1
|
Petric PS, Teodorescu A, Miron AA, Manea MC, Ifteni P. Cognitive Outcomes in Nonacute Patients With Schizophrenia Treated With Long-Acting Injectable Antipsychotics Versus Oral Antipsychotics. Am J Ther 2024; 31:e219-e228. [PMID: 38691662 DOI: 10.1097/mjt.0000000000001729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND Patients with schizophrenia often face challenges related to cognitive function, affecting their daily functioning and overall quality of life. The choice of antipsychotic treatment may play a crucial role in determining cognitive outcomes. STUDY QUESTION Our study aimed to investigate whether there was a difference in cognitive ability between the patients with schizophrenia receiving oral antipsychotics (OAP) versus long-acting injectable antipsychotics (LAI-APs). STUDY DESIGN We conducted a cross-sectional study using analytical methods between January 1, 2020, and January 1, 2022. Participants were divided into 2 groups: patients undergoing treatment with OAP and patients undergoing treatment with LAI-AP. All participants underwent version A of Brief Assessment of Cognition in Schizophrenia (BACS). MEASURES AND OUTCOMES The primary objective was to compare cognitive function in patients with schizophrenia treated with LAI antipsychotics versus OAP using BACS. Primary outcome measures include overall BACS score, with secondary measures focusing on specific cognitive domains. This study contributes to the understanding of the cognitive effects of different antipsychotic formulations in schizophrenia treatment. RESULTS Although there was a slightly higher intelligence quotient in the LAI-AP group (102.2 vs. 101.32, P = 0.5401), it was not statistically significant. Olanzapine was the most commonly prescribed antipsychotic, with 48% of patients in the LAI-AP group and 40% in the OAP group. The LAI-AP group outperformed in all BACS evaluations. The most notable difference was in the token motor task (57.78 ± 17.03 vs. 50.04 ± 18.82, P = 0.0335), while the Tower of London test showed the smallest difference (17.26 ± 2.61 vs. 15.48 ± 3.47, P = 0.0046). Regression analysis revealed no significant variance in intelligence quotient scores; however, a significant discrepancy in BACS scores was evident, favoring the LAI treatment for better cognitive outcomes. CONCLUSIONS The use of long-acting antipsychotic treatment in individuals with schizophrenia offers promising advantages in preserving cognitive function.
Collapse
Affiliation(s)
- Paula Simina Petric
- Facultatea de Medicina, Universitatea Transilvania din Braşov, Braşov, Romania
- Spitalul Clinic de Psihiatrie şi Neurologie Braşov, Braşov, Romania
| | - Andreea Teodorescu
- Facultatea de Medicina, Universitatea Transilvania din Braşov, Braşov, Romania
- Spitalul Clinic de Psihiatrie şi Neurologie Braşov, Braşov, Romania
| | - Ana Aliana Miron
- Spitalul Clinic de Psihiatrie şi Neurologie Braşov, Braşov, Romania
| | - Mihnea Costin Manea
- Universitatea de Medicina si Farmacie, Carol Davila, Bucuresti, Romania; and
- Spitalul Clinic de Psihiatrie, Prof. Dr. Alexandru Obregia, Bucuresti, Romania
| | - Petru Ifteni
- Facultatea de Medicina, Universitatea Transilvania din Braşov, Braşov, Romania
- Spitalul Clinic de Psihiatrie şi Neurologie Braşov, Braşov, Romania
| |
Collapse
|
2
|
Lombardozzi G, Trovini G, Amici E, Kotzalidis GD, Perrini F, Giovanetti V, Di Giovanni A, De Filippis S. Brexpiprazole in patients with schizophrenia with or without substance use disorder: an observational study. Front Psychiatry 2023; 14:1321233. [PMID: 38111619 PMCID: PMC10725927 DOI: 10.3389/fpsyt.2023.1321233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023] Open
Abstract
Background Partial dopamine D2 receptor agonists are used for psychotic symptoms in adults with schizophrenia spectrum disorders. Recently, interest surged for partial dopamine D2 receptor agonists in substance use disorders (SUDs). Since it is believed that SUDs decrease the efficacy of pharmacotherapy of underlying psychiatric disorders, we tested the efficacy of the partial D2 agonist brexpiprazole in patients with schizophrenia who were either comorbid with a SUD (SUD group) or not comorbid (non-SUD) to assess treatment response and the effect of brexpiprazole on substance craving in SUD. Methods We included patients with DSM-5/DSM-5-TR schizophrenia (using SCID-5-CV) aged 18-66 years with either comorbid SUD or non-SUD to treat with brexpiprazole 4 mg/day for 6 months during February-October 2022. Patients were assessed with the Clinical Global Impressions-Severity (CGI-S) scale, the 24-item Brief Psychiatric Rating Scale (BPRS), and the Positive And Negative Syndrome Scale (PANSS) at baseline, weekly for the first 2 months and monthly for the next four. Furthermore, we assessed substance craving in SUD with a visual analog scale for craving (VAScrav) at the same timepoints. Results The total sample was 86 (85 analysable) 18- to 64-year-old (mean 39.32 ± 14.09) patients with schizophrenia [51 men (59.3%) and 35 women (40.7%)], of whom 48 SUD (55.8%) (37 men and 11 women) and 38 non-SUD (44.2%) (14 men and 24 women). No serious or persistent adverse events developed over the study period, but one patient dropped out for subjective akathisia. Results indicated the main effects of time with improvements over the course of the study for CGI-S, BPRS, and PANSS in both SUD and non-SUD groups and the entire sample, and for VAScrav in SUD. Brexpiprazole was associated with similar significant improvements in both groups at the 6 month endpoint compared to baseline. Conclusion Treatment with brexpiprazole for 6 months improved psychotic symptoms in patients with schizophrenia, independently from whether they belonged to the SUD or the non-SUD group; hence, SUD comorbidity did not confer treatment resistance to brexpiprazole. Furthermore, in the SUD group, we observed reduced substance craving.
Collapse
Affiliation(s)
- Ginevra Lombardozzi
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
| | - Giada Trovini
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
| | - Emanuela Amici
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
| | - Georgios D. Kotzalidis
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
- Centro Lucio Bini, Rome, Italy
| | | | - Valeria Giovanetti
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
| | | | - Sergio De Filippis
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
| |
Collapse
|
3
|
Sánchez-Torres AM, Amoretti S, Enguita-Germán M, Mezquida G, Moreno-Izco L, Panadero-Gómez R, Rementería L, Toll A, Rodriguez-Jimenez R, Roldán A, Pomarol-Clotet E, Ibáñez Á, Usall J, Contreras F, Vieta E, López-Ilundain JM, Merchán-Naranjo J, González-Pinto A, Berrocoso E, Bernardo M, Cuesta MJ. Relapse, cognitive reserve, and their relationship with cognition in first episode schizophrenia: a 3-year follow-up study. Eur Neuropsychopharmacol 2023; 67:53-65. [PMID: 36495858 DOI: 10.1016/j.euroneuro.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/18/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022]
Abstract
Schizophrenia is frequently characterized by the presence of multiple relapses. Cognitive impairments are core features of schizophrenia. Cognitive reserve (CR) is the ability of the brain to compensate for damage caused by pathologies such as psychotic illness. As cognition is related to CR, the study of the relationship between relapse, cognition and CR may broaden our understanding of the course of the disease. We aimed to determine whether relapse was associated with cognitive impairment, controlling for the effects of CR. Ninety-nine patients with a remitted first episode of schizophrenia or schizophreniform disorder were administered a set of neuropsychological tests to assess premorbid IQ, attention, processing speed, working memory, verbal and visual memory, executive functions and social cognition. They were followed up for 3 years (n=53) or until they relapsed (n=46). Personal and familial CR was estimated from a principal component analysis of the premorbid information gathered. Linear mixed-effects models were applied to analyse the effect of time and relapse on cognitive function, with CR as covariate. Patients who relapsed and had higher personal CR showed less deterioration in attention, whereas those with higher CR (personal and familial CR) who did not relapse showed better performance in processing speed and visual memory. Taken together, CR seems to ameliorate the negative effects of relapse on attention performance and shows a positive effect on processing speed and visual memory in those patients who did not relapse. Our results add evidence for the protective effect of CR over the course of the illness.
Collapse
Affiliation(s)
- Ana M Sánchez-Torres
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute of Health Research (IdiSNA), Pamplona, Spain
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Spain; Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR); Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Mónica Enguita-Germán
- Navarra Institute of Health Research (IdiSNA), Pamplona, Spain; Unidad de Metodología. Navarrabiomed-CHN -UPNA. Pamplona
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Lucía Moreno-Izco
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute of Health Research (IdiSNA), Pamplona, Spain
| | - Rocío Panadero-Gómez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Lide Rementería
- BIOARABA Health Research Institute. OSI Araba. University Hospital. University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Alba Toll
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Hospital del Mar Medical Research Institute (IMIM)
| | - Roberto Rodriguez-Jimenez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12); Universidad Complutense de Madrid (UCM), Plaza Ramón y Cajal, s/n, 28040 Madrid, Spain
| | - Alexandra Roldán
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Edith Pomarol-Clotet
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Ángela Ibáñez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat
| | - Fernando Contreras
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Psychiatric Department. Bellvitge Universitary Hospital. IDIBELL
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Jose M López-Ilundain
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute of Health Research (IdiSNA), Pamplona, Spain
| | - Jessica Merchán-Naranjo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Ana González-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; BIOARABA Health Research Institute. OSI Araba. University Hospital. University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Esther Berrocoso
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychology, University of Cadiz, Spain, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute of Health Research (IdiSNA), Pamplona, Spain.
| | | |
Collapse
|
4
|
Montaner-Ferrer MJ, Gadea M, Sanjuán J. Cognition and social functioning in first episode psychosis: A systematic review of longitudinal studies. Front Psychiatry 2023; 14:1055012. [PMID: 36950257 PMCID: PMC10025326 DOI: 10.3389/fpsyt.2023.1055012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/03/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction This systematic review aimed to answer whether we can predict subsequent social functioning in first episode psychosis (FEP) by means of an initial cognitive examination. In order to do this, we gathered longitudinal studies which evaluated neurocognition and/or social cognition regarding their impact on long-term social functioning of FEP patients. Methods The MOOSE method was employed and 28 studies covering data from a total of 2572 patients with longitudinal trajectories from 2 months to 5 years were reviewed. Results In general, cognitive deficits impacted on the social functioning of the FEP patients across the time. The neurocognitive domains which most closely predicted social functioning were processing speed, sustained attention and working memory. An overall cognitive dysfunction, low IQ and the academic trajectory were also found predictive. Regarding social cognition, the findings were not unanimous. Discussion In addition of the impact of each variable, several of the articles found a complex relationship between social cognition, neurocognition, social functioning and negative symptoms, pointing social cognition as a modulator of neurocognition but being modulated as well by negative symptoms. The principal clinical implication of this review is that the initial assessment of FEP patients and their rehabilitation must take cognition into account.
Collapse
Affiliation(s)
| | - Marien Gadea
- Department of Psychobiology, Faculty of Psychology, Universitat de València, Valencia, Spain
- CIBERSAM-Mental Health, Madrid, Spain
- *Correspondence: Marien Gadea,
| | - Julio Sanjuán
- CIBERSAM-Mental Health, Madrid, Spain
- Department of Psychiatry, Faculty of Medicine, Universitat de València, Valencia, Spain
| |
Collapse
|
5
|
Evidence supporting the use of a brief cognitive assessment in routine clinical assessment for psychosis. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:113. [PMID: 36528607 PMCID: PMC9759520 DOI: 10.1038/s41537-022-00322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
Cognitive impairment is a core feature of psychosis. Full cognitive assessments are not often conducted in routine clinical practice as administration is time-consuming. Here, we investigated whether brief tests of cognition could be used to predict broader neurocognitive performance in a manner practical for screening use in mental health services. We carried out a principal component analysis (PCA) to obtain an estimate of general cognitive function (N = 415). We investigated whether brief tests of memory accounted for a significant percentage of variation in the PCA scores. We used discriminant function analysis to determine if measures could predict classification as lower, intermediate or higher level of cognitive function and to what extent these groups overlapped with groups based on normative data. Memory tests correctly classified 65% of cases in the highest scoring group, 35% of cases in the intermediate group, and 77% of cases in the lowest scoring group. These PCA-derived groups and groups based on normative scores for the two tests were significantly associated (χ2 = 164.00, p < 0.001). These measures accurately identified three quarters of the low performing group, the group of greatest interest from the perspective of identifying those likely to need greater supports as part of clinical care. In so doing they suggest a potentially useful approach to screening for cognitive impairment in clinical services, upon which further assessment can be built if required.
Collapse
|
6
|
Li SB, Liu C, Zhang JB, Wang LL, Hu HX, Chu MY, Wang Y, Lv QY, Lui SSY, Cheung EFC, Yi ZH, Chan RCK. Revisiting the latent structure of negative symptoms in schizophrenia: Evidence from two second-generation clinical assessments. Schizophr Res 2022; 248:131-139. [PMID: 36037646 DOI: 10.1016/j.schres.2022.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 07/15/2022] [Accepted: 08/20/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Negative symptoms are core symptom of schizophrenia, and many previous research studied the latent structure of negative symptoms based on a single measurement scale. Applying two second-generation negative symptom scales to the same sample can address measurement-invariance of latent structure. METHODS Three-hundred-and-five schizophrenia patients were assessed using the CAINS and the BNSS. Confirmatory Factor Analysis (CFA) tested four competing factor-models: (1) a 1-factor model; (2) a 2-factor model comprising the motivation and pleasure (MAP) domain and the diminished expression (EXP) domain; (3) a 5-factor model comprising anhedonia, avolition, asociality, blunted affect and alogia; (4) a hierarchical model comprising the "first-order" 5-domain factors and the "second-order" MAP & EXP factors. RESULTS The CFA results for the data of the CAINS showed that the 2-factor model had the best data fit over the other competing models. The CFA using the BNSS data in the same sample also supported the superiority of the 2-factor model. Lastly, after combining the items of the BNSS and CAINS together in the same sample for CFA, the 2-factor model prevailed over the other competing models. CONCLUSIONS The 2-factor model appears to be measurement-invariant latent structure of negative symptoms. The novel method of combining the items of the CAINS and BNSS might have circumvented the possible imperfect construct of a single scale. Our findings support the MAP and EXP factors as the latent structure for negative symptoms.
Collapse
Affiliation(s)
- Shuai-Biao Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Liu
- Nantong Fourth People's Hospital, Jiangsu, China
| | | | - Ling-Ling Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hui-Xin Hu
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Min-Yi Chu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Qin-Yu Lv
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, Shanghai, China
| | - Simon S Y Lui
- Department of Psychiatry, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Zheng-Hui Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, Shanghai, China; Institute of Mental Health, Fudan University, Shanghai, China.
| | - Raymond C K Chan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| |
Collapse
|
7
|
Bechi M, Abu-Akel A, Agostoni G, Buonocore M, Bosia M, Martini F, Cavallaro R. Theory of mind and stereotypic behavior promote daily functioning in patients with schizophrenia. Aust N Z J Psychiatry 2022; 56:818-827. [PMID: 34376088 DOI: 10.1177/00048674211038513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Functional disruption is a main feature of schizophrenia and still represents a major treatment challenge. A more in-depth identification of functional predictors is crucial for the creation of individualized rehabilitation treatments, which can translate into better functional outcomes. In this study, we aimed at pinpointing specific domains that affect different functional profiles, using a data-driven approach. METHODS We included a comprehensive evaluation of functional predictors, namely demographic, cognitive, sociocognitive and clinical variables, with a focus on constituent subdomains of autistic symptoms that have been associated with functioning in the recent literature. RESULTS In 123 schizophrenia patients, a two-step cluster analysis identified two groups of patients with different functional profiles (low vs high functioning). A backward stepwise logistic regression analysis showed that the odds of being a member of the high functioning group are significantly higher for individuals with (1) more years of education, (2) better Theory of Mind abilities, (3) higher levels of stereotypies/narrowed interests, (4) lower difficulties in social interaction, (5) lower communication difficulties and with (6) being male. CONCLUSION Findings raise the intriguing possibility that stereotypic behaviors may have a beneficial effect on functioning in schizophrenia. While the underlying mechanism is currently unknown, we hypothesize that patients may benefit from contexts in which more predictive relationships between environmental entities can systematically be established. This study underscores the potential utility of routinely assessing autistic symptomatology in schizophrenia, which can be instrumental in identifying novel therapeutic targets that can be utilized to improve daily functioning.
Collapse
Affiliation(s)
- Margherita Bechi
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ahmad Abu-Akel
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Giulia Agostoni
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Mariachiara Buonocore
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Bosia
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesca Martini
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Cavallaro
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
8
|
The network structure of cognitive deficits in first episode psychosis patients. Schizophr Res 2022; 244:46-54. [PMID: 35594732 DOI: 10.1016/j.schres.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 08/26/2021] [Accepted: 05/09/2022] [Indexed: 11/20/2022]
Abstract
Network analysis is an important conceptual and analytical approach in mental health research. However, few studies have used network analysis to examine the structure of cognitive performance in psychotic disorders. We examined the network structure of the cognitive scores of a sample of 207 first-episode psychosis (FEP) patients and 188 healthy controls. Participants were assessed using a battery of 10 neuropsychological tests. Fourteen cognitive scores encompassing six cognitive domains and premorbid IQ were selected to perform the network analysis. Many similarities were found in the network structure of FEP patients and healthy controls. Verbal memory, attention, working memory and executive function nodes were the most central nodes in the network. Nodes in both groups corresponding to the same tests tended to be strongly connected. Verbal memory, attention, working memory and executive function were central dimensions in the cognitive network of FEP patients and controls. These results suggest that the interplay between these core dimensions is essential for demands to solve complex tasks, and these interactions may guide the aims of cognitive rehabilitation. Network analysis of cognitive dimensions might have therapeutic implications that deserve further research.
Collapse
|
9
|
Amoretti S, Verdolini N, Varo C, Mezquida G, Sánchez-Torres AM, Vieta E, Garcia-Rizo C, Lobo A, González-Pinto A, Abregú-Crespo R, Corripio I, Serra M, de la Serna E, Mané A, Ramos-Quiroga JA, Ribases M, Cuesta MJ, Bernardo M. Is the effect of cognitive reserve in longitudinal outcomes in first-episode psychoses dependent on the use of cannabis? J Affect Disord 2022; 302:83-93. [PMID: 35066012 DOI: 10.1016/j.jad.2022.01.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cognitive reserve (CR) is a protective factor against cognitive and functional impairment in first-episode psychosis (FEP). The aim of this study was to evaluate the differences in clinical presentation according to the use of cannabis (cannabis users vs non-users) among patients presenting a FEP (non-affective vs affective psychosis), to investigate the impact of CR and cannabis use on several outcomes and to explore the potentially mediatory role played by CR in the relationship between cognitive domains or clinical status and functionality, depending on the use of cannabis. METHODS Linear regression analysis models were carried out to assess the predictive value of CR on clinical, functional and cognitive variables at baseline and at two-year follow-up. The mediation analyzes were performed according to the principles of Baron and Kenny. RESULTS CR was associated with better cognitive performance, regardless of cannabis consumption or diagnosis. In both diagnoses, CR was associated with better clinical and functional outcomes in those patients who did not use cannabis. In terms of mediation procedure, CR mediates the relationship between some cognitive domains and functioning at follow-up only in patients without cannabis use. LIMITATIONS The small sample size of the affective group. CONCLUSIONS CR plays a differential role in the outcome of psychoses according to whether patients are cannabis users or not. Both in affective and non-affective groups CR exerted a greater effect in patients without cannabis use. Our results suggest that the deleterious effect of cannabis use on functioning in FEP surpasses the protective effect of CR.
Collapse
Affiliation(s)
- Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry and Psychology, Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences, IDIBAPS, University of Barcelona, Villarroel, 170, Catalonia, Barcelona 08036, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Catalonia, Barcelona, Spain
| | - Norma Verdolini
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry and Psychology, Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences, IDIBAPS, University of Barcelona, Villarroel, 170, Catalonia, Barcelona 08036, Spain
| | - Cristina Varo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry and Psychology, Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences, IDIBAPS, University of Barcelona, Villarroel, 170, Catalonia, Barcelona 08036, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Eduard Vieta
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry and Psychology, Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences, IDIBAPS, University of Barcelona, Villarroel, 170, Catalonia, Barcelona 08036, Spain.
| | - Clemente Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.
| | - Antonio Lobo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Medicine and Psychiatry, Zaragoza University. Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Ana González-Pinto
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Araba University Hospital, Bioaraba Research Institute, Spain; University of the Basque Country (UPV-EHU), Spain
| | - Renzo Abregú-Crespo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - Iluminada Corripio
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Maria Serra
- Department of Psychiatry and Psychology, Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences, IDIBAPS, University of Barcelona, Villarroel, 170, Catalonia, Barcelona 08036, Spain
| | - Elena de la Serna
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Child and Adolescent Psychiatry and Psychology, SGR2017881, Institut Clinic de Neurociències, Hospital Clínic Universitari, CIBERSAM, IDIBAPS, Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Anna Mané
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Hospital del Mar Medical research Institute (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - J Antoni Ramos-Quiroga
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Catalonia, Barcelona, Spain; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Catalonia, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Barcelona, Spain
| | - Marta Ribases
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Catalonia, Barcelona, Spain; Department of Child and Adolescent Psychiatry and Psychology, SGR2017881, Institut Clinic de Neurociències, Hospital Clínic Universitari, CIBERSAM, IDIBAPS, Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | | |
Collapse
|
10
|
Lee R, Leighton SP, Thomas L, Gkoutos GV, Wood SJ, Fenton SJH, Deligianni F, Cavanagh J, Mallikarjun PK. Prediction models in first-episode psychosis: systematic review and critical appraisal. Br J Psychiatry 2022; 220:1-13. [PMID: 35067242 PMCID: PMC7612705 DOI: 10.1192/bjp.2021.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND People presenting with first-episode psychosis (FEP) have heterogenous outcomes. More than 40% fail to achieve symptomatic remission. Accurate prediction of individual outcome in FEP could facilitate early intervention to change the clinical trajectory and improve prognosis. AIMS We aim to systematically review evidence for prediction models developed for predicting poor outcome in FEP. METHOD A protocol for this study was published on the International Prospective Register of Systematic Reviews, registration number CRD42019156897. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance, we systematically searched six databases from inception to 28 January 2021. We used the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies and the Prediction Model Risk of Bias Assessment Tool to extract and appraise the outcome prediction models. We considered study characteristics, methodology and model performance. RESULTS Thirteen studies reporting 31 prediction models across a range of clinical outcomes met criteria for inclusion. Eleven studies used logistic regression with clinical and sociodemographic predictor variables. Just two studies were found to be at low risk of bias. Methodological limitations identified included a lack of appropriate validation, small sample sizes, poor handling of missing data and inadequate reporting of calibration and discrimination measures. To date, no model has been applied to clinical practice. CONCLUSIONS Future prediction studies in psychosis should prioritise methodological rigour and external validation in larger samples. The potential for prediction modelling in FEP is yet to be realised.
Collapse
Affiliation(s)
- Rebecca Lee
- Institute for Mental Health, University of Birmingham, UK
| | | | | | | | - Stephen J Wood
- Orygen Youth Health Research Centre, National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Australia
- School of Psychology, University of Birmingham, UK
| | | | | | - Jonathan Cavanagh
- Institute of Infection, Immunity and Inflammation, University of Glasgow, UK
| | | |
Collapse
|
11
|
Iozzino L, Harvey PD, Canessa N, Gosek P, Heitzman J, Macis A, Picchioni M, Salize HJ, Wancata J, Koch M, Ferrari C, de Girolamo G. Neurocognition and social cognition in patients with schizophrenia spectrum disorders with and without a history of violence: results of a multinational European study. Transl Psychiatry 2021; 11:620. [PMID: 34880208 PMCID: PMC8651972 DOI: 10.1038/s41398-021-01749-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Neurocognitive impairment has been extensively studied in people with schizophrenia spectrum disorders and seems to be one of the major determinants of functional outcome in this clinical population. Data exploring the link between neuropsychological deficits and the risk of violence in schizophrenia has been more inconsistent. In this study, we analyse the differential predictive potential of neurocognition and social cognition to discriminate patients with schizophrenia spectrum disorders with and without a history of severe violence. METHODS Overall, 398 (221 cases and 177 controls) patients were recruited in forensic and general psychiatric settings across five European countries and assessed using a standardized battery. RESULTS Education and processing speed were the strongest discriminators between forensic and non-forensic patients, followed by emotion recognition. In particular, increased accuracy for anger recognition was the most distinctive feature of the forensic group. CONCLUSIONS These results may have important clinical implications, suggesting potential enhancements of the assessment and treatment of patients with schizophrenia spectrum disorders with a history of violence, who may benefit from consideration of socio-cognitive skills commonly neglected in ordinary clinical practice.
Collapse
Affiliation(s)
- Laura Iozzino
- grid.419422.8Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Philip D. Harvey
- grid.26790.3a0000 0004 1936 8606Department of Psychiatry and Behavioral Sciences; Research Service, University of Miami Miller School of Medicine, Miami, FL USA
| | - Nicola Canessa
- grid.30420.350000 0001 0724 054XScuola Universitaria Superiore IUSS, IUSS Cognitive Neuroscience (ICoN) Center, Pavia, Italy ,grid.511455.1Cognitive Neuroscience Laboratory of Pavia Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Pawel Gosek
- grid.418955.40000 0001 2237 2890Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Janusz Heitzman
- grid.418955.40000 0001 2237 2890Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Ambra Macis
- grid.419422.8Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Marco Picchioni
- grid.13097.3c0000 0001 2322 6764Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,St Magnus Hospital, Haslemere, Surrey UK
| | - Hans Joachim Salize
- grid.413757.30000 0004 0477 2235Medical Faculty Mannheim/Heidelberg University, Central Institute of Mental Health Mannheim, Mannheim, Germany
| | - Johannes Wancata
- grid.22937.3d0000 0000 9259 8492Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Marlene Koch
- grid.22937.3d0000 0000 9259 8492Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Clarissa Ferrari
- grid.419422.8Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| |
Collapse
|
12
|
Huo L, Lu X, Wu F, Chang C, Ning Y, Zhang XY. Elevated activity of superoxide dismutase in male late-life schizophrenia and its correlation with clinical symptoms and cognitive deficits. BMC Psychiatry 2021; 21:606. [PMID: 34863137 PMCID: PMC8642951 DOI: 10.1186/s12888-021-03604-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/15/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Despite inconsistent findings, accumulative evidence has shown abnormalities of the key antioxidant enzyme, superoxide dismutase (SOD), in patients with schizophrenia. However, few studies explored SOD in late-life schizophrenia (LLS). Our work aimed to investigate changes in SOD activity and the relationship between SOD activity and psychotic symptoms or cognitive deficits in LLS. METHODS 32 geriatric male patients with schizophrenia (age ≥ 60) and 28 age-matched male normal controls were recruited in the study. We assessed cognitive functions with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), evaluated the severity of clinical symptoms with the Positive and Negative Syndrome Scale (PANSS), and measured the plasma levels of SOD. RESULTS Patients with LLS presented with higher total levels of SOD compared to the controls (81.70 vs. 65.26 U/ml, p < .001). Except for the visuospatial index, the cognitive performance was significantly worse on RBANS total and other domain scores in the schizophrenia group than the control group. In the schizophrenia group, SOD levels were positively correlated with subscores of general psychopathology and negative symptoms and total scores of the PANSS (all p < .05), and inversely associated with performance in immediate memory, language, and RBANS total scores (all p < .05). CONCLUSIONS Our findings suggest that patients with LLS display disturbances in the antioxidant system, which may underlie the pathological process of cognitive impairments and negative symptoms in the late stage of schizophrenia. Supplementing with antioxidants could be a potential treatment.
Collapse
Affiliation(s)
- Lijuan Huo
- grid.410737.60000 0000 8653 1072Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510000 China ,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510000 China
| | - Xiaobing Lu
- grid.410737.60000 0000 8653 1072Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510000 China ,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510000 China
| | - Fengchun Wu
- grid.410737.60000 0000 8653 1072Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510000 China ,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510000 China
| | - Catherine Chang
- grid.267308.80000 0000 9206 2401Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Yuping Ning
- grid.410737.60000 0000 8653 1072Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510000 China ,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510000 China ,grid.284723.80000 0000 8877 7471The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiang Yang Zhang
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510000, China. .,CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China.
| |
Collapse
|
13
|
Cowman M, Holleran L, Lonergan E, O’Connor K, Birchwood M, Donohoe G. Cognitive Predictors of Social and Occupational Functioning in Early Psychosis: A Systematic Review and Meta-analysis of Cross-Sectional and Longitudinal Data. Schizophr Bull 2021; 47:1243-1253. [PMID: 33761534 PMCID: PMC8379554 DOI: 10.1093/schbul/sbab033] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Many individuals with early psychosis experience impairments in social and occupational function. Identification of modifiable predictors of function such as cognitive performance has the potential to inform effective treatments. Our aim was to estimate the strength of the relationship between psychosocial function in early psychosis and different domains of cognitive and social cognitive performance. We conducted a systematic review and meta-analysis of peer-reviewed, cross-sectional, and longitudinal studies examining cognitive predictors of psychosocial function. Literature searches were conducted in PsycINFO, PubMed, and reference lists of relevant articles to identify studies for inclusion. Of the 2565 identified, 46 studies comprising 3767 participants met inclusion criteria. Separate meta-analyses were conducted for 9 cognitive domains. Pearson correlation values between cognitive variables and function were extracted. All cognitive domains were related to psychosocial function both cross-sectionally and longitudinally. Importantly, these associations remained significant even after the effects of symptom severity, duration of untreated psychosis, and length of illness were accounted for. Overall, general cognitive ability and social cognition were most strongly associated with both concurrent and long-term function. Associations demonstrated medium effect sizes. These findings suggest that treatments targeting cognitive deficits, in particular those focusing on social cognition, are likely to be important for improving functional outcomes in early psychosis.
Collapse
Affiliation(s)
- Megan Cowman
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Laurena Holleran
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Edgar Lonergan
- First Episode Psychosis Service, South Lee Mental Health Service, Cork, Ireland
| | - Karen O’Connor
- First Episode Psychosis Service, South Lee Mental Health Service, Cork, Ireland
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Gary Donohoe
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
14
|
Molina-García M, Fraguas D, del Rey-Mejías Á, Mezquida G, Sánchez-Torres AM, Amoretti S, Lobo A, González-Pinto A, Andreu-Bernabeu Á, Corripio I, Vieta E, Baeza I, Mané A, Cuesta M, de la Serna E, Payá B, Zorrilla I, Arango C, Bernardo M, Rapado-Castro M, Parellada M. The Role of Premorbid IQ and Age of Onset as Useful Predictors of Clinical, Functional Outcomes, and Recovery of Individuals with a First Episode of Psychosis. J Clin Med 2021; 10:2474. [PMID: 34199653 PMCID: PMC8199787 DOI: 10.3390/jcm10112474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND premorbid IQ (pIQ) and age of onset are predictors of clinical severity and long-term functioning after a first episode of psychosis. However, the additive influence of these variables on clinical, functional, and recovery rates outcomes is largely unknown. METHODS we characterized 255 individuals who have experienced a first episode of psychosis in four a priori defined subgroups based on pIQ (low pIQ < 85; average pIQ ≥ 85) and age of onset (early onset < 18 years; adult onset ≥ 18 years). We conducted clinical and functional assessments at baseline and at two-year follow-up. We calculated symptom remission and recovery rates using the Positive and Negative Symptoms of Schizophrenia Schedule (PANSS) and the Global Assessment Functioning (GAF or Children-GAF). We examined clinical and functional changes with pair-wise comparisons and two-way mixed ANOVA. We built hierarchical lineal and logistic regression models to estimate the predictive value of the independent variables over functioning or recovery rates. RESULTS early-onset patients had more severe positive symptoms and poorer functioning than adult-onset patients. At two-year follow-up, only early-onset with low pIQ and adult-onset with average pIQ subgroups differed consistently, with the former having more negative symptoms (d = 0.59), poorer functioning (d = 0.82), lower remission (61% vs. 81.1%), and clinical recovery (34.1% vs. 62.2%). CONCLUSIONS early-onset individuals with low pIQ may present persistent negative symptoms, lower functioning, and less recovery likelihood at two-year follow-up. Intensive cognitive and functional programs for these individuals merit testing to improve long-term recovery rates in this subgroup.
Collapse
Affiliation(s)
- Mariola Molina-García
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Gregorio Marañón Health Research Institute (IiSGM), Hospital General Universitario Gregorio Marañón, Research Networking Center for Mental Health Network (CIBERSAM), School of Medicine, Complutense University of Madrid (UCM), 28007 Madrid, Spain; (Á.A.-B.); (C.A.); (M.R.-C.); (M.P.)
| | - David Fraguas
- Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos (IdISSC), Research Networking Center for Mental Health Network (CIBERSAM), School of Medicine, Complutense University of Madrid (UCM), 28040 Madrid, Spain;
| | - Ángel del Rey-Mejías
- Data Science Unit, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, School of Psychology, Complutense University of Madrid (UCM), 28223 Madrid, Spain;
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic of Barcelona, Research Networking Center for Mental Health Network (CIBERSAM), University of Barcelona, 08036 Barcelona, Spain; (G.M.); (S.A.); (M.B.)
| | - Ana M. Sánchez-Torres
- Department of Psychiatry, Navarra Institute for Health Research (IdiSNA), Complejo Hospitalario de Navarra, 31008 Pamplona, Spain; (A.M.S.-T.); (M.C.)
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic of Barcelona, Research Networking Center for Mental Health Network (CIBERSAM), University of Barcelona, 08036 Barcelona, Spain; (G.M.); (S.A.); (M.B.)
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, 50009 Zaragoza, Spain;
| | - Ana González-Pinto
- Department of Psychiatry, Bioaraba Health Research Institute, Hospital Universitario de Álava, Research Networking Center for Mental Health Network (CIBERSAM), University of the Basque Country (UPV/EHU), 01009 Vitoria, Spain; (A.G.-P.); (I.Z.)
| | - Álvaro Andreu-Bernabeu
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Gregorio Marañón Health Research Institute (IiSGM), Hospital General Universitario Gregorio Marañón, Research Networking Center for Mental Health Network (CIBERSAM), School of Medicine, Complutense University of Madrid (UCM), 28007 Madrid, Spain; (Á.A.-B.); (C.A.); (M.R.-C.); (M.P.)
| | - Iluminada Corripio
- Department of Psychiatry, Institut d’Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Research Networking Center for Mental Health Network (CIBERSAM), Universitat Autònoma de Barcelona (UAB), 08041 Barcelona, Spain;
| | - Eduard Vieta
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Institute of Neurosciences, Hospital Clinic, Research Networking Center for Mental Health Network (CIBERSAM), University of Barcelona, 08036 Barcelona, Spain;
| | - Inmaculada Baeza
- Child and Adolescent Psychiatry and Psychology Department, SGR-881, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Research Networking Center for Mental Health Network (CIBERSAM), Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Anna Mané
- Hospital del Mar Medical Research Institute, Research Networking Center for Mental Health Network (CIBERSAM), Autonomous University of Barcelona, 08003 Barcelona, Spain;
| | - Manuel Cuesta
- Department of Psychiatry, Navarra Institute for Health Research (IdiSNA), Complejo Hospitalario de Navarra, 31008 Pamplona, Spain; (A.M.S.-T.); (M.C.)
| | - Elena de la Serna
- Child and Adolescent Psychiatry and Psychology Department, Hospital Clinic of Barcelona, Research Networking Center for Mental Health Network (CIBERSAM), 08036 Barcelona, Spain;
| | - Beatriz Payá
- IDIVAL, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
| | - Iñaki Zorrilla
- Department of Psychiatry, Bioaraba Health Research Institute, Hospital Universitario de Álava, Research Networking Center for Mental Health Network (CIBERSAM), University of the Basque Country (UPV/EHU), 01009 Vitoria, Spain; (A.G.-P.); (I.Z.)
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Gregorio Marañón Health Research Institute (IiSGM), Hospital General Universitario Gregorio Marañón, Research Networking Center for Mental Health Network (CIBERSAM), School of Medicine, Complutense University of Madrid (UCM), 28007 Madrid, Spain; (Á.A.-B.); (C.A.); (M.R.-C.); (M.P.)
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic of Barcelona, Research Networking Center for Mental Health Network (CIBERSAM), University of Barcelona, 08036 Barcelona, Spain; (G.M.); (S.A.); (M.B.)
| | - Marta Rapado-Castro
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Gregorio Marañón Health Research Institute (IiSGM), Hospital General Universitario Gregorio Marañón, Research Networking Center for Mental Health Network (CIBERSAM), School of Medicine, Complutense University of Madrid (UCM), 28007 Madrid, Spain; (Á.A.-B.); (C.A.); (M.R.-C.); (M.P.)
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, 161 Barry Street, Carlton South, VIC 3053, Australia
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Gregorio Marañón Health Research Institute (IiSGM), Hospital General Universitario Gregorio Marañón, Research Networking Center for Mental Health Network (CIBERSAM), School of Medicine, Complutense University of Madrid (UCM), 28007 Madrid, Spain; (Á.A.-B.); (C.A.); (M.R.-C.); (M.P.)
| | | |
Collapse
|
15
|
Active psychosis and pro-inflammatory cytokines in first-episode of psychosis. J Psychiatr Res 2021; 134:150-157. [PMID: 33385633 DOI: 10.1016/j.jpsychires.2020.12.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/19/2020] [Accepted: 12/19/2020] [Indexed: 11/23/2022]
Abstract
Higher levels of pro-inflammatory cytokines are consistently found in the serum of first episode psychosis (FEP) patients and this immune dysfunction could contribute to neural harm. On the other hand, lengthy periods of active psychosis during the early phases of the illness appear to be associated to worst functional outcome. We aim to explore the possible relationship between lengthy periods of active psychosis during early phases of the illness and the levels of pro-inflammatory cytokines. This is a prospective clinical study consisting of a 3-year clinical follow-up. We assessed the relation between the duration of active psychosis in patients with FEP and the serum levels of 21 cytokines at baseline and 3 months after initiating antipsychotic medication. We used the Human High Sensitivity T Cell Magnetic Bead Panel protocol from the Milliplex® Map Kit. The sample consisted of 59 patients with a FEP. The percentage of variation of the serum levels of the chemokine MIP-3α during the first 3 months of antipsychotic treatment and the score in negative psychotic symptoms 3 months after the initiation of antipsychotic medication, acted as predictors of the initial time to remission of positive psychotic symptoms. Our findings open the possibility to investigating the potential use of the variation in chemokine MIP-3α serum levels during the first months of antipsychotic treatment to identify a subtype of FEP patients that could benefit from an add-on treatment with immune modulators. CLINICALTRIALS.GOV ID: NCT02897167. DATE OF FIRST REGISTRATION: September 13, 2016. "Study of the Activation of Proinflammatory Pathways of Toll-like Receptors in Schizophrenia Patients (PAFIP_TLR)". https://clinicaltrials.gov/ct2/show/NCT02897167.
Collapse
|
16
|
Huo L, Zheng Z, Lu X, Wu F, Ning Y, Zhang XY. Decreased Peripheral BDNF Levels and Cognitive Impairment in Late-Life Schizophrenia. Front Psychiatry 2021; 12:641278. [PMID: 34239458 PMCID: PMC8257950 DOI: 10.3389/fpsyt.2021.641278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/14/2021] [Indexed: 02/04/2023] Open
Abstract
Objectives: There are relatively few studies on mechanisms of cognitive deficits in late-life schizophrenia (LLS). Brain-derived neurotrophic factor (BDNF), as an important neuroplastic molecule, has been reported to be involved in neurocognitive impairment in schizophrenia. This study aimed to examine whether peripheral BDNF levels were associated with cognitive deficits in LLS, which has not been explored yet. Methods: Forty-eight LLS patients and 45 age-matched elderly controls were recruited. We measured all participants on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for cognition and serum BDNF levels. Psychopathological symptoms in patients were assessed by the Positive and Negative Syndrome Scale (PANSS). Results: The levels of BDNF in LLS patients were significantly lower than those in healthy controls (8.80 ± 2.30 vs. 12.63 ± 5.08 ng/ml, p < 0.001). The cognitive performance of LLS patients was worse than that of the controls on RBANS total score and scores of immediate memory, attention, language, and delayed memory (all p ≤ 0.005). BDNF was positively associated with attention in LLS patients (r = 0.338, p = 0.019). Conclusion: Our findings suggest that older patients with schizophrenia exhibit lower BDNF levels and more cognitive deficits than older controls, supporting the accelerated aging hypothesis of schizophrenia. Moreover, decreased BDNF is related to attention deficits, indicating that BDNF might be a candidate biomarker of cognitive impairments in LLS patients.
Collapse
Affiliation(s)
- Lijuan Huo
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Zhiwei Zheng
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Xiaobing Lu
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Fengchun Wu
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yuping Ning
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiang Yang Zhang
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
17
|
Jung S, Kim JH, Sung G, Ko YG, Bang M, Park CI, Lee SH. Uncinate fasciculus white matter connectivity related to impaired social perception and cross-sectional and longitudinal symptoms in patients with schizophrenia spectrum psychosis. Neurosci Lett 2020; 737:135144. [PMID: 32534095 DOI: 10.1016/j.neulet.2020.135144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022]
Abstract
Dysfunctional social-emotional perception in patients with schizophrenia can result in adverse clinical symptoms and poorer long-term outcomes. The white matter tracts that interact among a number of brain regions have an important role to play. However, few neuroimaging studies focus on the effects of white matter connectivity on social-emotional perception in schizophrenia and its impact on patients' clinical symptoms and long-term outcomes. Forty-one patients with schizophrenia spectrum psychosis and 42 healthy controls underwent structural magnetic resonance imaging. The white matter fractional anisotropy values of the emotion recognition areas, the bilateral anterior thalamic radiation, inferior longitudinal fasciculus, cingulum bundle, superior longitudinal fasciculus, and uncinate fasciculus were compared between patients with schizophrenia spectrum psychosis and healthy controls. Social-emotional perception levels and symptom severity at baseline and after 1 year were examined. A group analysis showed that white matter connectivity was significantly lower in the bilateral anterior thalamic radiation, cingulum bundle, right inferior longitudinal fasciculus, and uncinate fasciculus of patients with schizophrenia spectrum psychosis compared to the healthy controls. Contrastingly, a correlation analysis revealed that larger right uncinate fasciculus fractional anisotropy values were associated with lower social-emotional perception levels in patients with schizophrenia spectrum psychosis. Additionally, the white matter fractional anisotropy values of the right uncinate fasciculus showed a significant positive correlation with the severity of positive symptoms at baseline and with poor outcomes after 1 year. The findings of the present study suggest that impaired social-emotional perception in patients with schizophrenia spectrum psychosis is associated with larger white matter connectivity of the uncinate fasciculus, which is also associated with more severe symptoms at baseline and after 1-year. These results suggest that the uncinate fasciculus could affect the pathophysiology of schizophrenia.
Collapse
Affiliation(s)
- Sra Jung
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Ji-Hye Kim
- CHA University School of Medicine, Seongnam, Republic of Korea
| | - Gihye Sung
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Young-Gun Ko
- Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Chun-Il Park
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
| |
Collapse
|
18
|
Ohayon S, Yitzhaky A, Hertzberg L. Gene expression meta-analysis reveals the up-regulation of CREB1 and CREBBP in Brodmann Area 10 of patients with schizophrenia. Psychiatry Res 2020; 292:113311. [PMID: 32712449 DOI: 10.1016/j.psychres.2020.113311] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 01/26/2023]
Abstract
Cognitive impairments characterize individuals with schizophrenia, and are correlated to the patients' functional outcome. The transcription factor Cyclic AMP-responsive element-binding protein-1 (CREB1) is involved in learning and memory processes. CREB1 and both CREB-binding protein (CREBBP) and E1A Binding Protein P300 (EP300), co-activators of CREB1, have been associated with schizophrenia. We performed a systematic meta-analysis of CREB1, CREBBP and EP300 differential expression in post mortem Brodmann Area 10 (BA10) samples of patients with schizophrenia vs. healthy controls, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Two microarray datasets met the inclusion criteria (overall 41 schizophrenia samples and 38 controls were analyzed). We detect up-regulation of CREB1 and CREBBP in BA10 samples of patients with schizophrenia, while EP300 wasn't differentially expressed. The integration of two independent datasets and the positive correlation between the expression patterns of CREB1 and CREBBP increase the validity of the results. The up-regulation of CREB1 and its co-activator CREBBP might relate to BA10 altered activation that has been shown in schizophrenia. As BA10 was shown to be involved in the cognitive impairments associated with schizophrenia, this suggests involvement of CREB1 and CREBBP in the cognitive symptoms that characterize the disease.
Collapse
Affiliation(s)
- Shay Ohayon
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Assif Yitzhaky
- Department of Physics of Complex Systems, Weizmann Institute of Science, Rehovot, Israel.
| | - Libi Hertzberg
- Department of Physics of Complex Systems, Weizmann Institute of Science, Rehovot, Israel; Shalvata Mental Health Center, affiliated with the Sackler School of Medicine, Tel-Aviv University, 13 Aliat Hanoar St. Hod Hasharon 45100, Israel.
| |
Collapse
|
19
|
Sklar AL, Coffman BA, Salisbury DF. Localization of Early-Stage Visual Processing Deficits at Schizophrenia Spectrum Illness Onset Using Magnetoencephalography. Schizophr Bull 2020; 46:955-963. [PMID: 32052843 PMCID: PMC7342265 DOI: 10.1093/schbul/sbaa010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Impairments in early-stage visual processing are observed in chronic psychosis. However, their presence, localization within the brain, and contribution to cognitive symptoms remain less well established early in disease course. The present study utilized magnetoencephalography (MEG) to examine sensory responses within primary visual cortex (V1). MEG was recorded from 38 individuals diagnosed with a schizophrenia spectrum illness at first psychotic episode (FESz) and 38 matched healthy controls (HC) during visual search tasks. The inverse solution for cortical activity contributing to the M100 visual evoked field was derived. Task performance and V1 activation were compared between groups. FESz exhibited a reduced V1 response relative to HC. This group deficit, however, was selective for the left hemisphere (LH). A similar interaction was observed for response time with FESz exhibiting slower responses to right visual field targets, a difference not observed among HC. Among FESz, larger LH V1 activity was associated with larger hallucination subscale scores on the Scale for the Assessment of Positive Symptoms. Early-stage visual processing deficits localized to V1 are present at disease onset in the schizophrenia spectrum. This impairment appears to be restricted to the LH, consistent with previous reports detailing a predominantly LH disease process in early psychosis, and activity within this region was associated with an increased experience of hallucinations. These findings detail the cortical responses contributing to visual processing impairments and their relationship with symptoms at disease onset, advancing our understanding of their developmental trajectory over the course of psychotic illness.
Collapse
Affiliation(s)
- Alfredo L Sklar
- Clinical Neurophysiology Research Laboratory, UPMC Western Psychiatric Hospital, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA,UPMC Western Psychiatric Hospital, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Brian A Coffman
- Clinical Neurophysiology Research Laboratory, UPMC Western Psychiatric Hospital, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA,UPMC Western Psychiatric Hospital, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Dean F Salisbury
- Clinical Neurophysiology Research Laboratory, UPMC Western Psychiatric Hospital, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA,UPMC Western Psychiatric Hospital, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA,To whom correspondence should be addressed; Clinical Neurophysiology Research Laboratory, UPMC Western Psychiatric Hospital, Department of Psychiatry, University of Pittsburgh School of Medicine, 3501 Forbes Avenue, Suite 420 Oxford Building, Pittsburgh, PA 15213, USA; tel: +1-412-246-5123, fax: 412-246-6636, e-mail:
| |
Collapse
|
20
|
Chan SY, Brady R, Hwang M, Higgins A, Nielsen K, Öngür D, Hall MH. Heterogeneity of Outcomes and Network Connectivity in Early-Stage Psychosis: A Longitudinal Study. Schizophr Bull 2020; 47:138-148. [PMID: 32572485 PMCID: PMC7825010 DOI: 10.1093/schbul/sbaa079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Imaging studies in psychotic disorders typically examine cross-sectional relationships between magnetic resonance imaging (MRI) signals and diagnosis or symptoms. We sought to examine changes in network connectivity identified using resting-state functional MRI (fMRI) corresponding to divergent functional recovery trajectories and relapse in early-stage psychosis (ESP). Prior studies have linked schizophrenia to hyperconnectivity in the default mode network (DMN). Given the correlations between the DMN and behavioral impairments in psychosis, we hypothesized that dynamic changes in DMN connectivity reflect the heterogeneity of outcomes in ESP. Longitudinal data were collected from 66 ESP patients and 20 healthy controls. Longitudinal cluster analysis identified subgroups of patients with similar trajectories in terms of symptom severity and functional outcomes. DMN connectivity was measured in a subset of patients (n = 36) longitudinally over 2 scans separated by a mean of 12 months. We then compared connectivity between patients and controls, and among the different outcome trajectory subgroups. Among ESP participants, 4 subgroups were empirically identified corresponding to: "Poor," "Middle," "Catch-up," and "Good" trajectory outcomes in the complete dataset (n = 36), and an independent replication (n = 30). DMN connectivity changes differed significantly between functional subgroups (F3,32 = 6.06, P-FDR corrected = .01); DMN connectivity increased over time in the "Poor" outcome cluster (β = +0.145) but decreased over time in the "Catch-up" cluster (β = -0.212). DMN connectivity is dynamic and correlates with a change in functional status over time in ESP. This approach identifies a brain-based marker that reflects important neurobiological processes required to sustain functional recovery.
Collapse
Affiliation(s)
- Shi Yu Chan
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA,Psychosis Neurobiology Laboratory, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,To whom correspondence should be addressed; Psychosis Neurobiology Lab/Schizophrenia and Bipolar Disorders Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478; tel: 1-617-855-3528, fax: 1-617-855-2895, e-mail:
| | - Roscoe Brady
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA
| | - Melissa Hwang
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA
| | - Amy Higgins
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA,Psychosis Neurobiology Laboratory, McLean Hospital, Belmont, MA
| | - Kathryn Nielsen
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA
| | - Dost Öngür
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA,Psychosis Neurobiology Laboratory, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Mei-Hua Hall
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA,Psychosis Neurobiology Laboratory, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| |
Collapse
|
21
|
Duration of active psychosis during early phases of the illness and functional outcome: The PAFIP 10-year follow-up study. Schizophr Res 2020; 220:240-247. [PMID: 32276867 DOI: 10.1016/j.schres.2020.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 02/21/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Longer duration of active psychosis (presence of positive psychotic symptoms) has been associated to worsening of functional and symptomatic outcome in patients with a first-episode of psychosis. There could be a "critical period" of increased brain vulnerability in the early phases of the illness when the effect of active psychosis would be exceptionally pernicious. OBJECTIVES We aim to explore the impact of lengthy periods of active psychosis during early phases of illness on long-term functional outcome. METHODS This is a prospective clinical study. We assessed the effect of the duration active psychosis in patients with a first-episode of nonaffective psychosis on long-term social functioning and functional recovery. The study consisted of a 3-year clinical follow-up and a functional evaluation performed after a 10-year period. RESULTS The sample consisted of 169 patients with a first-episode of non-affective psychosis. The duration of active psychosis after treatment (DAT) during the 3-year clinical follow-up acted as predictor of social functioning at the 10-year functional evaluation (Wald: 10.705; p = .001), but not of functional recovery. The duration of untreated psychosis (DUP) did not act as a predictor of any of the two long-term measures of functional outcome. CONCLUSIONS Active psychosis in early phases of the illness seems to be correlated to worst long-term functionality. In this study the duration of active psychosis after treatment (DAT) was a better predictor of long-term outcome than the duration of untreated psychosis (DUP). Reducing DAT should be considered an important objective for early intervention programs.
Collapse
|
22
|
Pardo-de-Santayana G, Vázquez-Bourgon J, Gómez-Revuelta M, Ayesa-Arriola R, Ortiz-Garcia de la Foz V, Crespo-Facorro B, Pelayo-Terán JM. Data regarding active psychosis and functional outcome, among other clinical variables, during early phases of the illness in first-episode psychosis in the PAFIP 10-year follow-up program. Data Brief 2020; 30:105599. [PMID: 32395579 PMCID: PMC7210416 DOI: 10.1016/j.dib.2020.105599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/08/2020] [Accepted: 04/15/2020] [Indexed: 10/26/2022] Open
Abstract
This article describes data related to the research study entitled "Duration of active psychosis during early phases of the illness and functional outcome: The PAFIP 10-year follow-up study." [1]. We present data concerning the clinical and sociodemographic characteristics of a sample of drug-naïve patients with a first episode of non-affective psychosis. The dataset was obtained from a 3-year longitudinal intervention program as part of an ongoing 10-year epidemiological study. The tables and figure shown present the data from the analysis between the active psychosis (presence of positive psychotic symptoms), among other sociodemographic and clinical predictor variables, recorded during the 3-year longitudinal intervention program and the evaluation of the functional outcome (social functioning and functional recovery) present at the 10-year mark. The data explores how those early parameters could influence long-term outcome.
Collapse
Affiliation(s)
- Guillermo Pardo-de-Santayana
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, CIBERSAM, School of Medicine, University of Cantabria, Santander, Spain
| | - Javier Vázquez-Bourgon
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, CIBERSAM, School of Medicine, University of Cantabria, Santander, Spain
| | - Marcos Gómez-Revuelta
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, CIBERSAM, School of Medicine, University of Cantabria, Santander, Spain
| | - Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, CIBERSAM, School of Medicine, University of Cantabria, Santander, Spain
| | - Victor Ortiz-Garcia de la Foz
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, CIBERSAM, School of Medicine, University of Cantabria, Santander, Spain
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, CIBERSAM, School of Medicine, University of Cantabria, Santander, Spain.,CIBERSAM, Virgen del Rocio University Hospital-IBIS, Seville University
| | - José María Pelayo-Terán
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, CIBERSAM, School of Medicine, University of Cantabria, Santander, Spain.,Department of Psychiatry and Mental Health, El Bierzo Hospital, GASBI, SACYL, CIBERSAM, Ponferrada, León, Spain
| | | |
Collapse
|
23
|
McGinty J, Upthegrove R. Depressive symptoms during first episode psychosis and functional outcome: A systematic review and meta-analysis. Schizophr Res 2020; 218:14-27. [PMID: 31964558 DOI: 10.1016/j.schres.2019.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES First episode psychosis (FEP) is associated with functional decline. Existing evidence was synthesised to explore the influence of depressive symptoms during FEP on future social, occupational and global functioning. METHODS Medline, Embase, PsychINFO, Cochrane Library, Open Grey, NICE Evidence and Web of Science were searched from inception to May 2018. Longitudinal studies of FEP patients were included. Study quality was assessed using the Downs and Black instrument. Two meta-analyses were performed using random effect models. The first meta-analysis correlates depressive symptoms during FEP with follow-up Global Assessment of Functioning (GAF) scores. The second meta-analysis shows the odds of long-term functional remission if depressive symptoms are present during FEP. RESULTS 4751 unique abstracts were found. 36 articles were included. The first meta-analysis included 7 studies (932 participants) and showed depressive symptoms during FEP were negatively correlated with follow-up GAF scores (r = -0.16, 95% CI: -0.24 to -0.09, p < 0.001). The second meta-analysis of 9 studies (2265 participants) showed weak evidence of an association between the presence of depressive symptoms in FEP and reduction in functional remission (OR = 0.87, 95% CI: 0.68 to 1.13, p = 0.294). CONCLUSION Depressive symptoms during FEP are associated with poorer long-term global functioning and may be associated with a reduced chance of achieving functional remission. Clinical trials are needed to identify efficacious management of depressive symptoms in early psychosis.
Collapse
Affiliation(s)
- Jessica McGinty
- University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - Rachel Upthegrove
- University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom; University of Birmingham, Institute for Mental Health, Birmingham, United Kingdom; Early Intervention Service, Birmingham Womens and Childrens NHS Trust, Birmingham, United Kingdom.
| |
Collapse
|
24
|
Hall MH, Holton KM, Öngür D, Montrose D, Keshavan MS. Longitudinal trajectory of early functional recovery in patients with first episode psychosis. Schizophr Res 2019; 209:234-244. [PMID: 30826261 PMCID: PMC7003957 DOI: 10.1016/j.schres.2019.02.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/11/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is a large variability in the recovery trajectory and outcome of first episode of psychosis [FEP] patients. To date, individuals' outcome trajectories at early stage of illness and potential risk factors associated with a poor outcome trajectory are largely unknown. This study aims to apply three separate predictors (positive symptoms, negative symptoms, and soft neurological signs) to identify homogeneous function outcome trajectories in patients with FEP using objective data-driven methods, and to explore the potential risk /protective factors associated with each trajectory. METHODS A total of 369 first episode patients (93% antipsychotic naive) were included in the baseline assessments and followed-up at 4-8 weeks, 6 months, and 1 year. K means cluster modeling for longitudinal data (kml3d) was used to identify distinct, homogeneous clusters of functional outcome trajectories. Patients with at least 3 assessments were included in the trajectory analyses (N = 129). The Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), and Neurological examination abnormalities (NEA) were used as predictors against Global Assessment of Functioning Scale (GAF). RESULTS In each of the three predictor models, four distinct functional outcome trajectories emerged: "Poor", "Intermediate", High" and "Catch-up". Individuals with male gender; ethnic minority status; low premorbid adjustment; low executive function/IQ, low SES, personality disorder, substance use history may be risk factors for poor recovery. CONCLUSIONS Functioning recovery in individuals with FEP is heterogeneous, although distinct recovery profiles are apparent. Data-driven trajectory analysis can facilitate better characterization of individual longitudinal patterns of functioning recovery.
Collapse
Affiliation(s)
- Mei-Hua Hall
- Psychotic Disorders Division, McLean Hospital HMS, Boston, MA, USA.
| | | | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital HMS, Boston, MA
| | - Debra Montrose
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Matcheri S. Keshavan
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA,,Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, HMS, Boston, MA
| |
Collapse
|
25
|
Ceylan ME, Evrensel A, Dönmez A, Önen Ünsalver B, Kaya Yertutanol FD, Çom AM. The psycho-periodic cube. Med Hypotheses 2019; 126:69-77. [PMID: 31010503 DOI: 10.1016/j.mehy.2019.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/04/2019] [Accepted: 03/21/2019] [Indexed: 11/27/2022]
Abstract
The current diagnostic classification systems in psychiatry have been developed primarily for evidence-based clinical decision making with both categorical and dimensional approaches having their own advantages and disadvantages. Efforts have been made to improve these classification systems, and we are now at the point where we must expand beyond the one-dimensionality of these systems. In this paper, we propose that psychiatric disorders can be arranged in a three-dimensional classification system according to the degree of dysfunctions on three specific axes in a way that is similar to the arrangement of chemical elements according to their atomic weights in Mendeleyev's periodic table. For the three axes, we chose externalization, drive, and attention to represent the three-dimensional descriptions of mental health, namely, well-being in social, motivational, and cognitive areas, respectively. Throughout the paper, we explain our reasons for choosing these three axes and compare our hypothesis with categorical diagnostic systems as well as Cloninger's dimensional diagnostic system using personality disorders, affective disorders, and schizophrenia as the specific diagnostic samples.
Collapse
Affiliation(s)
- Mehmet Emin Ceylan
- Departments of Psychology and Philosophy, Üsküdar University, İstanbul, Turkey
| | - Alper Evrensel
- Department of Psychology, Üsküdar University, İstanbul, Turkey.
| | - Aslıhan Dönmez
- Department of Psychology, Üsküdar University, İstanbul, Turkey
| | - Barış Önen Ünsalver
- Vocational School of Health Services, Department of Medical Documentation and Secretariat, Üsküdar University, İstanbul, Turkey
| | | | | |
Collapse
|
26
|
Wright AC, Davies G, Fowler D, Greenwood K. Three-Year Follow-Up Study Exploring Metacognition and Function in Individuals With First Episode Psychosis. Front Psychiatry 2019; 10:182. [PMID: 31031648 PMCID: PMC6473558 DOI: 10.3389/fpsyt.2019.00182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/13/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction: Research has demonstrated that functional outcome in psychosis is predicted by factors such as neurocognition, functional capacity, symptoms and, more recently, metacognition. Metacognitive ability has been demonstrated to mediate between neurocognition and functional outcome in First Episode Psychosis (FEP). Whether metacognition also predicts longer-term recovery in first episode psychosis is unknown. This study assessed whether neurocognition, functional capacity and metacognitive ability in FEP predicted functional outcome three years later. Methods: Eighty individuals with First Episode Psychosis were re-contacted after an average 3 years (range: 26-45 month follow-up) from baseline. Twenty-six participants (33%) completed completed measures of neurocognition, metacognition, functional capacity, functional outcome (hours spent in structured activity per week) and psychopathology at baseline and at follow-up. Results: Individual regression analyses demonstrated neurocognition, functional capacity, and metacognitive ability at baseline significantly predicted functional outcome at three years. However, when baseline functional outcome was controlled, only metacognitive ability was a significant predictor of change in functional outcome from baseline to follow-up, p < 0.001. This model explained 72% (adjusted r 2 = 0.69) of the variance in functional outcome at follow-up. Negative symptoms did not change the model. Discussion: This study demonstrated that better metacognitive ability significantly predicted improvement in functioning in FEP across a 3-year period. This highlights the potential value of clinical interventions that focus on improving metacognitive ability at first point of illness to maximize recovery.
Collapse
Affiliation(s)
- Abigail C Wright
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom.,Center of Excellence for Psychosocial and Systemic Research, Massachusetts General Hospital, Boston, MA, United States
| | - Geoff Davies
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| |
Collapse
|
27
|
Hergenrather KC, Emmanuel D, McGuire-Kuletz M, Rhodes SD. Employment as a Social Determinant of Health: Exploring the Relationship Between Neurocognitive Function and Employment Status. REHABILITATION RESEARCH, POLICY, AND EDUCATION 2018. [DOI: 10.1891/2168-6653.32.2.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose:To explore employment as a social determinant of health through examining the relationship between neurocognitive function and employment status.Method:The authors explored the causal relationship between employment status and neurocognitive function by conducting a systematic review of 15 longitudinal studies. The identified studies were conducted in Australia, Denmark, Norway, and the United States.Results:Five neurocognitive function domains were identified (i.e., complex attention, executive function, learning and memory, language, perceptual-motor function) across diagnosis (i.e., bipolar disorder, first-episode psychosis, human immunodeficiency virus, major depression, schizophrenia-spectrum disorders, traumatic brain injury). Unemployment was correlated with poorer attention, executive function, learning and memory, perceptual-motor function, and language. Employment was correlated with better attention, executive function, learning and memory, perceptual-motor function.Conclusion:The acknowledgment of the relationship between neurocognitive function and employment status can assist service providers in assessing and developing strategies to enhance and maintain employment outcomes. The assessment of neurocognitive function could be further explored by identifying standard measures and assessment timelines to assess the six domains across diagnosis. Vocational rehabilitation services could integrate cognitive interventions (cognitive rehabilitation, cognitive enhancement therapy, cognitive remediation) to explore the effect on neurocognitive function and employment outcomes. Further longitudinal research studies are needed, for both persons with disabilities and persons without disabilities, to elucidate the relationship between employment status and neurocognitive function.
Collapse
|
28
|
Pelayo-Terán JM, Gajardo-Galán V, Gómez-Revuelta M, Ortiz-García de la Foz V, Ayesa-Arriola R, Tabarés-Seisdedos R, Crespo-Facorro B. Duration of active psychosis and functional outcomes in first-episode non-affective psychosis. Eur Psychiatry 2018; 52:29-37. [PMID: 29614389 DOI: 10.1016/j.eurpsy.2018.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/06/2018] [Accepted: 03/08/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The duration of untreated psychosis (DUP) has been associated with negative outcomes in psychosis; however, few studies have focused on the duration of active psychotic symptoms after commencing treatment (DAT). In this study, we aimed to evaluate the effect of DUP and DAT on functional long-term outcomes (3 years) in patients with early psychosis. METHODS We evaluated the Scale for the Assessment of Positive Symptoms (SAPS) at frequent intervals for 3 years after presentation to determine the DAT for 307 individuals with first-episode psychosis together with DUP and clinical variables. The functional outcomes were assessed using the Disability Assessment Scale (DAS) at three years, and functional recovery was defined as minimal impairment and return to activity. Associated variables, DAT and DUP were included in logistic regression models to predict functional outcomes. Receiver operating characteristic curves and Youden's index were applied to assess the best cut-off values. RESULTS DAT, (Wald: 13.974; ExpB: 1.097; p < 0.001), premorbid adjustment, initial BPRS score, gender, age of onset and schizophrenia diagnosis were significant predictors of social functioning, whereas only premorbid adjustment (Wald: 11.383; ExpB:1.009), DAT (Wald: 4.850; ExpB: 1.058; p = 0.028) and education were significant predictors of recovery. The optimal cut-off of DAT for predicting social functioning was 3.17 months for DAT (sensitivity: 0.68; specificity: 0.64; Youden's index: 0.314). CONCLUSIONS DAT is strongly related to functional outcomes independent of the DUP period or other variables. As a modifiable variable, the reduction of the DAT should be considered a main focus of intervention from the onset of the illness to improve long-term outcomes.
Collapse
Affiliation(s)
- José María Pelayo-Terán
- University Hospital Marqués de Valdecilla, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; Unidad de Gestión Clínica de Psiquiatría y Salud Mental, Hospital El Bierzo, Servicio de Salud de Castilla y León (SACYL), Ponferrada, León, Spain.
| | - Virginia Gajardo-Galán
- University Hospital Marqués de Valdecilla, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; Hospital de Merida, Servicio Estremeño de Salud (SES), Mérida, Badajoz, Spain
| | - Marcos Gómez-Revuelta
- University Hospital Marqués de Valdecilla, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Victor Ortiz-García de la Foz
- University Hospital Marqués de Valdecilla, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Rosa Ayesa-Arriola
- University Hospital Marqués de Valdecilla, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Rafael Tabarés-Seisdedos
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; Department of Psychiatry, University of Valencia, CIBERSAM, Valencia, Spain
| | - Benedicto Crespo-Facorro
- University Hospital Marqués de Valdecilla, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| |
Collapse
|
29
|
The relationship between level of cognitive impairments and functional outcome trajectories in first-episode schizophrenia. Schizophr Res 2017; 190:144-149. [PMID: 28302394 DOI: 10.1016/j.schres.2017.03.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 02/21/2017] [Accepted: 03/02/2017] [Indexed: 01/28/2023]
Abstract
Although cognitive impairments are consistently linked to functional outcome in chronic schizophrenia, the relationship remains unclear for patients with first-episode schizophrenia. The objective of this present study was to determine whether there are distinct developmental trajectories for functional outcome in patients with different levels of baseline cognition. The present study has a multi-follow-up design, and includes data from six follow-ups over four years. Assessments were conducted yearly, apart from the first year where assessments were conducted every six months. A total of 28 patients with first-episode schizophrenia participated in the study, with 79% of patients retained at the 4-year follow-up. Cognition was assessed with MATRICS Consensus Cognitive Battery. Functional outcomes were obtained through Global functioning: Social and Global functioning: Role. Data were analyzed with linear multilevel models. Results suggest steady improvements in social and role functioning among the patients across the four year period. Baseline attention, verbal learning, and verbal working memory were significantly associated with social outcome. Role functioning was significantly associated with attention, verbal working memory, and reasoning/problem solving. Furthermore, the rate of change in social outcome varies among patients depending on their baseline level of attention and verbal working memory, with the lowest scoring group showing the least improvement over the years. The subgroup of patients with the largest cognitive impairments at the onset of the disorder shows limited improvements in social functioning compared to higher functioning groups.
Collapse
|
30
|
Mellor-Marsá B, Caballero FF, Cabello M, Ayuso-Mateos JL, Setién-Suero E, Vázquez-Bourgon J, Crespo-Facorro B, Ayesa-Arriola R. Disability multilevel modelling in first episodes of psychosis at 3-year follow-up. Schizophr Res 2017; 185:101-106. [PMID: 28062261 DOI: 10.1016/j.schres.2016.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 11/30/2022]
Abstract
The description of longitudinal bio-psycho-social profiles in FEP samples may be useful for the prediction of disability trajectories. This study aimed to describe the differences between disability status of FEP patients at baseline and their change over time, analysing how variables associated to the psychological status, and the environment of the patient can affect his or her disability trajectory, once the influence of health condition and socio-demographic variables has been controlled for. Using data from a 3-year follow-up study on early psychosis (PAFIP), a multilevel structure in which the longitudinal measurements (within level) were nested within the individuals (between level), was modeled. The contribution of the different time-varying and time-invariant variables to the patients' disability outcomes was tested through eight nested models. Consecutive models, that successively added health related, socio-demographic, psychological and environmental variables to the unconditional model were estimated, by means of deviance and fit statistics. The present work revealed the importance of psychological and environmental factors in the explanation of disability changes in the context of FEP. We may conclude that longitudinal assessments of time-varying predictors - living situation (b=-0.10, p<0.05), economic support (b=0.11, p<0.01) and insight (b=-0.08, p<0.05) - explain a relevant amount of disability variation over time, independently from symptoms' severity, duration of untreated psychosis, age, gender and years of education. Additionally, the level of premorbid adjustment (b=0.05, p<0.001) was associated to differences in disability outcomes among FEP patients.
Collapse
Affiliation(s)
- Blanca Mellor-Marsá
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Instituto de Investigación de la Princesa (IIS-IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - Francisco Félix Caballero
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Instituto de Investigación de la Princesa (IIS-IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - María Cabello
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Instituto de Investigación de la Princesa (IIS-IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Instituto de Investigación de la Princesa (IIS-IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - Esther Setién-Suero
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Javier Vázquez-Bourgon
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Benedicto Crespo-Facorro
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Rosa Ayesa-Arriola
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain.
| |
Collapse
|
31
|
Salisbury DF, Polizzotto NR, Nestor PG, Haigh SM, Koehler J, McCarley RW. Pitch and Duration Mismatch Negativity and Premorbid Intellect in the First Hospitalized Schizophrenia Spectrum. Schizophr Bull 2017; 43:407-416. [PMID: 27231308 PMCID: PMC5605266 DOI: 10.1093/schbul/sbw074] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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
Mismatch negativity (MMN) is a robustly abnormal brainwave in chronically ill schizophrenia that has generated interest as a disease presence biomarker. Reports of MMN reduction in first-episode schizophrenia have been equivocal, raising uncertainty about its reduction at first psychotic break. Here we tested 29 schizophrenia-spectrum participants under 1 year from their first hospitalization for psychosis and 40 age-, gender-, parental socioeconomic status-, and Wechsler Adult Intelligence Scales III Information-matched healthy controls on both pitch and duration MMN. Participants performed a visual checkerboard tracking task while standard (1kHz, 50ms, 80%), pitch-deviant (1.2kHz, 50ms, 10%) and duration-deviant (1kHz, 100ms, 10%) tones were presented over headphones (75 dB) and EEG was recorded. Independent component analysis was used to remove eye movements and visual stimulus processing activity. Groups did not differ in pitch MMN or duration MMN amplitudes. Smaller pitch and duration MMN amplitudes were associated with lower estimates of premorbid intellect in all participants and independently with greater positive symptoms in first hospitalized schizophrenia. Overall MMN reduction was not present in these relatively high functioning individuals at the first episode of schizophrenia, and therefore is not a good disease presence biomarker for this sample. Future research is warranted to determine the degree of MMN reduction at the first episode of psychosis across a greater range of cognitive impairment, the utility of MMN as an indicator of risk or diagnosis, and its role for understanding pathophysiological mechanisms in emerging psychosis.
Collapse
Affiliation(s)
- Dean F Salisbury
- Clinical Neurophysiology Research Laboratory, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nicola R Polizzotto
- Clinical Neurophysiology Research Laboratory, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Paul G Nestor
- Department of Psychology, University of Massachusetts, Boston, MA, USA
| | - Sarah M Haigh
- Clinical Neurophysiology Research Laboratory, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Justine Koehler
- Clinical Neurophysiology Research Laboratory, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Robert W McCarley
- Department of Psychiatry, Harvard Medical School, VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
| |
Collapse
|
32
|
Stouten LH, Veling W, Laan W, van der Helm M, van der Gaag M. Psychosocial functioning in first-episode psychosis and associations with neurocognition, social cognition, psychotic and affective symptoms. Early Interv Psychiatry 2017; 11:23-36. [PMID: 25585960 DOI: 10.1111/eip.12210] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 10/29/2014] [Indexed: 11/29/2022]
Abstract
AIM Most studies on the determinants of psychosocial functioning in first-episode psychosis used few predictors. This study examines the effects of multiple cognitive domains and multiple symptoms on psychosocial functioning. METHODS A total of 162 patients with a first-episode psychosis were assessed within 3 months after referral to an early psychosis treatment department. Four psychopathological subdomains (positive and negative symptoms, depression and anxiety) and five subdomains of psychosocial functioning (work/study, relationships, self-care, disturbing behaviour and general psychosocial functioning) were measured. Neurocognitive and social cognitive factors were identified through principal component analyses (PCA) of a 15-measure cognitive battery. Stepwise backward regression models were computed to identify the determinants of psychosocial functioning. RESULTS The three neurocognitive and four social cognitive factors identified through PCA were largely independent of psychopathology. The strongest associations were between cognitive factors and anxiety. Higher levels of negative symptoms, poor general neurocognition and poor general social cognition showed strongest associations with impaired psychosocial functioning, followed by low verbal processing speed and low emotion processing speed. Together, these factors accounted for 39.4% of the variance in psychosocial functioning. CONCLUSIONS The results suggest that negative symptoms, impaired neurocognition and poor social cognition are related to psychosocial problems in patients with first-episode psychosis. None of the affective or positive symptoms had a marked impact on psychosocial functioning.
Collapse
Affiliation(s)
- Luyken H Stouten
- Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Wim Veling
- Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands.,Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Winfried Laan
- Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Mischa van der Helm
- Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Mark van der Gaag
- Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands.,Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| |
Collapse
|
33
|
Anda L, Brønnick KS, Johnsen E, Kroken RA, Jørgensen H, Løberg EM. The Course of Neurocognitive Changes in Acute Psychosis: Relation to Symptomatic Improvement. PLoS One 2016; 11:e0167390. [PMID: 27977720 PMCID: PMC5157988 DOI: 10.1371/journal.pone.0167390] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 11/14/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Cognitive impairment is a core aspect of psychosis, but the course of cognitive functioning during acute psychosis remains poorly understood, as does the association between symptom change and neurocognitive change. Some studies have found cognitive improvement to be related to improvement in negative symptoms, but few have examined cognitive changes in the early acute phase, when clinical improvement mainly happens. This study's aim was to investigate the relation between cognitive and symptomatic change in clinically heterogeneous patients during the early acute phase of psychosis. METHOD Participants (n = 84), including both first-episode and previously ill patients, were recruited from consecutive admissions to the acute psychiatric emergency ward of Haukeland University Hospital, Bergen, Norway, as part of the Bergen Psychosis Project (BPP). The RBANS neurocognitive test battery was administered on admission and again at discharge from the acute ward (mean time 4.1 weeks, SD 1.86 weeks). Symptomatic change was measured by PANSS. RESULTS The proportion of subjects with cognitive impairment (t < 35) was 28.6% in the acute phase and 13.1% at follow-up. A sequential multiple linear regression model with RBANS change as the dependent variable found PANSS negative symptoms change to significantly predict total RBANS performance improvement (beta = -.307, p = .016). There was no significant difference between subjects with schizophrenia and those with other psychotic disorders in terms of cognitive change. CONCLUSION The proportion of subjects with mild to moderate impairment in cognitive test performance is reduced across the acute phase of psychosis, with improvement related to amelioration of negative symptoms.
Collapse
Affiliation(s)
- Liss Anda
- TIPS, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Kolbjørn S. Brønnick
- TIPS, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Institute of Health, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rune A. Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hugo Jørgensen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
34
|
Sánchez-Torres AM, Elosúa MR, Lorente-Omeñaca R, Moreno-Izco L, Peralta V, Ventura J, Cuesta MJ. Using the cognitive assessment interview to screen cognitive impairment in psychosis. Eur Arch Psychiatry Clin Neurosci 2016; 266:629-37. [PMID: 27272500 DOI: 10.1007/s00406-016-0700-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/23/2016] [Indexed: 12/24/2022]
Abstract
Cognitive impairment in psychosis is closely related to functional outcome, so research into psychotic disorders is focusing most effort on treatments for improving cognition. New treatments must show not only an improvement on neuropsychological tests but also in co-primary measures of cognition. The cognitive assessment interview (CAI) is an interview-based measure of cognition which assesses the impact of cognitive deficits in patients' daily lives. Information obtained from patients and their relatives is integrated into a rater composite score. This study examines the validity of the CAI (adapted to Spanish, CAI-Sp) as a screening instrument for cognitive impairment, compared to an objective test of cognitive functioning. The psychometric properties of the CAI-Sp and its association with clinical dimensions are also explored. Eighty-one patients with a psychotic disorder and 38 healthy controls were assessed using the CAI-Sp and the screen for cognitive impairment in psychiatry (SCIP-S). Patients also underwent a clinical assessment. Poorer cognitive functioning as assessed with the CAI-Sp was associated to illness severity, specifically positive, negative and disorganised syndromes. Binary logistic regression showed that the CAI-Sp was able to detect cognitive impairment in patients, when considering CAI-Sp patient and informant information and CAI-Sp rater scores. The CAI-Sp was found to be a valid and reliable scale to assess cognitive functioning in the context of its impact on daily living. Given its ease and speed of application, the CAI-Sp could prove useful in clinical practice, though not a substitute of objective cognitive testing.
Collapse
Affiliation(s)
- Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, c/Irunlarrea 4, 31008, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, c/Irunlarrea 4, 31008, Pamplona, Spain.,Department of Basic Psychology I, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - María Rosa Elosúa
- Department of Basic Psychology I, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Ruth Lorente-Omeñaca
- Department of Psychiatry, Complejo Hospitalario de Navarra, c/Irunlarrea 4, 31008, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, c/Irunlarrea 4, 31008, Pamplona, Spain
| | - Lucía Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, c/Irunlarrea 4, 31008, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, c/Irunlarrea 4, 31008, Pamplona, Spain
| | - Victor Peralta
- Department of Psychiatry, Complejo Hospitalario de Navarra, c/Irunlarrea 4, 31008, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, c/Irunlarrea 4, 31008, Pamplona, Spain
| | - Joseph Ventura
- UCLA Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, c/Irunlarrea 4, 31008, Pamplona, Spain. .,IdiSNA, Navarra Institute for Health Research, c/Irunlarrea 4, 31008, Pamplona, Spain.
| |
Collapse
|
35
|
Chang WC, Kwong VWY, Chan GHK, Jim OTT, Lau ESK, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Prediction of functional remission in first-episode psychosis: 12-month follow-up of the randomized-controlled trial on extended early intervention in Hong Kong. Schizophr Res 2016; 173:79-83. [PMID: 27017490 DOI: 10.1016/j.schres.2016.03.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/09/2016] [Accepted: 03/14/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Functional remission (FR) is an intermediate and necessary step toward recovery, but is understudied in first-episode psychosis (FEP). We aimed to examine the rate and predictors of FR in FEP patients in the context of a randomized-controlled trial (RCT) comparing a 1-year extension of early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI). METHODS One hundred sixty Chinese patients were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months. Assessments on premorbid adjustment and personality, clinical profiles, functioning, and treatment characteristics were conducted. FR was operationalized as simultaneous fulfillment of attaining adequate functional levels (measured by Social and Occupational Functioning Scale and Role Functioning Scale) and competitive employment at 6 and 12 months. Data analysis was based on 156 subjects who completed follow-up functional assessments. RESULTS Thirty-one (19.9%) patients achieved FR status. Multivariate binary regression analysis showed that female gender, lower degrees of premorbid schizoid-schizotypal traits, Extended EI treatment condition, lower levels of positive symptoms at intake, and better baseline functioning independently predicted FR. CONCLUSION This is the first RCT providing supportive evidence to an extension of EI service beyond 2-year treatment duration on further enhancing the likelihood of FR attainment in FEP. Our findings that only approximately 20% of patients achieved FR indicate an unmet therapeutic need for promoting sustained adequate functional improvement in the early stage of psychotic illness.
Collapse
Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong.
| | - Vivian Wing Yan Kwong
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Gloria Hoi Kei Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Olivia Tsz Ting Jim
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Emily Sin Kei Lau
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| |
Collapse
|
36
|
Zhang L, Li J, Zhao Y, Su Y, Si T. Critical evaluation of paliperidone in the treatment of schizophrenia in Chinese patients: a systematic literature review. Neuropsychiatr Dis Treat 2016; 12:113-31. [PMID: 26811684 PMCID: PMC4714741 DOI: 10.2147/ndt.s64672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Paliperidone (9-hydroxyrisperidone), the major active metabolite of risperidone, has been introduced as a novel atypical antipsychotic agent in many countries. It is available both as an oral extended-release (ER) formulation and as a long-acting injection (paliperidone palmitate, PP), which have been approved for treating schizophrenia in the People's Republic of China since 2009 and 2012, respectively. This systematic review summarizes the efficacy, effectiveness, and safety of paliperidone in the treatment of schizophrenia in the Chinese population. METHODS A systematic literature search was conducted on the databases covering international and Chinese core journals, published from January 1, 2008, to May 22, 2015. RESULTS A total of 122 publications were retrieved, of which 63 studies were identified for inclusion; most studies were related to paliperidone ER (n=53), nine were related to PP, and one study was related to both agents. Paliperidone ER demonstrated at least comparable efficacy with active comparators, including risperidone, olanzapine, ziprasidone, or aripiprazole, and was found to be superior with respect to the onset of action and improvement in the Personal and Social Performance Scale score. Paliperidone ER appeared to be associated with a lower risk of metabolic syndromes; the most common treatment-emergent adverse events were extrapyramidal symptoms, akathisia, insomnia, and somnolence. Results from interventional and observational studies showed that PP was also an effective and well-tolerated treatment for Chinese patients with schizophrenia. The findings were generally consistent with those observed in non-Chinese populations. CONCLUSION Both paliperidone ER and PP were effective and well-tolerated agents for the treatment of schizophrenia in the Chinese population according to the data we reviewed. No new safety signals specific for the Chinese population were raised for paliperidone. Further studies may be needed to collect more data on long-term treatment of schizophrenia in the People's Republic of China.
Collapse
Affiliation(s)
- LiLi Zhang
- Medical Affairs, Xian Janssen Pharmaceutical Co, Ltd, Beijing, People's Republic of China
| | - JiTao Li
- National Clinical Research Center for Mental Disorders, Beijing, People's Republic of China; Peking University Sixth Hospital, Institute of Mental Health, Beijing, People's Republic of China; The Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, People's Republic of China
| | - YanJie Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Yun'Ai Su
- National Clinical Research Center for Mental Disorders, Beijing, People's Republic of China; Peking University Sixth Hospital, Institute of Mental Health, Beijing, People's Republic of China; The Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, People's Republic of China
| | - Tianmei Si
- National Clinical Research Center for Mental Disorders, Beijing, People's Republic of China; Peking University Sixth Hospital, Institute of Mental Health, Beijing, People's Republic of China; The Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, People's Republic of China
| |
Collapse
|
37
|
Juola P, Miettunen J, Salo H, Murray GK, Ahmed AO, Veijola J, Isohanni M, Jääskeläinen E. Neurocognition as a predictor of outcome in schizophrenia in the Northern Finland Birth Cohort 1966. SCHIZOPHRENIA RESEARCH-COGNITION 2015; 2:113-119. [PMID: 29379761 PMCID: PMC5779303 DOI: 10.1016/j.scog.2015.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 11/02/2022]
Abstract
The purpose of this study was to study neurocognitive performance as a predictor of outcomes in midlife schizophrenia. There is a lack of studies with unselected samples and a long follow-up. The study is based on the prospective, unselected population-based Northern Finland Birth Cohort 1966. The study includes 43 individuals with schizophrenia and 73 controls, whose neurocognitive performance was assessed twice, at 34 and 43 years. At both time points we used identical neurocognitive tests to assess verbal and visual memory and executive functions. Our main aim was to analyse neurocognitive performance at 34 years as a predictor of clinical, vocational and global outcomes at 43 years. Additionally, the analysis addressed cross-sectional associations between cognitive performance and clinical, vocational and global measures at 43 years. The assessment of outcomes was performed in the schizophrenia group only. In the longitudinal analysis poorer visual memory predicted poorer vocational outcome and poorer long-term verbal memory predicted poorer global outcome. In the cross-sectional analysis poorer visual memory and lower composite score of neurocognition were associated with poorer global outcome. No individual neurocognitive test or the composite score of these predicted remission. These data indicate that neurocognition, especially memory function, is an important determinant of long-term functional outcome in midlife schizophrenia.
Collapse
Affiliation(s)
- P Juola
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, P.O. BOX 5000, FIN-90014, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. BOX 5000, FIN-90014, Finland
| | - J Miettunen
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, P.O. BOX 5000, FIN-90014, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. BOX 5000, FIN-90014, Finland.,Center for Life Course Epidemiology and Systems Medicine, University of Oulu, P.O. BOX 5000, FIN-90014, Finland
| | - H Salo
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, P.O. BOX 5000, FIN-90014, Finland
| | - G K Murray
- University of Cambridge, Department of Psychiatry, Box 189 Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.,University of Cambridge, Behavioural and Clinical Neuroscience Institute, Herchel Smith Building, Forvie Site, Cambridge Biomedical Campus, Cambridge CB2 0SZ, United Kingdom
| | - A O Ahmed
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Georgia Regents University; 997 Saint Sebastian Way, Augusta, GA 30912, USA
| | - J Veijola
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, P.O. BOX 5000, FIN-90014, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. BOX 5000, FIN-90014, Finland.,Department of Psychiatry, Oulu University Hospital, P.O.BOX 26, FIN-90029 Oulu, Finland
| | - M Isohanni
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, P.O. BOX 5000, FIN-90014, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. BOX 5000, FIN-90014, Finland.,Department of Psychiatry, Oulu University Hospital, P.O.BOX 26, FIN-90029 Oulu, Finland
| | - E Jääskeläinen
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, P.O. BOX 5000, FIN-90014, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. BOX 5000, FIN-90014, Finland.,Center for Life Course Epidemiology and Systems Medicine, University of Oulu, P.O. BOX 5000, FIN-90014, Finland
| |
Collapse
|
38
|
Torgalsbøen AK, Mohn C, Czajkowski N, Rund BR. Relationship between neurocognition and functional recovery in first-episode schizophrenia: Results from the second year of the Oslo multi-follow-up study. Psychiatry Res 2015; 227:185-91. [PMID: 25890693 DOI: 10.1016/j.psychres.2015.03.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 03/13/2015] [Accepted: 03/31/2015] [Indexed: 11/25/2022]
Abstract
Lack of control of confounding variables, high attrition rate, and too few neurocognitive domains completed at each assessment point are some of the limitations identified in studies of the relationship between cognition and functional outcome in schizophrenia. In the ongoing Oslo multi-follow-up study 28 first episode schizophrenia patients and a pairwise matched control group (N=28) are assessed with the MATRICS Consensus Cognitive Battery (MCCB), a clinical interview, an inventory on social and role functioning and criteria of remission and recovery at several follow-up points. The current paper describes the rate of remission and full recovery, and investigates the relationship between neurocognition and functional outcome. At 2-year follow-up, 80.0% of the patients were in remission and 16.0% of them fulfilled the criteria for full recovery. The attrition rate was very low. In the follow-up period, there was a statistically significant decline in Verbal Learning and a significant improvement on Reasoning/Problem Solving and Social Cognition in the schizophrenia group, but not in the control group. This indicates a differentiated neurocognitive course. In the schizophrenia group, Attention/Vigilance and years of education at baseline were significant predictors of social and role functioning 2 years later.
Collapse
Affiliation(s)
| | | | - Nikolai Czajkowski
- Department of Psychology, University of Oslo, Norway; Division of Mental Health, Norwegian Institute of Public Health, Postbox 4404, Nydalen N-0403 Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Norway; Vestre Viken Hospital Trust, 3004 Drammen, Norway
| |
Collapse
|
39
|
Minor KS, Friedman-Yakoobian M, Leung YJ, Meyer EC, Zimmet SV, Caplan B, Monteleone T, Bryant C, Guyer M, Keshavan MS, Seidman LJ. The impact of premorbid adjustment, neurocognition, and depression on social and role functioning in patients in an early psychosis treatment program. Aust N Z J Psychiatry 2015; 49:444-52. [PMID: 25586755 DOI: 10.1177/0004867414565473] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Functional impairments are debilitating concomitants of psychotic disorders and are present early in the illness course and, commonly, prior to psychosis onset. The factors affecting social and role functioning in early psychosis (EP) following treatment are unclear. We evaluated whether six months of participation in the PREP(R), Boston, EP treatment program, part of a public-academic community mental health center, was related to improvements in social and role functioning and whether premorbid adjustment in adolescence, baseline neurocognition, and depression symptoms predicted functional improvement. METHOD The Global Functioning Social and Role scales, MATRICS neurocognitive battery, and Calgary Depression Scale were assessed at baseline and six months during naturalistic treatment, while premorbid adjustment was measured at baseline. All participants were psychotic disorder patients in PREP(R) (n = 46 with social functioning and 47 with role functioning measures at both time points). RESULTS Large improvements were observed in role functioning (d = 0.84) and medium to large improvements were observed in social functioning (d = 0.70). Models consisting of adolescent premorbid adjustment and change in depression symptoms predicted social and role functioning change, whereas neuropsychological functioning did not. CONCLUSIONS Substantial improvements in social and role functioning were observed among this sample participating in a recovery-based EP program. The impact of clinical factors on social and role functioning was highlighted. Further studies of premorbid adjustment in adolescence and the treatment of depression in EP programs in controlled treatment trials are needed to confirm these findings.
Collapse
Affiliation(s)
- Kyle S Minor
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN, USA
| | - Michelle Friedman-Yakoobian
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Y Jude Leung
- Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric C Meyer
- U.S. Department of Veteran Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA Central Texas Veterans Healthcare System, Temple, TX, USA
| | - Suzanna V Zimmet
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Thomas Monteleone
- Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Mental Health, Massachusetts Mental Health Center, Boston, MA, USA
| | - Caitlin Bryant
- Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Margaret Guyer
- Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Mental Health, Massachusetts Mental Health Center, Boston, MA, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
40
|
González-Blanch C, Gleeson JF, Koval P, Cotton SM, McGorry PD, Alvarez-Jimenez M. Social functioning trajectories of young first-episode psychosis patients with and without cannabis misuse: a 30-month follow-up study. PLoS One 2015; 10:e0122404. [PMID: 25849623 PMCID: PMC4388449 DOI: 10.1371/journal.pone.0122404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/20/2015] [Indexed: 11/21/2022] Open
Abstract
The aim of the study was to investigate trajectories of social functioning in young people with first-episode psychosis (FEP) with and without cannabis misuse using a secondary analysis of data from the Episode-II trial. Forty-two young people with FEP and comorbid cannabis use disorder were compared with 39 young people with FEP but without a cannabis use disorder. Social functioning was assessed every 6 months during a 30-month follow-up. Multilevel linear growth curve modeling was used to compare the social functioning trajectories over time for those with and without cannabis misuse. Cannabis misuse was not associated with social functioning at baseline assessment. Over a 30-month follow-up, FEP patients without cannabis disorder showed significant improvements in their social functioning, whereas patients with cannabis misuse at baseline displayed no such improvement. Patients with and without cannabis misuse differed significantly in their levels of social functioning after 24 months. Similar results were obtained after adjusting for potential confounders (i.e., age, gender, negative symptoms, premorbid functioning, DSM-IV diagnoses, baseline social functioning and other substance use). In the context of a specialized early intervention service, patients with cannabis misuse at baseline did not attain the improvements in social outcomes observed in their counterparts without cannabis misuse. There is a need to develop effective interventions to reduce cannabis misuse to ultimately improve social outcomes in young people with psychosis.
Collapse
Affiliation(s)
- César González-Blanch
- Mental Health Centre, University Hospital “Marqués de Valdecilla”, Santander, Spain
- * E-mail:
| | - John F. Gleeson
- School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Peter Koval
- School of Psychology, Australian Catholic University, Melbourne, Australia
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Sue M. Cotton
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen Youth Health Research Centre. Melbourne, Australia
| | - Patrick D. McGorry
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen Youth Health Research Centre. Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen Youth Health Research Centre. Melbourne, Australia
| |
Collapse
|
41
|
Sepede G, Spano MC, Lorusso M, Berardis DD, Salerno RM, Giannantonio MD, Gambi F. Sustained attention in psychosis: Neuroimaging findings. World J Radiol 2014; 6:261-273. [PMID: 24976929 PMCID: PMC4072813 DOI: 10.4329/wjr.v6.i6.261] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/07/2014] [Accepted: 05/16/2014] [Indexed: 02/06/2023] Open
Abstract
To provide a systematic review of scientific literature on functional magnetic resonance imaging (fMRI) studies on sustained attention in psychosis. We searched PubMed to identify fMRI studies pertaining sustained attention in both affective and non-affective psychosis. Only studies conducted on adult patients using a sustained attention task during fMRI scanning were included in the final review. The search was conducted on September 10th, 2013. 15 fMRI studies met our inclusion criteria: 12 studies were focused on Schizophrenia and 3 on Bipolar Disorder Type I (BDI). Only half of the Schizophrenia studies and two of the BDI studies reported behavioral abnormalities, but all of them evidenced significant functional differences in brain regions related to the sustained attention system. Altered functioning of the insula was found in both Schizophrenia and BDI, and therefore proposed as a candidate trait marker for psychosis in general. On the other hand, other brain regions were differently impaired in affective and non-affective psychosis: alterations of cingulate cortex and thalamus seemed to be more common in Schizophrenia and amygdala dysfunctions in BDI. Neural correlates of sustained attention seem to be of great interest in the study of psychosis, highlighting differences and similarities between Schizophrenia and BDI.
Collapse
|
42
|
Acosta FJ, Chinea E, Hernández JL, Rodríguez F, García-Bello M, Medina G, Nieves W. Influence of antipsychotic treatment type and regimen on the functionality of patients with schizophrenia. Nord J Psychiatry 2014; 68:180-8. [PMID: 23672274 DOI: 10.3109/08039488.2013.790475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Enhanced functionality is a major goal in the treatment of schizophrenia. However, possible differences in the effectiveness of first- vs. second-generation antipsychotics or between depot/long-acting injectable (D/LAI) vs. D/LAI plus oral antipsychotics are not clear. AIMS This study was designed to evaluate possible differences between the effects of different antipsychotic treatment types or regimens on the functionality of patients with schizophrenia. METHODS 85 outpatients with schizophrenia, who were being treated with D/LAI antipsychotics--co-administered or not with oral antipsychotics--and had been adherent to the treatment during the previous year were evaluated. Socio-demographic, clinical, treatment-related, global severity and functionality variables were evaluated. Patients were grouped according to the type of antipsychotic drug (first- vs. second-generation) or according to the co-administration (or not) of oral antipsychotics. RESULTS No differences were found between first- and second-generation antipsychotics in terms of global functionality. Patients treated with LAI risperidone showed better global functionality and better performance in their habitual social activities and personal-social relationships than patients treated with risperidone plus oral second-generation antipsychotics. Better functionality was also found to be associated with higher education level, paranoid subtype of schizophrenia, harmful use of nicotine, adherence to oral treatment and absence of concomitant oral anticholinergic or psychopharmacological treatment. CONCLUSIONS Our results suggest that D/LAI antipsychotic treatments should be administered in monotherapy whenever possible and that the treatment schedule should be simple, in order to achieve better functionality.
Collapse
Affiliation(s)
- Francisco J Acosta
- Francisco J. Acosta, Mental Health Research Program, Service of Mental Health, General Health Care Programs Direction, Canary Health Service , Gran Canaria , Spain
| | | | | | | | | | | | | |
Collapse
|
43
|
Donoghue K, Doody GA, Murray RM, Jones PB, Morgan C, Dazzan P, Hart J, Mazzoncini R, Maccabe JH. Cannabis use, gender and age of onset of schizophrenia: data from the ÆSOP study. Psychiatry Res 2014; 215:528-32. [PMID: 24461684 DOI: 10.1016/j.psychres.2013.12.038] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 12/23/2013] [Accepted: 12/26/2013] [Indexed: 11/19/2022]
Abstract
An earlier age of onset of schizophrenia has been identified as a poor prognostic indicator. The current study examines the interaction effect of gender and cannabis use on age of onset of schizophrenia and schizoaffective disorder. This research forms part of a two-centre epidemiological study of first-episode psychosis and included individuals with a diagnosis of schizophrenia or schizoaffective disorder and an age of onset between age 16 and 45. Kaplan-Meier curves and Cox proportional hazards regression were used to compare the effects of cannabis use and gender on age of first symptom of schizophrenia. Akaike's information criteria were used to find the model with the best fit to the data. Cannabis users had an earlier age of first symptom than non-users. There was an interaction with gender; the gender difference in age of onset was diminished in cannabis smokers compared with non-cannabis smokers. The model including cannabis use interacting with gender was the most parsimonious model, followed by cannabis use alone. The addition of other illegal drug use did not improve the model. Cannabis use is associated with an earlier age of onset of schizophrenia, and the gender difference in age of onset is reduced among cannabis smokers.
Collapse
Affiliation(s)
- Kim Donoghue
- Addictions Department, Institute of Psychiatry, King's College London, 4 Windsor Walk, London SE5 8BB, England, UK.
| | - Gillian A Doody
- Division of Psychiatry, University of Nottingham, England, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, England, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, England, UK
| | - Craig Morgan
- Section of Social Psychiatry, Institute of Psychiatry, King's College London, England, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, England, UK
| | - Jozella Hart
- Section of Social Psychiatry, Institute of Psychiatry, King's College London, England, UK
| | - Rodolfo Mazzoncini
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
| | - James H Maccabe
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, England, UK
| |
Collapse
|
44
|
Revisiting the therapeutic effect of rTMS on negative symptoms in schizophrenia: a meta-analysis. Psychiatry Res 2014; 215:505-13. [PMID: 24411074 PMCID: PMC4127383 DOI: 10.1016/j.psychres.2013.12.019] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/18/2013] [Accepted: 12/14/2013] [Indexed: 02/06/2023]
Abstract
This study sought to determine the moderators in the treatment effect of repetitive transcranial magnetic stimulation (rTMS) on negative symptoms in schizophrenia. We performed a meta-analysis of prospective studies on the therapeutic application of rTMS in schizophrenia assessing the effects of both low-frequency and high-frequency rTMS on negative symptoms. Results indicate that rTMS is effective in alleviating negative symptoms in schizophrenia. The effect size was moderate (0.63 and 0.53, respectively). The effect size of rTMS on negative symptoms in sham-controlled trials was 0.80 as measured by the SANS and 0.41 as measured by the PANSS. A longer duration of illness was associated with poorer efficacy of rTMS on negative symptoms. A 10 Hz setting, at least 3 consecutive weeks of treatment, treatment site at the left dorsolateral prefrontal cortex (DLPFC) and a 110% motor threshold (MT) were found to be the best rTMS parameters for the treatment of negative symptoms. The results of our meta-analysis suggest that rTMS is an effective treatment option for negative symptoms in schizophrenia. The moderators of rTMS on negative symptoms included duration of illness, stimulus frequency, duration of illness, position and intensity of treatment as well as the type of outcome measures used.
Collapse
|
45
|
Rajji TK, Miranda D, Mulsant BH. Cognition, function, and disability in patients with schizophrenia: a review of longitudinal studies. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:13-7. [PMID: 24444319 PMCID: PMC4079219 DOI: 10.1177/070674371405900104] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper aims to review longitudinal studies assessing the impact of cognition on function in patients with schizophrenia. PubMed and Scholars Portal were searched using search terms related to schizophrenia, cognition, function, and longitudinal studies. Some functional abilities have been studied more than others. Some studies suggest that the impact of cognition on function depends on the severity of baseline cognitive deficits. Other studies suggest that the impact of cognition on function depend on what phase of the illness the patient is in or what stage in that particular function the patient is involved in. Finally, few studies assessed interactions between cognition and other aspects of schizophrenia in predicting function, such as functional capacity, insight, motivation, and negative symptoms. More longitudinal and comprehensive studies are needed. A focus on community living is of high public significance as patients with schizophrenia continue to grow old. Future studies should also focus on the longitudinal interactions between cognition and other dimensions of schizophrenia as well as on the biological factors that underlie these interactions.
Collapse
Affiliation(s)
- Tarek K Rajji
- Assistant Professor, Department of Psychiatry, University of Toronto; Chief, Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Dielle Miranda
- Research Manager, Geriatric Mental Health Services, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Benoit H Mulsant
- Professor and Vice Chair, Department of Psychiatry, University of Toronto; Physician-in-Chief, Centre for Addiction and Mental Health, Toronto, Ontario
| |
Collapse
|
46
|
Apathy, poor verbal memory and male gender predict lower psychosocial functioning one year after the first treatment of psychosis. Psychiatry Res 2013; 210:55-61. [PMID: 23489592 PMCID: PMC4066735 DOI: 10.1016/j.psychres.2013.02.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/29/2013] [Accepted: 02/07/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND Apathy is a negative symptom associated with poor psychosocial functioning in schizophrenia but has not been sufficiently studied as predictor of poor functioning in first episode psychosis (FEP). OBJECTIVE The main aim of the current study was to evaluate if apathy predicts poor functioning after 1 year in FEP patients in the context of other clinical variables with influence on outcome. METHOD Sixty-four FEP patients completed an extensive clinical and neuro-psychological test battery at baseline and 1-year follow-up. Symptoms were assessed with the Positive and Negative Syndrome scale (PANSS), apathy with the shortened Apathy Evaluation Scale (AES-C-12) and psychosocial functioning with the functioning score from the split version of the Global Assessment of Functioning scale (GAF-F). RESULTS High levels of apathy, poor verbal memory and being male were the baseline variables that best predicted poor functioning at 1-year follow-up, explaining 34% of the variance in GAF-F. When PANSS negative factor was included in the analysis, the significance of AES-C-12 diminished. CONCLUSION These findings points to a robust role for apathy among the negative symptoms in the development of persisting psychosocial dysfunction in FEP and supports the current effort in targeting motivation to improve functioning.
Collapse
|
47
|
Ayesa-Arriola R, Rodríguez-Sánchez JM, Pérez-Iglesias R, González-Blanch C, Pardo-García G, Tabares-Seisdedos R, Vázquez-Barquero JL, Crespo-Facorro B. The relevance of cognitive, clinical and premorbid variables in predicting functional outcome for individuals with first-episode psychosis: a 3 year longitudinal study. Psychiatry Res 2013; 209:302-8. [PMID: 23403293 DOI: 10.1016/j.psychres.2013.01.024] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 01/11/2013] [Accepted: 01/15/2013] [Indexed: 11/26/2022]
Abstract
Real-world functional deficits are common and persistent in individuals with psychosis. Cognitive deficits have been shown to compromise functioning. We aimed to study the predictive values of premorbid, sociodemographic, and baseline clinical and neurocognitive factors on long-term functional outcome for individuals with first episode non-affective psychosis. We failed to demonstrate a significant relationship between cognitive deficits at baseline and functional disability at 3 year follow-up. Diagnosis of schizophrenia (OR=2.457, p=0.011), shorter education (OR=1.177, p=0.005) and poor premorbid social adjustment (OR=1.628, p=0.013) emerged as the strongest predictors for the 114 subjects (56%) that exhibited functional disability at 3-year follow-up. A considerable proportion of the variance in functioning (74% at 1 year and 77% at 3 year) remained unexplained by baseline variables. The set of variables that predicted functional outcome at medium- (1 year) and long-term (3 years) differed. In conclusion, the length of follow-up influenced the relationship between baseline variables and functional outcome. A substantial proportion of the variance in function was not explained by these variables and therefore the influence of other factors warrants further investigation. The data support the notion that premorbid social adjustment is an important aspect in functional outcome over the course of the illness.
Collapse
Affiliation(s)
- Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IFIMAV, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Lee WK. Effectiveness of computerized cognitive rehabilitation training on symptomatological, neuropsychological and work function in patients with schizophrenia. Asia Pac Psychiatry 2013; 5:90-100. [PMID: 23857809 DOI: 10.1111/appy.12070] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 01/30/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There has been plenty of interest in cognitive rehabilitation for schizophrenia here in Korea since the year 2000. But the efficacy studies of cognitive remediation intervention are still deficient. The primary purpose of this study was to develop a computer-assisted cognitive remediation program and conduct a clinical trial in a group of schizophrenic patients. METHODS Sixty patients with schizophrenia were randomly assigned to a computerized cognitive rehabilitation (Cog-trainer) group plus usual rehabilitation (UR) or to a usual rehabilitation (UR) group only. Clinical, neuropsychological and functional outcome variables were assessed at baseline and after intervention. The Cog-trainer group received 20 sessions of computerized cognitive remediation training over 3 months. This training program consists of 10 units, with each unit being divided into three stages: (i) practice; (ii) application; and (iii) advanced. RESULTS Compared to the UR group, the Cog-trainer exhibited a significant improvement in attention, concentration and working memory. The Cog-trainer group also showed improvement in the work quality subscale of the work behavior inventory. However, there were no significant benefits of computerized cognitive remediation where symptoms were concerned. DISCUSSION These results indicate that computerized cognitive rehabilitation training can contribute to an improvement in the cognitive function of people with schizophrenia. The changes in cognitive outcomes can also contribute to improvement in job functioning. Further study of generalization to other functional outcome measures will be necessary. Long-term follow-up studies are needed to confirm the maintenance of such improvements.
Collapse
Affiliation(s)
- Woo Kyeong Lee
- Department of Counseling Psychology, Seoul Cyber University, Seoul, Korea.
| |
Collapse
|
49
|
Prepulse inhibition predicts working memory performance whilst startle habituation predicts spatial reference memory retention in C57BL/6 mice. Behav Brain Res 2013; 242:166-77. [DOI: 10.1016/j.bbr.2012.12.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 12/01/2012] [Accepted: 12/06/2012] [Indexed: 12/26/2022]
|
50
|
Tandberg M, Ueland T, Andreassen OA, Sundet K, Melle I. Factors associated with occupational and academic status in patients with first-episode psychosis with a particular focus on neurocognition. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1763-73. [PMID: 22310699 DOI: 10.1007/s00127-012-0477-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 01/17/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE Employment rates for patients with chronic schizophrenia and first-episode psychosis (FEP) are low despite a larger variation in reported rates for FEP patients. This could partly be due to various methodologies used. The association between neurocognition and occupational functioning is well known in patients with chronic schizophrenia, while corresponding FEP studies are scarce and results more ambiguous. The current study investigated employment rates in a FEP sample using a threefold division of activity that separated students from employed and unemployed patients. Further, it investigated the relationship between students, employed and unemployed patients and clinical, neurocognitive, global, and social functioning. METHODS A total of 128 FEP patients with a broad DSM-IV schizophrenia spectrum disorder were assessed with clinical, neurocognitive, and global and social functioning measures. Three groups were defined based on occupational and academic status. RESULTS Twenty-six percent of the patients were employed, and 23% were students. The students and the employed patients performed better than the unemployed patients on clinical and global and social functioning measures. There were no differences between employed patients and students on any of the investigated measures, although there was a non-significant trend for the students to show better working memory capacity compared to the other two groups. CONCLUSIONS Students and employed patients showed better clinical, global and social functioning compared with unemployed patients. There were no significant differences between the three groups on neurocognitive measures. The results pose an argument for grouping the students with the employed patients if a dichotomous variable is preferred.
Collapse
Affiliation(s)
- Marte Tandberg
- Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway.
| | | | | | | | | |
Collapse
|