Psychiatric Rating Scale (BPRS) total score in the DS group. At the nodal level, both the NDS and DS groups showed higher functional connectivity in the inferior frontal gyrus and hippocampus, and lower connectivity in the visual areas and striatum than the controls. The DS group exhibited higher nodal connectivity in the right inferior temporal gyrus than the NDS and HC group. The diminished expression of Scale for the Assessment of Negative Symptoms (SANS) subfactors negatively correlated with nodal connectivity of right putamen, while asociality/amotivation positively correlated with right hippocampus across whole patients. We highlighted the convergence and divergence of brain functional network dysfunctions in patients with DS and NDS, which provides crucial insights into pathophysiological mechanisms of the 2 schizophrenic subtypes.
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Affiliation(s)
- Miao Yu
- Department of Neuropsychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhengjia Dai
- Department of Psychology, Sun Yat-sen University, Guangzhou, China,State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Xiaowei Tang
- Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, China
| | - Xiang Wang
- Medical Psychological Institute of the Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaobin Zhang
- Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, China
| | - Weiwei Sha
- Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, China
| | - Shuqiao Yao
- Medical Psychological Institute of the Second Xiangya Hospital, Central South University, Changsha, China
| | - Ni Shu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Xindi Wang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Jiaying Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, China
| | - Xiangyang Zhang
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Xiangrong Zhang
- Department of Neuropsychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China,Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China,To whom correspondence should be addressed; Department of Neuropsychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, No.87 DingJiaQiao Road, Nanjing 210009, China; tel: 0086-25-822906586, fax:0086-25-83719457, e-mail:
| | - Yong He
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Zhijun Zhang
- Department of Neuropsychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China,Beijing Institute for Brain Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
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13
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Bucci P, Mucci A, Piegari G, Nobile M, Pini S, Rossi A, Vita A, Galderisi S, Maj M. Characterization of premorbid functioning during childhood in patients with deficit vs. non-deficit schizophrenia and in their healthy siblings. Schizophr Res 2016; 174:172-176. [PMID: 26825584 DOI: 10.1016/j.schres.2016.01.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 01/05/2016] [Accepted: 01/14/2016] [Indexed: 01/08/2023]
Abstract
Impaired premorbid adjustment has been reported in patients with schizophrenia, generally in association with unfavorable aspects of the illness (e.g., poor outcome and severe negative symptoms). Several studies attempted to define the domains of premorbid dysfunction associated with negative symptoms and poor outcome; however, most of them assessed broadly defined negative symptoms. The present study was aimed to characterize premorbid functioning in a group of patients with deficit schizophrenia (DS), characterized by the presence of at least two primary and persistent negative symptoms (PPNS), and one of patients with a diagnosis of schizophrenia who did not meet criteria for DS (NDS). The presence of emotional/behavioral problems during childhood was investigated using the Childhood Behavior Checklist (CBCL) in both patient groups and in their respective healthy siblings. The Premorbid Adjustment Scale (PAS) was also used to assess premorbid functioning during childhood in the two patient groups. PPNS were also treated as a continuous variable and correlated with the indices of premorbid functioning regardless the DS/NDS categorization. DS patients, as compared to NDS, showed higher scores on the CBCL subscale "Withdrawn". Both DS and NDS patients showed, as compared to their healthy siblings, a greater impairment on almost all CBCL subscales. PAS findings revealed that DS patients had poorer premorbid adjustment than NDS. No significant correlation between premorbid functioning and PPNS was observed. These findings support the hypothesis that DS has a different developmental trajectory with respect to NDS, and that premorbid adjustment is one of the essential aspects of its characterization.
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Affiliation(s)
- Paola Bucci
- Department of Psychiatry, University of Naples SUN, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Naples SUN, Italy
| | | | - Maria Nobile
- Eugenio Medea Scientific Institute, Child Psychiatry Department, Bosisio Parini, LC, Italy
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Italy
| | - Alessandro Rossi
- Institute of Experimental Medicine-Section of Psychiatry, University of L'Aquila, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | | | - Mario Maj
- Department of Psychiatry, University of Naples SUN, Italy
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14
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Gallagher BJ, Jones BJ. Neglect and hereditary risk: Their relative contribution to schizophrenia with negative symptomatology. Int J Soc Psychiatry 2016; 62:235-42. [PMID: 26842730 DOI: 10.1177/0020764015623974] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is evidence that genetic and environmental stressors contribute to the genesis of schizophrenia. However, the relevant impact of each factor remains unclear. We tested for an interactive effect between childhood neglect and family history of serious mental illness. Data were further analyzed for a possible connection to type of schizophrenic symptoms. SAMPLING/METHODS Data for the study are taken from the medical records of 641 patients with schizophrenia from a large state hospital in the northeastern United States. Clinical assessments were divided into positive and negative symptomatology through application of the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS) and the Positive and Negative Syndrome Scale (PANSS). Detailed information about childhood neglect and family history of serious mental illness was obtained through Social Service Assessment interviews at intake and during hospital stay. RESULTS Among clients with no family history of mental illness, childhood neglect does not meaningfully affect the risk of negative versus positive schizophrenia. For clients with such history, on the other hand, neglect significantly raises the risk of schizophrenia with negative symptomatology. CONCLUSION Our central finding is that risk for negative symptoms of schizophrenia are elevated by childhood neglect combined with a history of serious mental illness within the family. This is the only report to combine schizophrenic symptoms, familial risk and childhood neglect to date. Implications for primary prevention and treatment are discussed.
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Affiliation(s)
- Bernard J Gallagher
- Department of Sociology and Criminology, Villanova University, Villanova, PA, USA
| | - Brian J Jones
- Department of Sociology and Criminology, Villanova University, Villanova, PA, USA
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15
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Yu M, Tang X, Wang X, Zhang X, Zhang X, Sha W, Yao S, Shu N, Zhang X, Zhang Z. Neurocognitive Impairments in Deficit and Non-Deficit Schizophrenia and Their Relationships with Symptom Dimensions and Other Clinical Variables. PLoS One 2015; 10:e0138357. [PMID: 26381645 PMCID: PMC4575183 DOI: 10.1371/journal.pone.0138357] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/28/2015] [Indexed: 11/18/2022] Open
Abstract
Background Deficit schizophrenia (DS) has been proposed as a pathophysiologically distinct subgroup within schizophrenia. Earlier studies focusing on neurocognitive function of DS patients have yielded inconsistent findings ranging from substantial deficits to no significant difference relative to non-deficit schizophrenia patients (NDS). The present study investigated the severity and characteristic patterns of neurocognitive impairments in DS and NDS patients and their relationships with clinical variables. Methods Attention, ideation fluency, cognitive flexibility and visuospatial memory function were assessed in 40 DS patients, 57 NDS patients, and 52 healthy controls by a comprehensive neuropsychological battery. Results Both schizophrenia subgroups had overall more severe cognitive impairments than controls while DS performed worse on every neuropsychological measure except the Stroop interference than the NDS patients with age and education as the covariates. Profile analysis found significantly different patterns of cognitive profiles between two patients group mainly due to their differences in attention and cognitive flexibility functions. Age, education, illness duration and negative symptoms were found to have the correlations with cognitive impairments in the NDS group, while only age and the negative symptoms were correlated with the cognitive impairments in the DS group. Multiple regression analyses revealed that sustained attention and cognitive flexibility were the core impaired cognitive domains mediating other cognitive functions in DS and NDS patients respectively. Conclusions DS patients exemplified worse in almost all cognitive domains than NDS patients. Sustained attention and cognitive flexibility might be the key impaired cognitive domains for DS and NDS patients respectively. The present study suggested the DS as a specific subgroup of schizophrenia.
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Affiliation(s)
- Miao Yu
- Department of Neuropsychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - XiaoWei Tang
- Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, Jiangsu, China
| | - Xiang Wang
- Medical Psychological Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - XiangRong Zhang
- Department of Neuropsychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
- * E-mail: (XRZ); (ZJZ)
| | - XiaoBin Zhang
- Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, Jiangsu, China
| | - WeiWei Sha
- Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, Jiangsu, China
| | - ShuQiao Yao
- Medical Psychological Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ni Shu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - XiangYang Zhang
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States of America
| | - ZhiJun Zhang
- Department of Neuropsychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- * E-mail: (XRZ); (ZJZ)
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16
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Ahmed AO, Strauss GP, Buchanan RW, Kirkpatrick B, Carpenter WT. Are Negative Symptoms Dimensional or Categorical? Detection and Validation of Deficit Schizophrenia With Taxometric and Latent Variable Mixture Models. Schizophr Bull 2015; 41:879-91. [PMID: 25399026 PMCID: PMC4466177 DOI: 10.1093/schbul/sbu163] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Studies have supported the validity of the deficit form of schizophrenia (ie, people with primary and enduring negative symptoms). A test of whether that group is a true taxon-that is, a distinct, discontinuous group-has yet to be conducted and the underlying structure of negative symptoms as categorical or dimensional remains undetermined. The present study examined the latent structure of negative and deficit symptoms to determine if a nonarbitrary boundary distinguishes deficit from nondeficit forms of schizophrenia (ie, whether these symptoms reflect a continuous or categorical variable). Schedule for the Deficit Syndrome ratings of 789 individuals with a psychotic disorder were submitted to taxometric and latent variable mixture analyses to test categorical vs dimensional hypotheses of negative symptoms and deficit schizophrenia. Analytic models favored a taxonic structure of negative symptoms and the validity of the deficit/nondeficit classification scheme. Taxometric classification outperformed clinician-based deficit/nondeficit classification in its association with summer birth, male sex, premorbid adjustment, neurocognition, and psychosocial functioning. Within taxon and complement classes, severity scores remained significant predictors of premorbid adjustment, neurocognition, and psychosocial functioning. Thus, although a categorical approach is validated, a hybrid categorical-dimensional conceptualization of negative symptoms also has validity for the prediction of external variables.
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Affiliation(s)
- Anthony O. Ahmed
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY;,Department of Psychiatry and Health Behavior, Medical College of Georgia, Georgia Regents University, Augusta, GA;,*To whom correspondence should be addressed; Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, US; tel: 914-997-5251, fax: 914-682-6906, e-mail:
| | | | - Robert W. Buchanan
- Department of Psychiatry;,Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Brian Kirkpatrick
- Department of Psychiatry, University of Nevada School of Medicine, Reno, NV
| | - William T. Carpenter
- Department of Psychiatry;,Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
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17
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Executive functioning and psychopathological profile in relatives of individuals with deficit v. non-deficit schizophrenia: a pilot study. Epidemiol Psychiatr Sci 2014; 23:85-97. [PMID: 23545096 PMCID: PMC6998377 DOI: 10.1017/s2045796013000140] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aims. Heterogeneity of schizophrenia is known to be reflected in neuropsychological functioning of patients, but its expression in relatives is understudied. This study aims at exploring relationship between executive functioning and clinical profiles of first-degree relatives of patients who are classified as having or not having the deficit subtype of schizophrenia (DSRELs v. non-DSRELs), with the prediction of greater executive impairment in DSRELs. Methods. DSRELs (n = 15) and non-DSRELs (n = 40) were compared with community controls (CCs, n = 55) on executive functioning measured by the Wisconsin Card Sorting Test (WCST) and the phonemic verbal fluency (PVF), and clinical measures. Effects of psychopathology and intelligence quotient (IQ) measures were investigated to determine their association with executive performance. Results. DSRELs showed more executive dysfunction on WCST and poorer social functioning than CCs and more severe negative symptoms than non-DSRELs. Differences on WCST-categories achieved (WCST-CA) remained significant after adjustment for clinical confounders and IQ. WCST-CA was associated with apathy and paranoid ideation only within the DSREL subgroup. Conclusions. Executive functioning and negative symptoms are severely impaired in first-degree relatives of deficit syndrome patients, thus suggesting that some neurocognitive deficits in patients may be transmitted within families according to the pathophysiology of the probands.
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Abstract
A selective review of the negative symptoms of schizophrenia is an appropriate article to result from the festschrift honoring William T. Carpenter Jr, as he has made substantial contributions in this area. This review assesses progress in 3 areas in which he has been an important investigator: the distinction between primary vs secondary negative symptoms; the appropriate design for treatment trials; and the nosology of negative symptoms.
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Affiliation(s)
- Brian Kirkpatrick
- *To whom correspondence should be addressed; Department of Psychiatry and Behavioral Sciences, University of Nevada School of Medicine,1664 North Virginia Street, Mail Stop 0354, Reno, NV 89557-0354, US; tel: 775-682-8449, fax: 775-784-1428, e-mail:
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19
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Gershon ES, Badner JA. Incorporation of molecular data and redefinition of phenotype: new approaches to genetic epidemiology of bipolar manic depressive illness and schizophrenia. DIALOGUES IN CLINICAL NEUROSCIENCE 2012. [PMID: 22034205 PMCID: PMC3181639 DOI: 10.31887/dcns.2001.3.1/esgershon] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Considerable advances have been made in identifying specific genetic components of bipolar manic depressive illness (BP) and schizophrenia (SZ), despite their complex inheritance. Meta-analysis of all published whole-genome linkage scans reveals overall support for illness genes in several chromosomal regions. In two of these regions, on the lonq arm of chromosome 13 and on the long arm of chromosome 22, the combined studies of BP and SZ are consistent with a common susceptibility locus for the two disorders. This lends some plausibility to the hypothesis of some shared genetic predispositions for BP and SZ. Other linkages are supported by multiple studies of specific chromosomal regions, most notably two regions on chromosome 6 in SZ. The velocardiofacial syndrome is associated with deletions very close to the linkage region on chromosome 22, and with psychiatric manifestations of both BP and SZ. Endophenotypes of SZ, previously demonstrated to be heritable, have been found to have chromosomal linkage in at least one study. These include eye-tracking abnormalities linked to the short arm of chromosome 6, and abnormality of the P50 cortical evoked potential linked to chromosome 15. Variants in specific genes have been associated with susceptibility to illness, and other genes have been associated with susceptibility to side effects of pharmacological treatment. These genetic findings may eventually be part of an integrated genetic, environmental, and interactive-factor epidemiology of the major mental illnesses.
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Affiliation(s)
- E S Gershon
- Department of Psychiatry, University of Chicago, Chicago, III, USA
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20
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Garcia-Rizo C, Fernandez-Egea E, Oliveira C, Justicia A, Bernardo M, Kirkpatrick B. Inflammatory markers in antipsychotic-naïve patients with nonaffective psychosis and deficit vs. nondeficit features. Psychiatry Res 2012; 198:212-5. [PMID: 22405656 PMCID: PMC3374916 DOI: 10.1016/j.psychres.2011.08.014] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 07/07/2011] [Accepted: 08/24/2011] [Indexed: 12/20/2022]
Abstract
Newly diagnosed, antipsychotic-naïve patients with nonaffective psychosis appear to have increases in pro-inflammatory cytokines. Patients characterized by primary, enduring negative symptoms (deficit symptoms) differ from patients without such features with regard to course of illness, treatment response, risk factors and metabolic disturbances. We hypothesized that they would also differ on concentrations of the inflammatory markers interleukin-6 (IL6) and C-reactive protein (CRP). Newly diagnosed, antipsychotic-naïve patients with nonaffective psychosis were categorized into deficit (N=20) and nondeficit (N=42) groups, and were matched on age, gender, body mass index, smoking, cortisol level, socioeconomic status, and the severity of psychotic symptoms. Fasting concentrations of IL6 were significantly higher in deficit (mean [S.D.]) (8.0 pg/ml [12.7]) than nondeficit patients (0.3 pg/ml [1.3]). CRP levels were also significantly higher in the deficit patients (0.3 mg/dl [0.4]) vs. (0.2 mg/dl [0.4]), respectively. In contrast, 2-h glucose concentrations (2HG) in a glucose tolerance test were lower in the deficit than the nondeficit group. Our results show a double dissociation with regard to glucose intolerance and inflammation: the deficit group has greater inflammation, but less severe glucose intolerance. These results provide further evidence for the validity of the deficit/nondeficit categorization.
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Affiliation(s)
- Clemente Garcia-Rizo
- Schizophrenia Program, Department of Psychiatry, Neuroscience Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
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21
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Carpenter WT. The facts of schizophrenia: a personal commentary. Schizophr Res 2011; 128:3-4. [PMID: 21458240 DOI: 10.1016/j.schres.2011.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 03/01/2011] [Indexed: 11/28/2022]
Affiliation(s)
- William T Carpenter
- Maryland Psychiatric Research Center, VA Capitol Network (VISN 5) MIRECC, University of Maryland School of Medicine, USA
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22
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Keller WR, Fischer BA, Carpenter WT. Revisiting the diagnosis of schizophrenia: where have we been and where are we going? CNS Neurosci Ther 2011; 17:83-8. [PMID: 21199450 PMCID: PMC6493851 DOI: 10.1111/j.1755-5949.2010.00229.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Appropriate and reliable classification of mental illness is crucial for advancing the field of psychiatry as agreement on diagnosis has broad implications for treatment of mental disorders and research into the etiopathophysiology of mental disorders. Since schizophrenia was first recognized by Kraepelin (as dementia praecox), there has been much discussion about what does and does not diagnostically constitute the disorder. The importance placed upon different symptoms and course types associated with schizophrenia has been as heterogeneous as the disorder itself. This article focuses upon the classification of schizophrenia over the last 100 years, the current diagnosis of schizophrenia, changes for schizophrenia planned in the upcoming DSM 5, future directions for improving the diagnosis of schizophrenia, and the implications of a new diagnostic paradigm for the illness.
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Affiliation(s)
- William R Keller
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
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23
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Bowins B. A cognitive regulatory control model of schizophrenia. Brain Res Bull 2011; 85:36-41. [PMID: 21329746 DOI: 10.1016/j.brainresbull.2011.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 12/28/2010] [Accepted: 02/07/2011] [Indexed: 01/15/2023]
Abstract
A puzzling aspect of schizophrenia concerns the relationship between negative and positive symptoms. Perspectives suggesting that they arise from the same pathophysiological process are not consistent with the numerous differences such as treatment response, and the underlying neurochemistry relevant to treatment. Explanations viewing negative and positive symptoms as independent processes or diseases cannot readily account for the typical developmental course of schizophrenia, consisting of a lengthy prodromal phase of negative followed by positive symptoms. A model of schizophrenia is presented positing that negative and positive symptoms are distinct but interrelated processes, with the former bringing forth the latter due to damaged or impaired cognitive regulatory control processes. The extensive cognitive distortions, thought form variants, and sensory perceptual experiences comprising psychosis represent a natural propensity derived from the evolution of human intelligence. To facilitate reality congruency typically necessary for adaptive functioning, cognitive regulatory control processes normally prevent these extreme variants from entering the conscious and awake state. During sleep when there is no need for reality congruency the cognitive regulatory control processes are deactivated and psychotic equivalents are expressed. Psychological defensive functioning can also deactivate these processes and allow psychosis to manifest. The negative symptoms of schizophrenia are seen as arising from diverse neural deficits that impair to varying degrees the cognitive regulatory control processes, thus producing psychosis. The pattern of neural damage determines the negative symptom profile, and the impact on cognitive regulatory control processes influences whether negative or positive symptoms dominate or exist in relatively equal proportions.
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24
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Galderisi S, Maj M. Deficit schizophrenia: an overview of clinical, biological and treatment aspects. Eur Psychiatry 2009; 24:493-500. [PMID: 19553087 DOI: 10.1016/j.eurpsy.2009.03.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 03/18/2009] [Accepted: 03/19/2009] [Indexed: 10/20/2022] Open
Abstract
The concept of deficit schizophrenia is regarded as one of the most promising attempts to reduce heterogeneity within schizophrenia. This paper summarizes the clinical, neurocognitive, brain imaging and electrophysiological correlates of this subtype of schizophrenia. Attempts to identify genetic and non-genetic risk factors are reviewed. Methodological limitations of studies supporting the efficacy of atypical antipsychotics in the treatment of the syndrome are highlighted. Two decades of research on deficit schizophrenia have failed to prove that it represents the extreme end of a severity continuum in schizophrenia, while some findings support the claim that it may be a separate disease entity.
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Affiliation(s)
- S Galderisi
- Department of Psychiatry, Medical School, University of Naples SUN, Largo Madonna delle Grazie, Naples, Italy.
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25
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Kirkpatrick B, Fernandez-Egea E, Garcia-Rizo C, Bernardo M. Differences in glucose tolerance between deficit and nondeficit schizophrenia. Schizophr Res 2009; 107:122-7. [PMID: 19046857 PMCID: PMC2665916 DOI: 10.1016/j.schres.2008.09.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 09/17/2008] [Accepted: 09/18/2008] [Indexed: 10/21/2022]
Abstract
Some studies suggest that schizophrenia is associated with an increased risk of diabetes independently of antipsychotic use. People with deficit schizophrenia, which is characterized by primary (or idiopathic), enduring negative symptoms, differ from those with nondeficit schizophrenia on course of illness, treatment response, risk factors, and biological correlates. We hypothesized that deficit and nondeficit subjects would also differ with regard to glucose tolerance. Newly diagnosed, antipsychotic-naïve subjects with nonaffective psychosis and matched control subjects were administered a 75 g oral glucose tolerance test (GTT). Two-hour glucose concentrations were significantly higher in the nondeficit patients (N=23; mean [SD] of 121.6 [42.0]) than in deficit (N=23; 100.2 [23.1]) and control subjects (N=59; 83.8 [21.9]); the deficit subjects also had significantly higher two-hour glucose concentrations than did the control subjects. These results provide further support that the deficit group has a distinctive etiopathophysiology.
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Affiliation(s)
- Brian Kirkpatrick
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, Georgia 30912, USA.
| | - Emilio Fernandez-Egea
- Department of Psychiatry, Cambridge University, United Kingdom, Cambridgeshire & Peterborough Mental Health Trust, United Kingdom
| | - Clemente Garcia-Rizo
- Schizophrenia Program, Department of Psychiatry, Neuroscience Institute Hospital Clinic, Barcelona, Spain
| | - Miguel Bernardo
- Schizophrenia Program, Department of Psychiatry, Neuroscience Institute Hospital Clinic, Barcelona, Spain, Institute of Biomedical Research Agusti Pi i Sunyer (IDIBAPS), Barcelona, Spain
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26
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Cardno AG, Rijsdijk FV, Murray RM, McGuffin P. Twin study refining psychotic symptom dimensions as phenotypes for genetic research. Am J Med Genet B Neuropsychiatr Genet 2008; 147B:1213-21. [PMID: 18384051 DOI: 10.1002/ajmg.b.30756] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We investigated which psychotic symptom dimensions are likely to be most useful as phenotypes for genetic linkage and association studies. Two hundred twenty-four probandwise twin pairs (106 monozygotic,118 same-sex dizygotic), where probands had psychosis, were ascertained from the Maudsley Twin Register in London. Dimensions were defined as ordinal symptom scores using the OPCRIT checklist, based on previous factor analyses of this and other samples. To qualify as a potentially useful phenotype, dimensions had to show (a) a satisfactory polychoric model fit and significant within-pair correlation in MZ pairs concordant for DSM-III-R psychosis and (b) that they could not be better defined in terms of other combinations of relevant symptoms, single symptoms, or dichotomized dimension scores. Relationships between dimension scores in twin probands and risk of psychosis in co-twins were also investigated. None of the positive or negative dimensions satisfied the phenotypic criteria. The disorganized dimensions showed significant and substantial correlations which maximized for a narrow definition. Combined negative/disorganized dimensions also showed significant and substantial correlations, but did not have advantages over disorganized dimensions. None of the dimensions were significant predictors of psychosis risk in co-twins. We conclude that, of the dimensions analyzed, the narrow disorganized dimension shows most promise as a phenotype for molecular genetic research.
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Affiliation(s)
- Alastair G Cardno
- Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, Leeds, UK.
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27
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Galderisi S, Quarantelli M, Volpe U, Mucci A, Cassano GB, Invernizzi G, Rossi A, Vita A, Pini S, Cassano P, Daneluzzo E, De Peri L, Stratta P, Brunetti A, Maj M. Patterns of structural MRI abnormalities in deficit and nondeficit schizophrenia. Schizophr Bull 2008; 34:393-401. [PMID: 17728266 PMCID: PMC2632416 DOI: 10.1093/schbul/sbm097] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Negative symptoms of schizophrenia have generally been found in association with ventricular enlargement and prefrontal abnormalities. These relationships, however, have not been observed consistently, most probably because negative symptoms are heterogeneous and result from different pathophysiological mechanisms. The concept of deficit schizophrenia (DS) was introduced by Carpenter et al to identify a clinically homogeneous subgroup of patients characterized by the presence of primary and enduring negative symptoms. Findings of brain structural abnormalities reported by magnetic resonance imaging (MRI) studies focusing on DS have been mixed. The present study included 34 patients with DS, 32 with nondeficit schizophrenia (NDS), and 31 healthy comparison subjects, providing the largest set of MRI findings in DS published so far. The Schedule for the Deficit Syndrome was used to categorize patients as DS or NDS patients. The 2 patient groups were matched on age and gender and did not differ on clinical variables, except for higher scores on the negative dimension and more impaired interpersonal relationships in DS than in NDS subjects. Lateral ventricles were larger in NDS than in control subjects but were not enlarged in patients with DS. The cingulate gyri volume was smaller in NDS but not in DS patients as compared with healthy subjects. Both groups had smaller dorsolateral prefrontal cortex and temporal lobes than healthy subjects, but DS patients had significantly less right temporal lobe volume as compared with NDS patients. These findings do not support the hypothesis that DS is the extreme end of a severity continuum within schizophrenia.
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Affiliation(s)
- Silvana Galderisi
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy.
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28
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Hoogendoorn MLC, Vorstman JAS, Jalali GR, Selten JP, Sinke RJ, Emanuel BS, Kahn RS. Prevalence of 22q11.2 deletions in 311 Dutch patients with schizophrenia. Schizophr Res 2008; 98:84-8. [PMID: 17964762 PMCID: PMC2810966 DOI: 10.1016/j.schres.2007.09.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 09/08/2007] [Accepted: 09/18/2007] [Indexed: 11/30/2022]
Abstract
UNLABELLED The objectives of this study were 1) to examine whether the prevalence of 22q11.2 deletion syndrome (22q11DS) in schizophrenia patients with the Deficit syndrome is higher than the reported approximately 2% for the population of schizophrenia patients as a whole, and 2) to estimate the overall prevalence of 22q11DS among schizophrenia patients by combining all available studies. Our sample, enriched for patients with the Deficit syndrome, had 88% power to detect an estimated prevalence of 5% of 22q11.2 deletions. No 22q11.2 deletions were detected in 311 schizophrenia patients, 146 of whom met criteria for the Deficit syndrome. Our literature research revealed that in eight studies sixteen deletions were identified in 2133 patients with schizophrenia. This corresponds to a prevalence of 0.75% (95%CI: 0.5%-1.2%). IN CONCLUSION The prevalence of 22q11.2DS in schizophrenia patients with the Deficit syndrome is not higher than in the population of schizophrenia patients as a whole. The prevalence of 22q11.2DS in schizophrenia patients is lower than the frequently reported prevalence of 2% or more.
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Affiliation(s)
- Mechteld L C Hoogendoorn
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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29
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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30
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Allardyce J, Gaebel W, Zielasek J, van Os J. Deconstructing Psychosis conference February 2006: the validity of schizophrenia and alternative approaches to the classification of psychosis. Schizophr Bull 2007; 33:863-7. [PMID: 17548844 PMCID: PMC2632332 DOI: 10.1093/schbul/sbm051] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The DSM V planning process is currently underway and it has once again ignited the debate about the validity of the schizophrenia diagnosis. In this paper, we review the psychometric literature examining the evidence for discontinuity between schizophrenia and normality and the distinction between schizophrenia and other psychotic disorders. We conclude by proposing potential alternative approaches to refining the classification of psychosis.
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Affiliation(s)
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Heinrich-Heine-University, Rhineland State Clinics, Düsseldorf, Germany
| | - Jurgen Zielasek
- Department of Psychiatry and Psychotherapy, Heinrich-Heine-University, Rhineland State Clinics, Düsseldorf, Germany
| | - Jim van Os
- To whom correspondence should be addressed; tel: +31-43-3875-443, fax: + 31-43-3875-444, e-mail:
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Abstract
Persistent negative symptoms represent an alternative approach for assessing negative symptoms in the context of clinical trials. Persistent negative symptoms are designed to capture those symptoms that lead to functional impairment but are currently understudied and for which there are no currently available effective treatments. Persistent negative symptoms differ from the 2 most commonly used approaches: primary, enduring negative symptoms or deficit symptoms and negative symptoms broadly defined to include negative symptoms, regardless of their etiology or duration. In contrast to deficit symptoms, persistent negative symptoms may include secondary negative symptoms. However, in contrast to negative symptoms broadly defined, the secondary negative symptoms included in the assessment of persistent negative symptoms only include those that have failed to respond to usual treatments for secondary negative symptoms. In consequence, the presence of persistent negative symptoms identifies a patient population with clinically relevant symptomatology, which is larger than the one with the deficit syndrome but less heterogeneous than that captured through the use of a nonrestrictive definition of negative symptoms. This may facilitate the selection of subjects for inclusion into research and efforts to develop new pharmacological treatments and enhance our understanding of a relevant clinical problem. Ultimately, the investigation of the different entities characterized by negative symptoms, such as persistent negative symptoms, and the enhanced understanding of their biological and clinical characteristics may help to unravel the psychopathological and biological heterogeneity of schizophrenia.
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Affiliation(s)
- Robert W Buchanan
- Department of Psychiatry, University of Maryland, School of Medicine, Maryland Psychiatry Research Center, PO Box 21247, Baltimore, MD 21228, USA.
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32
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Bakker SC, Hoogendoorn MLC, Hendriks J, Verzijlbergen K, Caron S, Verduijn W, Selten JP, Pearson PL, Kahn RS, Sinke RJ. ThePIP5K2AandRGS4genes are differentially associated with deficit and non-deficit schizophrenia. GENES BRAIN AND BEHAVIOR 2007; 6:113-9. [PMID: 17410640 DOI: 10.1111/j.1601-183x.2006.00234.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Several putative schizophrenia susceptibility genes have recently been reported, but it is not clear whether these genes are associated with schizophrenia in general or with specific disease subtypes. In a previous study, we found an association of the neuregulin 1 (NRG1) gene with non-deficit schizophrenia only. We now report an association study of four schizophrenia candidate genes in patients with and without deficit schizophrenia, which is characterized by severe and enduring negative symptoms. Single-nucleotide polymorphisms (SNPs) were genotyped in the DTNBP1 (dysbindin), G72/G30 and RGS4 genes, and the relatively unknown PIP5K2A gene, which is located in a region of linkage with both schizophrenia and bipolar disorder. The sample consisted of 273 Dutch schizophrenia patients, 146 of whom were diagnosed with deficit schizophrenia and 580 controls. The strongest evidence for association was found for the A-allele of SNP rs10828317 in the PIP5K2A gene, which was associated with both clinical subtypes (P = 0.0004 in the entire group; non-deficit P = 0.016, deficit P = 0.002). Interestingly, this SNP leads to a change in protein composition. In RGS4, the G-allele of the previously reported SNP RGS4-1 (single and as part of haplotypes with SNP RGS4-18) was associated with non-deficit schizophrenia (P = 0.03) but not with deficit schizophrenia (P = 0.79). SNPs in the DTNBP1 and G72/G30 genes were not significantly associated in any group. In conclusion, our data provide further evidence that specific genes may be involved in different schizophrenia subtypes and suggest that the PIP5K2A gene deserves further study as a general susceptibility gene for schizophrenia.
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Affiliation(s)
- S C Bakker
- Department of Psychiatry, University Medical Center, Utrecht, the Netherlands.
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33
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Austin JC, Peay HL. Applications and limitations of empiric data in provision of recurrence risks for schizophrenia: a practical review for healthcare professionals providing clinical psychiatric genetics consultations. Clin Genet 2006; 70:177-87. [PMID: 16922717 DOI: 10.1111/j.1399-0004.2006.00658.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Schizophrenia is a common disorder that may frequently be encountered when taking family histories in the genetics clinic, whether or not the referral is for a psychiatric indication. Like in other common disorders, the provision of recurrence risks for schizophrenia is a complex clinical issue because empiric recurrence risks (while reasonably well established) can rarely be used without individual tailoring. This review seeks to identify and detail some pertinent issues surrounding the clinical utility of empiric recurrence risks for schizophrenia, and to provide an overview of important factors to consider when tailoring empiric risks for individual patients.
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Affiliation(s)
- J C Austin
- Centre for Complex Disorders and Department of Psychiatry, University of British Columbia, Vancouver General Hospital Research Pavillion, Vancouver, BC, Canada.
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34
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Abstract
Phenotypic variability and likely extensive genetic heterogeneity have been confounding the search for the causes of schizophrenia since the inception of the diagnostic category. The inconsistent results of genetic linkage and association studies using the diagnostic category as the sole schizophrenia phenotype suggest that the current broad concept of schizophrenia does not demarcate a homogeneous disease entity. Approaches involving subtyping and stratification by covariates to reduce heterogeneity have been successful in the genetic study of other complex disorders, but rarely applied in schizophrenia research. This article reviews past and present attempts at delineating schizophrenia subtypes based on clinical features, statistically derived measures, putative genetic indicators, and intermediate phenotypes, highlighting the potential utility of multidomain neurocognitive endophenotypes.
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Affiliation(s)
- A Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, WA, Australia.
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35
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Dickerson F, Kirkpatrick B, Boronow J, Stallings C, Origoni A, Yolken R. Deficit schizophrenia: association with serum antibodies to cytomegalovirus. Schizophr Bull 2006; 32:396-400. [PMID: 16166610 PMCID: PMC2632221 DOI: 10.1093/schbul/sbi054] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with deficit schizophrenia differ from nondeficit patients with schizophrenia relative to several neurobiological correlates and relative to the risk factors of family history and season of birth. Exposure to human herpesviruses is a possible risk factor for schizophrenia. We hypothesized that there would be deficit/nondeficit difference in the prevalence of serum antibodies to human herpesviruses. METHODS In deficit (N = 88) and nondeficit (N = 235) schizophrenia patients, we measured IgG class antibodies to the 6 known human herpesviruses: herpes simplex virus type 1, herpes simplex virus type 2, cytomegalovirus, Epstein-Barr virus, human herpes virus 6, and varicella-zoster virus. RESULTS Deficit categorization was associated with the presence of serum antibodies to cytomegalovirus (odds ratio = 2.01, p = .006). This association remained significant after covarying for positive psychotic symptoms and demographic features known to be associated with cytomegalovirus seropositivity and after correcting for multiple comparisons. An association between herpes simplex virus type 1 and deficit status was not significant after covarying for potentially confounding variables. No other human herpesvirus was significantly associated with deficit versus nondeficit categorization. CONCLUSIONS The association between deficit schizophrenia and cytomegalovirus antibody seropositivity provides further evidence for differences in etiopathophysiology between deficit and nondeficit schizophrenia.
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Affiliation(s)
- Faith Dickerson
- Stanley Research Center at Sheppard Pratt, 6501 North Charles St., Baltimore, MD 21204, USA.
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36
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Kimhy D, Yale S, Goetz RR, McFarr LM, Malaspina D. The factorial structure of the schedule for the deficit syndrome in schizophrenia. Schizophr Bull 2006; 32:274-8. [PMID: 16177274 PMCID: PMC2632208 DOI: 10.1093/schbul/sbi064] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Deficit schizophrenia (DS) is considered a distinct subtype within the diagnosis of schizophrenia. While the common assumption is that DS represents a single, cohesive domain of psychopathology, the factorial structure of DS has not been investigated. We assessed 52 individuals with DSM-IV diagnoses of schizophrenia with DS. A principal component analysis (PCA) was conducted on the symptoms of the Schedule for the Deficit Syndrome. The PCA resulted in 2 distinct factors explaining 73.8% of the variance. Factor 1 (avolition) is made up of symptoms of curbing of interests, diminished sense of purpose, and diminished social drive. Factor 2 (emotional expression) is made up of symptoms of restricted affect, diminished emotional range, and poverty of speech. The results indicate that DS is best characterized by these 2 factors. The great majority of participants (86%) displayed DS symptoms from both factors. On average, participants had 4.19 (S.D. = 1.39) symptoms that were primary, enduring, and at least moderate in severity. The mean severity of symptoms was 2.25 (S.D. = 1.06). We discuss possible links between the obtained factors and putative neurobiological mechanisms, as well as directions for future research.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Box 2, Columbia University, 1051 Riverside Drive, New York, NY 10032, USA.
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Arajärvi R, Varilo T, Haukka J, Suvisaari J, Suokas J, Juvonen H, Muhonen M, Suominen K, Hintikka J, Schreck M, Tuulio-Henriksson A, Partonen T, Lönnqvist J. Affective flattening and alogia associate with the familial form of schizophrenia. Psychiatry Res 2006; 141:161-72. [PMID: 16515808 DOI: 10.1016/j.psychres.2005.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2005] [Accepted: 08/10/2005] [Indexed: 11/16/2022]
Abstract
Family history of schizophrenia has been associated with negative symptoms in the clinical picture. Our aim was to examine the signs and symptoms of schizophrenia in a genetically homogeneous isolate and a nationwide multiplex family sample, and to investigate the symptom dimensions and their association with the degree of familial loading for psychotic disorders and with consanguinity. For factor analysis of the Scales for the Assessment of Negative and Positive Symptoms, we included 290 patients with a DSM-IV diagnosis of schizophrenia: 63 multiplex family and 133 singleton patients from the isolate, and 94 nationwide multiplex family patients. The factor analysis yielded four factors. There was a significant difference between the multiplex and singleton patients, the former having more severe affective flattening and alogia. Further, the patients in isolate groups had fewer delusions and hallucinations compared with the whole country multiplex patients regardless of their familial loading for schizophrenia. This may be related to genetic homogeneity in the isolate. We conclude that patients with first-degree relatives with psychotic disorder have more severe negative symptoms.
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Affiliation(s)
- Ritva Arajärvi
- National Public Health Institute, Department of Mental Health and Alcohol Research, University of Helsinki, Mannerheimintie 166, 00300 Helsinki, Finland.
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Galderisi S, Maj M, Kirkpatrick B, Piccardi P, Mucci A, Invernizzi G, Rossi A, Pini S, Vita A, Cassano P, Stratta P, Severino G, Del Zompo M. Catechol-O-methyltransferase Val158Met polymorphism in schizophrenia: associations with cognitive and motor impairment. Neuropsychobiology 2005; 52:83-9. [PMID: 16037677 DOI: 10.1159/000087096] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cognitive and motor deficits have been proposed as markers of abnormal neurodevelopment in schizophrenia and have been associated with genetic liability. In a multicenter study involving 106 subjects, 56 with deficit schizophrenia and 50 with nondeficit schizophrenia, we tested the hypothesis that the catechol-O-methyltransferase (COMT) Val(158)Met polymorphism is associated with cognitive and motor deficits either in schizophrenia as a whole or in its deficit subtype. The COMT Val(158)Met polymorphism shared 6.6% of the executive/attention dysfunction variance in patients with schizophrenia and 15.6% of the motor impairment variance in patients with deficit schizophrenia. These results support the hypothesis that the COMT Val(158)Met polymorphism influences executive functions in schizophrenia and the neuromotor performance in the deficit subtype only.
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Blanchard JJ, Horan WP, Collins LM. Examining the latent structure of negative symptoms: is there a distinct subtype of negative symptom schizophrenia? Schizophr Res 2005; 77:151-65. [PMID: 15916881 DOI: 10.1016/j.schres.2005.03.022] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Revised: 03/20/2005] [Accepted: 03/24/2005] [Indexed: 11/21/2022]
Abstract
Negative symptoms have emerged as a replicable factor of symptomatology within schizophrenia. Although rating scales provide assessments along dimensions of severity, categorization into a negative symptom subtype is typically conducted. A categorical view of negative symptoms is best reflected in the proposal that enduring, primary negative symptoms, or deficit symptoms, reflect a distinct subtype of schizophrenia . Despite an accumulation of findings that support a categorical conceptualization, the data are also consistent with a dimensional-only model where negative symptom subtypologies simply reflect an extreme on a continuum of severity. Using taxometric statistical methods , the present study examined whether a taxonic, or latent class, model best describes negative symptoms in a sample of 238 schizophrenia patients. In order to obtain more stable estimates of symptoms, ratings on the Scale for the Assessment of Negative Symptoms [Andreasen, N.C., 1982. Negative symptoms in schizophrenia: Definition and reliability. Arch. Gen. Psychiatry 39, 784-788.] were averaged across two assessments over a 6-month period. Two taxometric methods, maximum covariance analysis (MAXCOV) and mean above minus below a cut (MAMBAC) identified a latent class or taxon with a base rate of approximately 28-36%. Members of the negative symptom taxon differed from the nontaxon class in that taxon members were more likely to be male and demonstrated poorer social functioning. Taxon and nontaxon schizophrenia patients did not differ in psychotic or affective symptoms. The findings converge to provide support for a categorical view of negative symptoms. Further research is required to replicate the present taxonic findings and to examine characteristics (including possible etiological factors) associated with this negative symptom taxon.
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Affiliation(s)
- Jack J Blanchard
- Department of Psychology, University of Maryland, College Park, MD 20742-4411, USA.
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Herbener ES, Harrow M, Hill SK. Change in the relationship between anhedonia and functional deficits over a 20-year period in individuals with schizophrenia. Schizophr Res 2005; 75:97-105. [PMID: 15820328 DOI: 10.1016/j.schres.2004.12.013] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Revised: 12/13/2004] [Accepted: 12/17/2004] [Indexed: 11/28/2022]
Abstract
Although early theorists suggested that deficits in emotional experience be considered a hallmark characteristic of schizophrenia, there has been limited research, and inconsistent findings, on the relationship between anhedonia and functional capacity in individuals after the onset of schizophrenia. Stronger relationships have typically been reported for chronic samples in contrast to first episode samples, although it is not clear whether this is due to selection biases that influence recruitment in these different groups, or whether results reflect a change over the course of illness. The current longitudinal study examined the relationship between physical anhedonia and functional status in a sample of 61 individuals with schizophrenia at regular intervals over a 20-year period. Subjects were recruited into the study during an index hospitalization and completed assessments at 2-, 4.5-, 7.5-, 10-, 15-, and 20-year follow-ups. Analyses indicate that the relationship between anhedonia and impairments increases over time, although mean performance on these measures is stable across this same time period. These results suggest increasing convergence of impairments in emotional, adaptive, and cognitive capacities over time, with physical anhedonia associated with poorer outcome.
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Affiliation(s)
- Ellen S Herbener
- University of Illinois at Chicago, 912 S. Wood Street (M/C 913), Chicago, IL 60612, USA.
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Fanous AH, Kendler KS. Genetic heterogeneity, modifier genes, and quantitative phenotypes in psychiatric illness: searching for a framework. Mol Psychiatry 2005; 10:6-13. [PMID: 15618952 DOI: 10.1038/sj.mp.4001571] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Schizophrenia has long been thought to be clinically heterogeneous. A range of studies suggests that this is due to genetic heterogeneity. Some clinical features, such as negative symptoms, are associated with a greater risk of illness in relatives. Affected sibling pairs are correlated for clinical and course features as well as subforms of illness, and twin studies suggest that this is due to genetic factors. This is further supported by findings that subjects from families linked to some chromosomal regions may differ clinically from those from unlinked families. Moreover, some genes may affect clinical features without altering susceptibility (ie are modifier genes). High-risk genotypes may have quantitative, rather than categorical effects, and may influence milder or subclinical phenotypes. Another recent finding is that nonpsychotic relatives may have personality features that resemble those of their affected relatives. These findings taken together suggest that there may be several classes of gene action in schizophrenia: some genes may influence susceptibility only, others may influence clinical features only, and still others may have a mixed effect. Furthermore, subsets of these classes may affect personality and other traits in nonpsychotic relatives. Understanding these classes of gene action may help guide the design of linkage and association studies that have increased power. We describe five classes of genes and their predictions of the outcomes of family, twin, and several types of linkage studies. We go on to explore how these predictions can in turn be used to aid in the design of linkage studies.
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Affiliation(s)
- A H Fanous
- Washington VA Medical Center, Georgetown University Medical Center Schizophrenia Research Program, Washington DC 20008, USA.
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Hong LE, Avila MT, Adami H, Elliot A, Thaker GK. Components of the smooth pursuit function in deficit and nondeficit schizophrenia. Schizophr Res 2003; 63:39-48. [PMID: 12892856 DOI: 10.1016/s0920-9964(02)00388-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The diagnosis of schizophrenia likely encompasses a heterogeneous group of disorders, complicating the search for its causes. Studies of deficit schizophrenia represent an attempt to reduce this heterogeneity by identifying biologically distinct subgroups. Supplementing clinical phenotypes with biological markers of risk (e.g., eye-tracking and sensory-gating deficits) have also been used to reduce disease heterogeneity. In this study, we examined smooth pursuit eye movements in healthy controls (n = 37), and deficit (n = 18) and nondeficit (n = 32) patients with schizophrenia to determine what aspects of abnormal smooth pursuit are associated with the two patient groups, and which, if any, specifically mark the deficit phenotype. A small sample of relatives of deficit (n = 12) and nondeficit (n = 35) patients was also examined. Positive symptoms were equally present in deficit and nondeficit patients. Subtle, psychotic-like positive traits were also equally present in the relatives of both deficit and nondeficit probands, whereas negative symptoms were significantly more prevalent among the relatives of deficit probands. Deficits in predictive pursuit were present in both patient groups and both groups of relatives. Deficit patients showed significantly lower initiation acceleration. A similar pattern of results was seen in our pilot sample of relatives of deficit patients. These findings suggest that predictive smooth pursuit abnormality is associated with positive symptoms in schizophrenia, and that initiation abnormalities may be associated with the deficit syndrome.
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Affiliation(s)
- L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, P.O. Box 21247, Baltimore, MD 21228, USA.
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Kirkpatrick B, Messias NC, Conley RR, Roberts RC. Interstitial cells of the white matter in the dorsolateral prefrontal cortex in deficit and nondeficit schizophrenia. J Nerv Ment Dis 2003; 191:563-7. [PMID: 14504564 DOI: 10.1097/01.nmd.0000087181.61164.e1] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An increased density of neurons in the white matter of the neocortex has been found in schizophrenia, and the original reports suggested this abnormality was restricted to a subgroup of patients. In a study of the inferior parietal cortex, we found that deficit schizophrenia subjects, but not nondeficit subjects, had an increased density of ICWMs. We extended that finding by comparing the density of microtubule-associated protein 2-immunoreactive ICWMs in deficit schizophrenia (N = 3), nondeficit schizophrenia (N = 4), and control (N = 5) subjects, using postmortem tissue from the dorsolateral prefrontal cortex (Brodmann area 46). The deficit group differed significantly from the other two groups; the respective mean (SD) density values for the deficit, nondeficit, and control groups were 1.27 (.10),.53 (.39), and.76 (.20) cells per 10-6 cubic microns. These group differences provide further evidence that deficit and nondeficit schizophrenia differ in their pathophysiology.
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Affiliation(s)
- Brian Kirkpatrick
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Lencer R, Trillenberg-Krecker K, Schwinger E, Arolt V. Schizophrenia spectrum disorders and eye tracking dysfunction in singleton and multiplex schizophrenia families. Schizophr Res 2003; 60:33-45. [PMID: 12505136 DOI: 10.1016/s0920-9964(02)00165-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
One line of research which is helping to unravel the genetic susceptibility to schizophrenia (SZ) is the analysis of eye tracking dysfunction (ETD), a quantifiable phenotypic marker. To investigate if such a biological marker is also present in singleton schizophrenia families, we examined eye tracking in members of singleton families (N=53) and compared it to members of multiplex (N=76) and nonpsychiatric families (N=71) using high resolution infrared oculography. The prevalence of ETD defined by gain values (eye/target velocity) and saccadic frequencies during smooth pursuit at 15 degrees /s did not differ between multiplex and singleton families in either the schizophrenic index patients or their relatives, but was significantly different from nonpsychotic families. ETD rate was higher in those relatives with compared to those without a diagnosis of a schizophrenia spectrum disorder. In relatives with a spectrum disorder, ETD appeared to be associated with traits for "sensitivity" and "suspiciousness". In the group of relatives from singleton families without a schizophrenia spectrum disorder, we still found a higher prevalence of ETD than in nonpsychotic families. Our results suggest that eye tracking dysfunction is a very sensitive biological marker for the vulnerability to schizophrenia, even in those cases where no psychopathological symptoms or signs are obvious. ETD in schizophrenia is suggested to serve as a neurophysiological type model, indicating a perception deficit.
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Affiliation(s)
- Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck School of Medicine, Germany.
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Abstract
An association between deficit schizophrenia and summer birth has previously been reported. The authors attempted to replicate this association in a population-based study of incident cases of psychosis in the autonomous region of Cantabria, in northern Spain. Schizophrenia patients were categorized into deficit (N = 22) and nondeficit (N = 55) groups, and the pattern in the two groups was compared. After accounting for the variance due to disorganization, hallucinations and delusions, and demographic variables, deficit schizophrenia had a significant association with summer birth; this association did not depend on a single definition of summer. For instance, among the deficit patients, 59% were born from May to August, in contrast to 18% of nondeficit patients and 34% of the general population. These results confirm the association between summer birth in the Northern Hemisphere and deficit as opposed to nondeficit schizophrenia. The existence of a different risk factor for the two groups suggests a difference in etiology and pathophysiology.
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Affiliation(s)
- Brian Kirkpatrick
- Maryland Psychiatric Research Center, University of Maryland, Department of Psychiatry, P.O. Box 21247, Baltimore 21228, USA
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Gershon ES, Badner JA. Progress toward discovery of susceptibility genes for bipolar manic-depressive illness and schizophrenia. CNS Spectr 2001; 6:965-8, 977. [PMID: 15311192 DOI: 10.1017/s1092852900001073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The inconsistency in linkage results that has bedeviled psychiatric genetics has been observed to occur regularly in common diseases with complex inheritance. Nonetheless, in two such instances--noninsulin-dependent diabetes mellitus (NIDDM) and inflammatory bowel disease (IBD)--susceptibility genes have been discovered based on the follow-ups of linkage findings. In bipolar illness disorder (BPD) and schizophrenia (SZ), there are some linkage reports with replication of other studies similar to the situation in NIDDM and IBD before the successful positional cloning efforts. Two of the regions with linkage reports, BPD and SZ, on the long arms of chromosomes 13 and 22, show linkage to the same markers in both diseases. This lends some plausibility to the hypothesis of some shared genetic predispositions for both disorders. Cytogenetic evidence offers another positional approach to susceptibility genes. The velocardiofacial syndrome is associated with deletions very close to the linkage region on chromosome 22, and with psychiatric manifestations of both BPD and SZ. Endophenotypes of SZ, previously demonstrated to the be heritable, have been found to have chromosomal linkage in at least one study. These include eye-tracking abnormalities linked to 6p, and an abnormality of the P50 cortical evoked potential linked to chromosome 15. Variants in specific genes have been associated with susceptibility to the psychiatric illnesses. These genetic findings may contribute to etiologic subcategorization of BPD and SZ, and the development of new treatment approaches. A table of genetic terms is included for review
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Affiliation(s)
- E S Gershon
- Department of Psychiatry, University of Chicago, Chicago, Ill, USA.
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Abstract
An association between deficit schizophrenia and male gender could be expected, since male schizophrenic subjects have been repeatedly found more severe than females on several dimensions of severity. Surprisingly, very few studies have confirmed such an association. We performed a more definitive test of this association using a meta-analysis. A pooled odds ratio was computed based on the 23 studies that reported the gender ratio in deficit vs. non-deficit schizophrenia. We tested for the heterogeneity of the association and examined the potential impact of the sampling method, the method used to assess the deficit syndrome, the breadth of diagnoses included and the mean duration of illness. A highly significant association between male gender and deficit schizophrenia was observed (pooled odds ratio=1.75). There was no definitive evidence that differences across studies in sampling methods, breadth of diagnoses included, mean duration of illness and methods to assess the deficit syndrome affected the strength of the association. However, the studies using the "Proxy Deficit Syndrome" method to assess the deficit syndrome yielded qualitatively weaker evidence. This significant association between male gender and deficit schizophrenia may reflect the influence of a gender related factor (e.g. sexual hormones) or gender differences in the liability to different etiologies of schizophrenia. The role of gender as a potential confounder must be closely examined in studies comparing deficit and non-deficit SZ.
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Affiliation(s)
- M A Roy
- Centre de recherche Université Laval Robert-Giffard, département de Psychiatrie de la faculté de Médecine de l'Université Laval, Robert-Giffard, 2601 de la Canardière, Beauport, G1J 2G3, Québec, Canada.
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