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Phalen P, Kimhy D, Jobes D, Bennett M. Emotional distress and dysregulation as treatment targets to reduce suicide in psychosis: a scoping review. Eur Arch Psychiatry Clin Neurosci 2024; 274:955-961. [PMID: 37597022 DOI: 10.1007/s00406-023-01675-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
There is a pressing need for effective treatments that address the high rate of suicide observed among people with psychosis. In this scoping review we highlight two suicidogenic treatment targets that have been relatively neglected in people with psychotic disorders: emotional distress and emotion dysregulation. We review the research on these constructs in psychosis and their relationship to suicide in this population, and then make clinical recommendations based on research findings. Emotional distress and emotional dysregulation may be promising treatment targets for suicide among people with psychosis.
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Affiliation(s)
- Peter Phalen
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, USA.
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine, New York, NY, USA
- Education and Clinical Center, James J. Peters VA Medical Center, Mental Illness Research, New York, NY, USA
| | - David Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Melanie Bennett
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, USA
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2
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Chakrabarty T, Frangou S, Torres IJ, Ge R, Yatham LN. Brain age and cognitive functioning in first-episode bipolar disorder. Psychol Med 2023; 53:5127-5135. [PMID: 35875930 PMCID: PMC10476063 DOI: 10.1017/s0033291722002136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is significant heterogeneity in cognitive function in patients with bipolar I disorder (BDI); however, there is a dearth of research into biological mechanisms that might underlie cognitive heterogeneity, especially at disease onset. To this end, this study investigated the association between accelerated or delayed age-related brain structural changes and cognition in early-stage BDI. METHODS First episode patients with BDI (n = 80) underwent cognitive assessment to yield demographically normed composite global and domain-specific scores in verbal memory, non-verbal memory, working memory, processing speed, attention, and executive functioning. Structural magnetic resonance imaging data were also collected from all participants and subjected to machine learning to compute the brain-predicted age difference (brainPAD), calculated by subtracting chronological age from age predicted by neuroimaging data (positive brainPAD values indicating age-related acceleration in brain structural changes and negative values indicating delay). Patients were divided into tertiles based on brainPAD values, and cognitive performance compared amongst tertiles with ANCOVA. RESULTS Patients in the lowest (delayed) tertile of brainPAD values (brainPAD range -17.9 to -6.5 years) had significantly lower global cognitive scores (p = 0.025) compared to patients in the age-congruent tertile (brainPAD range -5.3 to 2.4 yrs), and significantly lower verbal memory scores (p = 0.001) compared to the age-congruent and accelerated (brainPAD range 2.8 to 16.1 yrs) tertiles. CONCLUSION These results provide evidence linking cognitive dysfunction in the early stage of BDI to apparent delay in typical age-related brain changes. Further studies are required to assess how age-related brain changes and cognitive functioning evolve over time.
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Affiliation(s)
- Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
| | - Sophia Frangou
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
- Department of Psychiatry Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Ivan J. Torres
- British Columbia Mental Health and Substance Use Services, Vancouver, BC, Canada
| | - Ruiyang Ge
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
| | - Lakshmi N. Yatham
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
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3
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Knudsen CB, Hemager N, Jepsen JRM, Gregersen M, Greve AN, Andreassen AK, Veddum L, Brandt JM, Krantz MF, Søndergaard A, Burton BK, Thorup AAE, Nordentoft M, Lambek R, Mors O, Bliksted VF. Early Childhood Neurocognition in Relation to Middle Childhood Psychotic Experiences in Children at Familial High Risk of Schizophrenia or Bipolar Disorder and Population-Based Controls: The Danish High Risk and Resilience Study. Schizophr Bull 2023; 49:756-767. [PMID: 36548470 PMCID: PMC10154705 DOI: 10.1093/schbul/sbac198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND HYPOTHESIS Familial high-risk (FHR) studies examining longitudinal associations between neurocognition and psychotic experiences are currently lacking. We hypothesized neurocognitive impairments at age 7 to be associated with increased risk of psychotic experiences from age 7 to 11 in children at familial high risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) and population-based controls (PBC), and further, impaired functioning in some neurocognitive functions to be associated with greater risk of psychotic experiences in children at FHR-SZ or FHR-BP relative to PBC. STUDY DESIGN Neurocognition was assessed at age 7 (early childhood) and psychotic experiences from age 7 to 11 (middle childhood) in 449 children from the Danish High Risk and Resilience Study. The neurocognitive assessment covered intelligence, processing speed, attention, visuospatial and verbal memory, working memory, and set-shifting. Psychotic experiences were assessed through face-to-face interviews with the primary caregiver and the child. STUDY RESULTS Set-shifting impairments at age 7 were associated with greater risk of psychotic experiences from age 7 to 11 in children at FHR-SZ. Children at FHR-BP and PBC showed no differential associations. Working memory and visuospatial memory impairments were related to increased risk of psychotic experiences across the cohort. However, adjusting for concurrent psychopathology attenuated these findings. CONCLUSIONS Early childhood neurocognitive impairments are risk markers of middle childhood psychotic experiences, of which impaired set-shifting appears to further increase the risk of psychotic experiences in children at FHR-SZ. More research is needed to examine longitudinal associations between neurocognitive impairments and psychotic experiences in FHR samples.
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Affiliation(s)
- Christina Bruun Knudsen
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Børglumvej 5, 1st floor, 8240 Risskov, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
| | - Nicoline Hemager
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center, Glostrup, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
| | - Maja Gregersen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Aja Neergaard Greve
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
| | - Anna Krogh Andreassen
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Børglumvej 5, 1st floor, 8240 Risskov, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
| | - Lotte Veddum
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Børglumvej 5, 1st floor, 8240 Risskov, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
| | - Julie Marie Brandt
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Falkenberg Krantz
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
| | - Anne Søndergaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Klee Burton
- Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital – Psychiatry Region Zealand, Roskilde, Denmark
| | - Anne Amalie Elgaard Thorup
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Lambek
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Ole Mors
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
| | - Vibeke Fuglsang Bliksted
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Børglumvej 5, 1st floor, 8240 Risskov, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
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4
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Smucny J, Vlasova RM, Lesh TA, Rowland DJ, Wang G, Chaudhari AJ, Chen S, Iosif AM, Hogrefe CE, Bennett JL, Shumann CM, Van de Water JA, Maddock RJ, Styner MA, Geschwind DH, McAllister AK, Bauman MD, Carter CS. Increased Striatal Presynaptic Dopamine in a Nonhuman Primate Model of Maternal Immune Activation: A Longitudinal Neurodevelopmental Positron Emission Tomography Study With Implications for Schizophrenia. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:505-513. [PMID: 36805246 PMCID: PMC10164700 DOI: 10.1016/j.bpsc.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epidemiological studies suggest that maternal immune activation (MIA) is a significant risk factor for future neurodevelopmental disorders, including schizophrenia (SZ), in offspring. Consistent with findings in SZ research and work in rodent systems, preliminary cross-sectional findings in nonhuman primates suggest that MIA is associated with dopaminergic hyperfunction in young adult offspring. METHODS In this unique prospective longitudinal study, we used [18F]fluoro-l-m-tyrosine positron emission tomography to examine the developmental time course of striatal presynaptic dopamine synthesis in male rhesus monkeys born to dams (n = 13) injected with a modified form of the inflammatory viral mimic, polyinosinic:polycytidylic acid [poly(I:C)], in the late first trimester. Striatal (caudate, putamen, and nucleus accumbens) dopamine from these animals was compared with that of control offspring born to dams that received saline (n = 10) or no injection (n = 4). Dopamine was measured at 15, 26, 38, and 48 months of age. Prior work with this cohort found decreased prefrontal gray matter volume in MIA offspring versus controls between 6 and 45 months of age. Based on theories of the etiology and development of SZ-related pathology, we hypothesized that there would be a delayed (relative to the gray matter decrease) increase in striatal fluoro-l-m-tyrosine signal in the MIA group versus controls. RESULTS [18F]fluoro-l-m-tyrosine signal showed developmental increases in both groups in the caudate and putamen. Group comparisons revealed significantly greater caudate dopaminergic signal in the MIA group at 26 months. CONCLUSIONS These findings are highly relevant to the known pathophysiology of SZ and highlight the translational relevance of the MIA model in understanding mechanisms by which MIA during pregnancy increases risk for later illness in offspring.
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Affiliation(s)
- Jason Smucny
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California.
| | - Roza M Vlasova
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Tyler A Lesh
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California; Center for Neuroscience, University of California, Davis, California
| | - Douglas J Rowland
- Center for Genomic and Molecular Imaging, University of California, Davis, California
| | - Guobao Wang
- Department of Radiology, University of California, Davis, California
| | - Abhijit J Chaudhari
- Center for Genomic and Molecular Imaging, University of California, Davis, California; Department of Radiology, University of California, Davis, California
| | - Shuai Chen
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, California
| | - Ana-Maria Iosif
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, California
| | - Casey E Hogrefe
- California National Primate Research Center, University of California, Davis, California
| | - Jeffrey L Bennett
- Department of Psychology, University of California, Davis, California
| | - Cynthia M Shumann
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California
| | - Judy A Van de Water
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, California
| | - Richard J Maddock
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California
| | - Martin A Styner
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina; Department of Computer Science, University of North Carolina, Chapel Hill, North Carolina
| | - Daniel H Geschwind
- Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | | | - Melissa D Bauman
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California; California National Primate Research Center, University of California, Davis, California
| | - Cameron S Carter
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California; Center for Neuroscience, University of California, Davis, California.
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5
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Andreassen AK, Lambek R, Hemager N, Knudsen CB, Veddum L, Carlsen AH, Bundgaard AF, Søndergaard A, Brandt JM, Gregersen M, Krantz MF, Burton BK, Jepsen JRM, Thorup AAE, Nordentoft M, Mors O, Bliksted VF, Greve A. Working memory heterogeneity from age 7 to 11 in children at familial high risk of schizophrenia or bipolar disorder- The Danish High Risk and Resilience Study. J Affect Disord 2023; 332:318-326. [PMID: 37059192 DOI: 10.1016/j.jad.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Despite the genetic overlap between bipolar disorder and schizophrenia, working memory impairments are mainly found in children of parents with schizophrenia. However, working memory impairments are characterized by substantial heterogeneity, and it is unknown how this heterogeneity develops over time. We used a data-driven approach to assess working memory heterogeneity and longitudinal stability in children at familial high risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP). METHODS Based on the performances on four working memory tasks by 319 children (FHR-SZ, N = 202, FHR-BP, N = 118) measured at age 7 and 11, latent profile transition analysis was used to test for the presence of subgroups, and the stability of subgroup membership over time. Population-based controls (VIA 7, N = 200, VIA 11, N = 173) were included as a reference group. The working memory subgroups were compared based on caregiver- and teacher ratings of everyday working memory function, and dimensional psychopathology. RESULTS A model with three subgroups characterized by different levels of working memory function (an impaired subgroup, a mixed subgroup, and an above average subgroup) best fitted the data. The impaired subgroup had the highest ratings of everyday working memory impairments and psychopathology. Overall, 98 % (N = 314) stayed in the same subgroup from age 7 to 11. CONCLUSION Persistent working memory impairments are present in a subset of children at FHR-SZ and FHR-BP throughout middle childhood. Attention should be given to these children, as working memory impairments influence daily life, and may serve as a vulnerability marker of transition to severe mental illness.
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Affiliation(s)
- Anna Krogh Andreassen
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Denmark.
| | - Rikke Lambek
- Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
| | - Nicoline Hemager
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark; CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Denmark
| | - Christina Bruun Knudsen
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Denmark
| | - Lotte Veddum
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Denmark
| | - Anders Helles Carlsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Denmark; Research Unit, Research Unit, Aarhus University Hospital Psychiatry, Denmark
| | | | - Anne Søndergaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark; CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Marie Brandt
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark; CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maja Gregersen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark; CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Falkenberg Krantz
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark; CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Denmark
| | - Birgitte Klee Burton
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Denmark
| | - Jens Richardt Møllegaard Jepsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark; CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Denmark; Center for Clinical Interventions and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Copenhagen University Hospital - Metal Health Services CPH, Denmark
| | - Anne Amalie Elgaard Thorup
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Denmark
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark; CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark
| | - Vibeke Fuglsang Bliksted
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Denmark
| | - Aja Greve
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark
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6
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Xie M, Cai J, Liu Y, Wei W, Zhao Z, Dai M, Wu Y, Huang Y, Tang Y, Xiao L, Zhang G, Li C, Guo W, Ma X, Deng W, Du X, Wang Q, Li T. Association between childhood trauma and white matter deficits in first-episode schizophrenia. Psychiatry Res 2023; 323:115111. [PMID: 36924585 DOI: 10.1016/j.psychres.2023.115111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/28/2023] [Accepted: 02/14/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE This study aimed to investigate the relationship between childhood trauma (ChT) and white matter (WM) deficits in first-episode schizophrenia (FES). METHODS A total of 103 individuals with FES and 206 healthy control individuals (HCs) were enrolled and assessed based on ChT Questionnaire (CTQ) and Positive and Negative Symptoms Scale (PANSS). Diffusion tensor imaging was acquired on a Signa 3.0 T scanner. Map of fractional anisotropy (FA) was analyzed using Tract-Based Spatial Statistics. Hierarchical logistic regression analyses were used to examine associations of sociodemographic characteristics, total CTQ scores, and WM deficits. RESULTS Compared with the HCs group, the FES group showed significantly lower FA in several WM bundles (left anterior thalamic radiation, left inferior frontal-occipital fasciculus, left cingulum, forceps major, and forceps minor), and the mean FA value in these WM bundles was inversely related to the total CTQ score. In addition, a higher CTQ score may increase the risk of schizophrenia, while higher FA values may decrease the risk of schizophrenia. CONCLUSION This study demonstrates that individuals with FES evince widespread cerebral WM abnormalities and that these abnormalities were associated with ChT. These results provide clues about the neural basis and potential biomarkers of schizophrenia.
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Affiliation(s)
- Min Xie
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jia Cai
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yunjia Liu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Wei Wei
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310013, Zhejiang, China
| | - Zhengyang Zhao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Minhan Dai
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yulu Wu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yunqi Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yiguo Tang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Liling Xiao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Guangya Zhang
- Suzhou Psychiatry Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu, China
| | - Chuanwei Li
- Suzhou Psychiatry Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu, China
| | - Wanjun Guo
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310013, Zhejiang, China
| | - Xiaohong Ma
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Wei Deng
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310013, Zhejiang, China
| | - Xiangdong Du
- Suzhou Psychiatry Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu, China
| | - Qiang Wang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Tao Li
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310013, Zhejiang, China.
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7
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Knudsen CB, Greve AN, Jepsen JRM, Lambek R, Andreassen AK, Veddum L, Brandt JM, Gregersen M, Krantz MF, Søndergaard A, Carlsen AH, Steffensen NL, Bundgaard AF, Burton BK, Thorup AAE, Nordentoft M, Mors O, Bliksted VF, Hemager N. Neurocognitive Subgroups in Children at Familial High-risk of Schizophrenia or Bipolar disorder: Subgroup Membership Stability or Change From Age 7 to 11-The Danish High Risk and Resilience Study. Schizophr Bull 2023; 49:185-195. [PMID: 36200864 PMCID: PMC9810011 DOI: 10.1093/schbul/sbac134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND HYPOTHESIS Subgroups with distinct levels of neurocognitive functioning exist in children of parents with schizophrenia or bipolar disorder. However, studies investigating the temporal stability of subgroup membership are currently lacking. We hypothesized that a minority of children at familial high-risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) would transition to a different neurocognitive subgroup from age 7 to 11 and that most transitions would be to a more impaired subgroup. STUDY DESIGN Latent profile analysis was used to identify subgroups at two assessments (age 7 and 11) based on the performance of 320 children at FHR-SZ or FHR-BP across eight neurocognitive functions. Temporal stability in subgroup membership was evaluated with latent profile transition analysis. Population-based controls (age 7, n = 199; age 11, n = 178) were included as a reference group. Children transitioning to a more impaired subgroup were compared with nontransitioning children on sex, FHR-status, global functioning, and psychopathology. STUDY RESULTS At both assessment points, we identified three subgroups based on neurocognitive performance: a moderately-severely impaired, a mildly impaired, and an above-average subgroup. A total of 12.8% of children transitioned to a different subgroup, of which the majority (85.2%) moved to a more impaired subgroup. Parental diagnosis of schizophrenia, but neither parental diagnosis of bipolar disorder, global functioning at age 7, psychopathology, nor sex significantly differentiated children transitioning to a more impaired subgroup from nontransitioning children. CONCLUSIONS During pre-adolescence, neurocognitive developmental lag is associated with being at FHR-SZ. Close attention to these children's neurocognitive development is indicated.
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Affiliation(s)
- Christina Bruun Knudsen
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
| | - Aja Neergaard Greve
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
| | - Jens Richardt Møllegaard Jepsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research and Center for Neuropsychiatric Schizophrenia Research, Mental Health Center, Glostrup, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
| | - Rikke Lambek
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Anna Krogh Andreassen
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
| | - Lotte Veddum
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
| | - Julie Marie Brandt
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maja Gregersen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Falkenberg Krantz
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
| | - Anne Søndergaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anders Helles Carlsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Research Unit, Department of Child- and Adolescent Psychiatry, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
| | - Nanna Lawaetz Steffensen
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
| | - Anette Faurskov Bundgaard
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
| | - Birgitte Klee Burton
- Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
| | - Vibeke Fuglsang Bliksted
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
| | - Nicoline Hemager
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research – iPSYCH, Aarhus, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
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8
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Buka SL, Lee YH, Goldstein JM. Infections During Pregnancy and Risks for Adult Psychosis: Findings from the New England Family Study. Curr Top Behav Neurosci 2023; 61:49-69. [PMID: 36376640 DOI: 10.1007/7854_2022_397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
For the past 40 years, our team has conducted a unique program of research investigating the prenatal risks for schizophrenia and related adult psychiatric disorders. The New England Family Study is a long-term prospective cohort study of over 16,000 individuals followed from the prenatal period for over 50 years. This chapter summarizes several major phases and findings from this work, highlighting recent results on maternal prenatal bacterial infections and brain imaging. Implications regarding the causes and potential prevention of major psychotic disorders are discussed.
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Affiliation(s)
- Stephen L Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | - Younga Heather Lee
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Departments of Psychiatry and Medicine, Harvard Medical School, Boston, MA, USA
| | - Jill M Goldstein
- Departments of Psychiatry and Medicine, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Innovation Center on Sex Differences in Medicine, Massachusetts General Hospital, Boston, MA, USA
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9
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Mandal PK, Gaur S, Roy RG, Samkaria A, Ingole R, Goel A. Schizophrenia, Bipolar and Major Depressive Disorders: Overview of Clinical Features, Neurotransmitter Alterations, Pharmacological Interventions, and Impact of Oxidative Stress in the Disease Process. ACS Chem Neurosci 2022; 13:2784-2802. [PMID: 36125113 DOI: 10.1021/acschemneuro.2c00420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Psychiatric disorders are one of the leading causes of disability worldwide and affect the quality of life of both individuals and the society. The current understanding of these disorders points toward receptor dysfunction and neurotransmitter imbalances in the brain. Treatment protocols are hence oriented toward normalizing these imbalances and ameliorating the symptoms. However, recent literature has indicated the possible role of depleted levels of antioxidants like glutathione (GSH) as well as an alteration in the levels of the pro-oxidant, iron in the pathogenesis of major psychiatric diseases, viz., schizophrenia (Sz), bipolar disorder (BD), and major depressive disorder (MDD). This review aims to highlight the involvement of oxidative stress (OS) in these psychiatric disorders. An overview of the clinical features, neurotransmitter abnormalities, and pharmacological treatments concerning these psychiatric disorders has also been presented. Furthermore, it attempts to synthesize literature from existing magnetic resonance spectroscopy (MRS) and quantitative susceptibility mapping (QSM) studies for these disorders, assessing GSH and iron, respectively. This manuscript is a sincere attempt to stimulate research discussion to advance the knowledge base for further understanding of the pathoetiology of Sz, BD, and MDD.
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Affiliation(s)
- Pravat K Mandal
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Manesar, Haryana 122050, India.,The Florey Institute of Neuroscience and Mental Health, Melbourne School of Medicine Campus, Melbourne 3052, Australia
| | - Shradha Gaur
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Manesar, Haryana 122050, India
| | - Rimil Guha Roy
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Manesar, Haryana 122050, India
| | - Avantika Samkaria
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Manesar, Haryana 122050, India
| | | | - Anshika Goel
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Manesar, Haryana 122050, India
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10
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Brain gyrification in bipolar disorder: a systematic review of neuroimaging studies. Brain Imaging Behav 2022; 16:2768-2784. [PMID: 36042153 DOI: 10.1007/s11682-022-00713-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/02/2022]
Abstract
Bipolar disorder (BD) is a severe mental illness with a strong genetic component. Genetic variations have been involved in the risk of this disorder, including those mediating brain function and neurodevelopment. Early neurodevelopment and neuroprogression processes could be reflected in brain gyrification patterns and help optimize the prediction and diagnosis of such disorders that is often delayed. Previous neuroimaging studies using this measure in patients with bipolar disorder revealed controversial results. This systematic review aimed to summarize available neuroimaging investigations on gyrification in BD compared to healthy controls (HC) and/or other psychiatric groups. Fourteen studies including 733 patients with BD, 585 patients with schizophrenia (SCZ), 90 with schizoaffective disorder (SZA), and 1380 healthy subjects were identified. Overall, a heterogeneous pattern of gyrification emerged between patients with BD and HC. Interestingly, increased gyrification or no differences were also observed in patients with BD compared to those with the schizophrenia-spectrum disorders. Furthermore, relatives of patients with BD showed lower or no differences in gyrification compared to healthy subjects without a family history of affective illness. Differences in the design and in methodological approaches could have contributed to the heterogeneity of the findings. The current review supports an altered brain gyrification pattern that underlies the pathophysiology of BD spanning large anatomical and functional neural networks, associated with altered cognitive functioning, difficulties in processing and affective regulation, and clinical symptoms. Longitudinal studies are needed to test different bipolar phenotypes and pharmacological effects on gyrification.
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11
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Fico G, Oliva V, De Prisco M, Giménez-Palomo A, Sagué-Vilavella M, Gomes-da-Costa S, Garriga M, Solé E, Valentí M, Fanelli G, Serretti A, Fornaro M, Carvalho AF, Vieta E, Murru A. The U-shaped relationship between parental age and the risk of bipolar disorder in the offspring: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2022; 60:55-75. [PMID: 35635997 DOI: 10.1016/j.euroneuro.2022.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 01/06/2023]
Abstract
Parenthood age may affect the risk for the development of different psychiatric disorders in the offspring, including bipolar disorder (BD). The present systematic review and meta-analysis aimed to appraise the relationship between paternal age and risk for BD and to explore the eventual relationship between paternal age and age at onset of BD. We searched the MEDLINE, Scopus, Embase, PsycINFO online databases for original studies from inception, up to December 2021. Random-effects meta-analyses were conducted. Sixteen studies participated in the qualitative synthesis, of which k = 14 fetched quantitative data encompassing a total of 13,424,760 participants and 217,089 individuals with BD. Both fathers [adjusted for the age of other parent and socioeconomic status odd ratio - OR = 1.29(95%C.I. = 1.13-1.48)] and mothers aged ≤ 20 years [(OR = 1.23(95%C.I. = 1.14-1.33)] had consistently increased odds of BD diagnosis in their offspring compared to parents aged 25-29 years. Fathers aged ≥ 45 years [adjusted OR = 1.29 (95%C.I. = 1.15-1.46)] and mothers aged 35-39 years [OR = 1.10(95%C.I. = 1.01-1.19)] and 40 years or older [OR = 1.2(95% C.I. = 1.02-1.40)] likewise had inflated odds of BD diagnosis in their offspring compared to parents aged 25-29 years. Early and delayed parenthood are associated with an increased risk of BD in the offspring. Mechanisms underlying this association are largely unknown and may involve a complex interplay between psychosocial, genetic and biological factors, and with different impacts according to sex and age range. Evidence on the association between parental age and illness onset is still tentative but it points towards a possible specific effect of advanced paternal age on early BD-onset.
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Affiliation(s)
- Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Vincenzo Oliva
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain; Department of Neuroscience, Section of Psychiatry, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Anna Giménez-Palomo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Maria Sagué-Vilavella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Susana Gomes-da-Costa
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Marina Garriga
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Eva Solé
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Marc Valentí
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Giuseppe Fanelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Michele Fornaro
- Department of Neuroscience, Section of Psychiatry, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Andre F Carvalho
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Vic., Australia 6 Perinatal Health Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Deakin University, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain.
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
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12
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Fett AKJ, Reichenberg A, Velthorst E. Lifespan evolution of neurocognitive impairment in schizophrenia - A narrative review. Schizophr Res Cogn 2022; 28:100237. [PMID: 35242606 PMCID: PMC8861413 DOI: 10.1016/j.scog.2022.100237] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 01/28/2023]
Abstract
Cognitive impairment is a well-recognized key feature of schizophrenia. Here we review the evidence on (1) the onset and sensitive periods of change in cognitive impairment before and after the first psychotic episode, and (2) heterogeneity in neurocognitive presentations across cognitive domains between and within individuals. Overall, studies suggest that mild cognitive impairment in individuals who develop schizophrenia or related disorders is already present during early childhood. Cross-sectional studies further suggest increasing cognitive impairments from pre- to post-psychosis onset, with the greatest declines between adolescence, the prodrome, and the first psychotic episode and with some variability between domains. Longitudinal studies with more than 10 years of observation time are scarce but support mild cognitive declines after psychosis onset until late adulthood. Whether and how much this cognitive decline exceeds normal aging, proceeds further in older patients, and is specific to certain cognitive domains and subpopulations of patients remains to be investigated. Finally, studies show substantial heterogeneity in cognitive performance in schizophrenia and suggest a variety of impairment profiles. This review highlights a clear need for long-term studies that include a control group and individuals from adolescence to old age to better understand critical windows of cognitive change and their predictors. The available evidence stresses the importance of interventions that aim to counter cognitive decline during the prodromal years, as well as careful assessment of cognition in order to determine who will profit most from which cognitive training.
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Affiliation(s)
- Anne-Kathrin J Fett
- Department of Psychology, City, University of London, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA.,Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA.,Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, NY, USA
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13
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Stone WS, Phillips MR, Yang LH, Kegeles LS, Susser ES, Lieberman JA. Neurodegenerative model of schizophrenia: Growing evidence to support a revisit. Schizophr Res 2022; 243:154-162. [PMID: 35344853 PMCID: PMC9189010 DOI: 10.1016/j.schres.2022.03.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/21/2022]
Abstract
Multidimensional progressive declines in the absence of standard biomarkers for neurodegeneration are observed commonly in the development of schizophrenia, and are accepted as consistent with neurodevelopmental etiological hypotheses to explain the origins of the disorder. Far less accepted is the possibility that neurodegenerative processes are involved as well, or even that key dimensions of function, such as cognition and aspects of biological integrity, such as white matter function, decline in chronic schizophrenia beyond levels associated with normal aging. We propose that recent research germane to these issues warrants a current look at the question of neurodegeneration. We propose the view that a neurodegenerative hypothesis provides a better explanation of some features of chronic schizophrenia, including accelerated aging, than is provided by neurodevelopmental hypotheses. Moreover, we suggest that neurodevelopmental influences in early life, including those that may extend to later life, do not preclude the development of neurodegenerative processes in later life, including some declines in cognitive and biological integrity. We evaluate these views by integrating recent findings in representative domains such as cognition and white and gray matter integrity with results from studies on accelerated aging, together with functional implications of neurodegeneration for our understanding of chronic schizophrenia.
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Affiliation(s)
- William S. Stone
- Harvard Medical School Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, Massachusetts,Corresponding Author: William S. Stone, Ph.D., Massachusetts Mental Health Center, 75 Fenwood Road, Boston, Massachusetts, USA,
| | - Michael R. Phillips
- Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, Shanghai, China,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Lawrence H. Yang
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York,New York University College of Global Public Health, New York, New York
| | - Lawrence S. Kegeles
- Department of Psychiatry, Columbia University, New York, New York,New York State Psychiatric Institute, New York, New York
| | - Ezra S. Susser
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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14
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Miskowiak KW, Mariegaard J, Jahn FS, Kjærstad HL. Associations between cognition and subsequent mood episodes in patients with bipolar disorder and their unaffected relatives: A systematic review. J Affect Disord 2022; 297:176-188. [PMID: 34699850 DOI: 10.1016/j.jad.2021.10.044] [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: 08/02/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is highly recurrent and prevention of relapse and illness onset is an urgent treatment priority. This systematic review examined whether cognitive assessments can aid prediction of recurrence in patients with BD and/or illness onset in individuals at familial risk. METHODS The review included longitudinal studies of patients with BD or individuals at familial risk of mood disorder that examined the association between cognitive functions and subsequent relapse or illness onset, respectively. We followed the procedures of the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) 2020 statement. Searches were conducted on PubMed/MEDLINE, EMBASE and PsychInfo databases from inception up until May 10th 2021. RESULTS We identified 19 eligible studies; 12 studies investigated cognitive predictors of recurrence in BD (N = 36-76) and seven investigated cognitive predictors of illness onset in at-risk individuals (N = 84-234). In BD, general cognitive impairment, poorer verbal memory and executive function and positive bias were associated with subsequent (hypo)manic relapse -but with not depressive relapse or mood episodes in general. In first-degree relatives, impairments in attention, verbal memory and executive functions and positive bias were associated with subsequent illness onset. LIMITATIONS The findings should be considered preliminary given the small-to-moderate sample sizes and scarcity of studies. CONCLUSIONS Subject to replication, the associations between cognitive impairment and (hypo)mania relapse and illness onset may provide a platform for personalised treatment and prophylactic strategies.
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Affiliation(s)
- Kamilla Woznica Miskowiak
- Neurocognition and Emotion in Affective Disorder (NEAD) Group, Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University hospital, Rigshospitalet, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
| | - Johanna Mariegaard
- Neurocognition and Emotion in Affective Disorder (NEAD) Group, Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University hospital, Rigshospitalet, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Frida Simon Jahn
- Neurocognition and Emotion in Affective Disorder (NEAD) Group, Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University hospital, Rigshospitalet, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Lie Kjærstad
- Neurocognition and Emotion in Affective Disorder (NEAD) Group, Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University hospital, Rigshospitalet, Denmark
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15
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Johnson MC, Sathappan A, Hanly JG, Ross GS, Hauptman AJ, Stone WS, Simon KM. From the Blood-Brain Barrier to Childhood Development: A Case of Acute-Onset Psychosis and Cognitive Impairment Attributed to Systemic Lupus Erythematosus in an Adolescent Female. Harv Rev Psychiatry 2022; 30:71-82. [PMID: 34995037 DOI: 10.1097/hrp.0000000000000315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
LEARNING OBJECTIVES After participating in this CME activity, the clinician will be better able to:• Interpret classifications of neuropsychiatric systemic lupus erythematosus (NPSLE).• Identify determining factors of neuropsychiatric events.• Analyze current evidence regarding disease pathways for NPSLE.
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Affiliation(s)
- Matthew C Johnson
- From Harvard Medical School (Drs. Johnson, Sathappan, Hauptman, Stone, and Simon); Beth Israel Deaconess Medical Center (Drs. Johnson, Sathappan, and Stone); Dalhousie University (Dr. Hanly); Department of Medicine, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Weill Cornell Medical College (Dr. Ross); Brigham and Women's Hospital, Boston, MA (Dr. Hauptman); Boston Children's Hospital, Boston, MA (Dr. Simon)
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16
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Grunze H, Cetkovich-Bakmas M. "Apples and pears are similar, but still different things." Bipolar disorder and schizophrenia- discrete disorders or just dimensions ? J Affect Disord 2021; 290:178-187. [PMID: 34000571 DOI: 10.1016/j.jad.2021.04.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/14/2021] [Accepted: 04/25/2021] [Indexed: 02/05/2023]
Abstract
Starting with the dichotomous view of Kraepelin, schizophrenia and bipolar disorder have traditionally been considered as separate entities. More recent, this taxonomic view of illnesses has been challenged and a continuum psychosis has been postulated based on genetic and neurobiological findings suggestive of a large overlap between disorders. In this paper we will review clinical and experimental data from genetics, morphology, phenomenology and illness progression demonstrating what makes schizophrenia and bipolar disorder different conditions, challenging the idea of the obsolescence of the categorical approach. However, perhaps it is also time to move beyond DSM and search for more refined clinical descriptions that could uncover clinical invariants matching better with molecular data. In the future, computational psychiatry employing artificial intelligence and machine learning might provide us a tool to overcome the gap between clinical descriptions (phenomenology) and neurobiology.
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Affiliation(s)
- Heinz Grunze
- Paracelsus Medical University, Nuremberg & Psychiatrie Schwäbisch Hall, Ringstrasse 1, 74523 Schwäbisch Hall, Germany.
| | - Marcelo Cetkovich-Bakmas
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
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17
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Díaz-Castro L, Hoffman K, Cabello-Rangel H, Arredondo A, Herrera-Estrella MÁ. Family History of Psychiatric Disorders and Clinical Factors Associated With a Schizophrenia Diagnosis. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211060797. [PMID: 34845937 PMCID: PMC8673879 DOI: 10.1177/00469580211060797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Schizophrenia (SCH) and bipolar disorder (BD) have both shared and unique genetic risk factors and clinical characteristics. The aim of the present study was to identify potential risk factors significantly associated with SCH, relative to a BD reference group. Methods Data were obtained from medical records of patients that entered a major Mexico City hospital during 2009–2010 presenting psychotic symptoms (n = 1132; 830 cases of SCH, 302 cases of BD; 714 men and 418 women). SCH and BD diagnoses were compared with respect to a number of family and clinical characteristics. Logistic and linear regression analyses were used to respectively identify factors selectively associated with the SCH diagnosis relative to the BD diagnosis and explore the relationship between PANSS scores and parental age at time of birth to the age of SCH onset. Results Patients with SCH showed greater functional impairment than those with BD. Family history of mental illness, premorbid schizoid-like personality, and obstetric trauma were significantly associated with the SCH diagnosis. The association of obstetric trauma with SCH was greatest in male patients with a family history of mental illness. In women, increased paternal and decreased maternal age at time of the patient’s birth were associated with an earlier age of SCH onset. Conclusion Male gender, showing premorbid schizoid-like personality, familial SCH, and obstetric trauma are risk factors that distinguish SCH from BD. Additionally, our results suggest that risk for SCH relative to BD may be importantly influenced by interactions between familial risk, gender, and obstetric trauma.
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Affiliation(s)
- Lina Díaz-Castro
- Research in Medical Sciences, Direction of Epidemiological and Psychosocial Research, National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Kurt Hoffman
- Carlos Beyer Center for Investigation of Animal Reproduction (CIRA), Autonomous University of Tlaxcala and Center for Investigation and Advanced Studies of the National Polytechnical Institute (UATx - CINVESTAV), Tlaxcala, Mexico
| | - Héctor Cabello-Rangel
- Research in Health Systems, Diagnostic Auxiliary Division, Psychiatric Hospital Fray Bernardino Álvarez, Mexico City, Mexico
| | - Armando Arredondo
- Research in Medical Sciences, Health Systems Research Center, National Institute of Public Health, Cuernavaca, Mexico
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Cognitive dysfunction in a psychotropic medication-naïve, clinical high-risk sample from the ShangHai-At-Risk-for-Psychosis (SHARP) study: Associations with clinical outcomes. Schizophr Res 2020; 226:138-146. [PMID: 32694037 DOI: 10.1016/j.schres.2020.06.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES 1) to assess generalizability of neurocognitive deficits reported in previous Western clinical high-risk (CHR) for psychosis studies in a prodromal program in Shanghai, China; and 2) to investigate neurocognition in CHR subjects in relation to a broader range of clinical outcomes (e.g. remission) than presence or absence of psychosis. METHOD Baseline neurocognitive assessments of CHR (n = 217) and healthy control (HC; n = 133) subjects were compared based on 1-year follow-up clinical status using MANOVA. CHR subjects were first divided into 'converter' (CHR-C; n = 41) and 'non-converter' (CHR-NC; n = 155) to psychosis groups and compared to HC and to each other. CHR subjects were then divided into 'remission' (i.e. achieved remission; n = 102), 'symptomatic' (persistent positive symptoms in the absence of conversion; n = 37) and 'poor-outcome' (converted and symptomatic subjects who did not respond to treatment; n = 57) groups. RESULTS CHR neurocognitive performance was broadly impaired compared to HC; CHR-C subjects showed lower performance in processing speed and visual learning than CHR-NC. CHRs with poor clinical outcomes showed lower performance on most MCCB tasks compared to HC, particularly in learning and processing speed, as clinical outcome worsened from remission to symptomatic to poor outcome groups. CONCLUSIONS Level and pattern of baseline neurocognitive weaknesses in SHARP CHR subjects were similar to those in NAPLS-2. Outcome stratification into remission, symptomatic and poor groups was associated with increasing cognitive deficits in learning and processing speed. These findings support cross-cultural generalizability and advance understanding of CHR neurocognitive heterogeneity associated with 1-year clinical outcomes.
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Early childhood social communication deficits in youth at clinical high-risk for psychosis: Associations with functioning and risk. Dev Psychopathol 2020; 32:559-572. [PMID: 31064575 DOI: 10.1017/s0954579419000385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Effective social functioning requires a broad range of social communication skills that are impaired in psychosis populations. However, little is known about early childhood (4- to 5-year period) social communication during the premorbid (pre-illness) stage of psychosis. The present study utilized retrospective parent reports to examine total early childhood social communication deficits, as well as deficits in two distinct domains, reciprocal social interaction (social smiling/eye gaze) and communication (social chat/gesture), in youth at clinical high-risk (CHR) for psychosis (ages 13-21; 37.2% female). Furthermore, associations between early childhood social communication and CHR youth's current functioning (social, academic/work), symptoms (positive/negative), and risk for conversion to psychosis were examined. Compared to healthy controls, CHR individuals had greater deficits in total and communication-specific early childhood social communication. Early childhood total, communication, and reciprocal social interaction deficits were associated with worse current functioning and greater current negative symptom severity (amotivation/anhedonia) in CHR youth. Early childhood total and reciprocal social interaction deficits were also associated with increased risk for conversion. These findings inform the field's understanding of the etiology and pathophysiology of psychosis by extending the current developmental literature on premorbid deficits in psychosis populations to specific domains of social behavior in a critical developmental period.
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20
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Dickson H, Hedges EP, Ma SY, Cullen AE, MacCabe JH, Kempton MJ, Downs J, Laurens KR. Academic achievement and schizophrenia: a systematic meta-analysis. Psychol Med 2020; 50:1949-1965. [PMID: 32684198 DOI: 10.1017/s0033291720002354] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cognitive impairments in childhood are associated with increased risk of schizophrenia in later life, but the extent to which poor academic achievement is associated with the disorder is unclear. METHODS Major databases were searched for articles published in English up to 31 December 2019. We conducted random-effects meta-analyses to: (1) compare general academic and mathematics achievement in youth who later developed schizophrenia and those who did not; (2) to examine the association between education level achieved and adult-onset schizophrenia; and, (3) compare general academic achievement in youth at-risk for schizophrenia and typically developing peers. Meta-regression models examined the effects of type of academic assessment, educational system, age at assessment, measurement of educational level attained, school leaving age, and study quality on academic achievement and education level among individuals with schizophrenia. RESULTS Meta-analyses, comprising data of over four million individuals, found that: (1) by age 16 years, those who later developed schizophrenia had poorer general academic (Cohen's d = -0.29, p ⩽ 0.0001) and mathematics achievement (d = -0.23, p = 0.01) than those who did not; (2) individuals with schizophrenia were less likely to enter higher education (odds ratio = 0.49, p ⩽ 0.0001); and, (3) youth reporting psychotic-like experiences and youth with a family history of schizophrenia had lower general academic achievement (d = -0.54, p ⩽ 0.0001; d = -0.39, p ⩽ 0.0001, respectively). Meta-regression analyses determined no effect modifiers. DISCUSSION Despite significant heterogeneity across studies, various routinely collected indices of academic achievement can identify premorbid cognitive dysfunction among individuals who are vulnerable for schizophrenia, potentially aiding the early identification of risk in the population.
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Affiliation(s)
- Hannah Dickson
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily P Hedges
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Shin Y Ma
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James H MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kristin R Laurens
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Queensland University of Technology (QUT), School of Psychology and Counselling, and Institute of Health and Biomedical Innovation, Brisbane, QLD, Australia
- School of Psychiatry, University of New South Wales, NSW, Australia
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Neuropsychological profile of children and adolescents with psychosis risk syndrome: the CAPRIS study. Eur Child Adolesc Psychiatry 2020; 29:1311-1324. [PMID: 31897849 DOI: 10.1007/s00787-019-01459-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 12/11/2019] [Indexed: 12/27/2022]
Abstract
Neuropsychological underperformance is well described in young adults at clinical high risk for psychosis, but the literature is scarce on the cognitive profile of at-risk children and adolescents. The aim of this study is to describe the neuropsychological profile of a child and adolescent sample of patients with psychosis risk syndrome (PRS) compared to healthy controls and to analyze associations between attenuated psychotic symptoms and cognitive impairment. Cross-sectional baseline data analysis from a longitudinal, naturalistic, case-control, two-site study is presented. Eighty-one help-seeking subjects with PRS and 39 healthy controls (HC) aged between 10 and 17 years of age were recruited. PRS was defined by: positive or negative attenuated symptoms, Brief Limited Intermittent Psychotic Symptoms (BLIPS), genetic risk (first- or second-degree relative), or schizotypal personality disorder plus impairment in functioning. A neuropsychological battery was administered to assess general intelligence, verbal and visual memory, visuospatial abilities, speed processing, attention, and executive functions. The PRS group showed lower general neuropsychological performance scores at a multivariate level and lower scores than controls in general intelligence and executive functions. Lower scores on executive function and poorer attention were associated with high scores of positive attenuated psychotic symptoms. No association with attenuated negative symptoms was found. This study provides evidence of cognitive impairment in PRS children and adolescents and shows a relationship between greater cognitive impairment in executive functions and attention tasks and severe attenuated positive symptoms. However, longitudinal studies are needed to clarify the nature of cognitive impairment as a possible vulnerability marker.
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Karcher NR, Loewy RL, Savill M, Avenevoli S, Huber RS, Simon TJ, Leckliter IN, Sher KJ, Barch DM. Replication of Associations With Psychotic-Like Experiences in Middle Childhood From the Adolescent Brain Cognitive Development (ABCD) Study. ACTA ACUST UNITED AC 2020; 1:sgaa009. [PMID: 32803159 PMCID: PMC7418869 DOI: 10.1093/schizbullopen/sgaa009] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The fields of psychology and psychiatry are increasingly recognizing the importance of replication efforts. The current study aimed to replicate previous findings examining the construct validity and psychometric properties of a psychotic-like experiences (PLEs) measure in middle childhood using an independent subset of the baseline Adolescent Brain Cognitive Development (ABCD) sample. Using a remainder baseline sample of 7013 nine- to eleven-year-old children with complete data, we examined measurement invariance across race/ethnicity and sex, and examined the associations between the Prodromal Questionnaire Brief-Child Version (PQ-BC) and other measures of PLEs, internalizing symptoms, neuropsychological test performance, and developmental milestones, to determine whether previously obtained results replicated in this nonoverlapping baseline sample subset. The results replicated measurement invariance across ethnicity and sex, and analyses again found higher PQ-BC scores for African American (β = .364, 95% CI = 0.292, 0.435) and Hispanic (β = .255, 95% CI = 0.185, 0.324) groups. We also replicated that higher PQ-BC scores were associated with psychosis risk measures, higher rates of child-reported internalizing symptoms (Distress: β = .378, 95% CI = 0.357,0.398), neuropsychological test performance deficits (eg, working memory; Distress: β = −.069, 95% CI = −0.096, −0.042), and motor (Distress: β = .026, 95% CI = 0.003, 0.049) and speech (Distress: β = .042, 95% CI = 0.018, 0.065) developmental milestone delays. The current results replicated many findings from the original study examining the PQ-BC. We replicated evidence for mean differences in race/ethnicity, and associations with other PLE measures, greater internalizing symptoms, cognitive impairments, and developmental milestone delays. These findings indicate robust and reliable associations between PLEs and hypothesized correlates can be found in middle childhood nonclinical samples.
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Affiliation(s)
- Nicole R Karcher
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Rachel L Loewy
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Mark Savill
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | | | - Rebekah S Huber
- Department of Psychiatry, University of Utah School of Medicine Salt Lake City, Salt Lake City, UT
| | - Tony J Simon
- MIND Institute, University of California, Davis, Davis, CA
| | | | - Kenneth J Sher
- Psychology Department, University of Missouri, Columbia, MO
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO.,Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO
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Bora E, Özerdem A. A meta-analysis of neurocognition in youth with familial high risk for bipolar disorder. Eur Psychiatry 2020; 44:17-23. [DOI: 10.1016/j.eurpsy.2017.02.483] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/11/2017] [Accepted: 02/12/2017] [Indexed: 12/11/2022] Open
Abstract
AbstractObjective:Neuropsychological impairment, including deficits in social cognition is evident in subjects at genetic high-risk for psychosis. However, findings in youth at genetic risk to bipolar disorder (BP) have been suggested to be less supportive of premorbid deficits. We aimed to conduct a meta-analysis of cognitive deficits in youth with familiar risk for bipolar disorder (FHR-BD).Methods:A novel meta-analysis of FHR-BD (mean age 10–25), including 18 studies (786 offsprings/siblings of patients with BD and 794 healthy controls), was conducted.Results:Both general cognition (d = 0.29, CI = 0.15–0.44) and social cognition (d = 0.23, CI = 0–0.45) were impaired in FHR-BD. In comparison to controls, FHR-BD had significant deficits in several cognitive domains, including visual memory (d = 0.35), verbal memory (d = 0.21), processing speed (d = 0.26) and sustained attention (d = 0.36). There was no significant difference between FHR-BD and controls in planning and working memory.Conclusions:Cognitive deficits are evident in individuals who are at genetic high-risk for developing BD. Neurodevelopmental abnormalities are likely playing a role not only in schizophrenia but also in BD.
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Neurodevelopmental pathways in bipolar disorder. Neurosci Biobehav Rev 2020; 112:213-226. [PMID: 32035092 DOI: 10.1016/j.neubiorev.2020.02.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 01/03/2020] [Accepted: 02/04/2020] [Indexed: 12/14/2022]
Abstract
Aberrations in neurodevelopmental trajectories have been implicated in the neurobiology of several mental disorders and evidence indicates a pathophysiological and genetic overlap of schizophrenia and bipolar disorder (BD). In this narrative review, we summarize findings related to developmental and perinatal factors as well as epidemiological, clinical, neuropsychological, brain imaging, postmortem brain and genomic studies that provide evidence for a putative neurodevelopmental pathogenesis and etiology of BD. Overall, aberrations in neurodevelopmental pathways have been more consistently implicated in the pathophysiology of schizophrenia compared to BD. Nevertheless, an accumulating body of evidence indicates that dysfunctional neurodevelopmental pathways may be implicated in the underlying pathophysiology of at least a subset of individuals with BD particularly those with an early age of illness onset and those exhibiting psychotic symptoms. A heuristic neurodevelopmental model for the pathophysiology of BD based on the findings of this review is proposed. Furthermore, we critically discuss clinical and research implications of this model. Finally, further research directions for this emerging field are provided.
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Van Rheenen TE, Lewandowski KE, Bauer IE, Kapczinski F, Miskowiak K, Burdick KE, Balanzá-Martínez V. Current understandings of the trajectory and emerging correlates of cognitive impairment in bipolar disorder: An overview of evidence. Bipolar Disord 2020; 22:13-27. [PMID: 31408230 DOI: 10.1111/bdi.12821] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Cognitive dysfunction affects a significant proportion of people with bipolar disorder (BD), but the cause, trajectory and correlates of such dysfunction remains unclear. Increased understanding of these factors is required to progress treatment development for this symptom dimension. METHODS This paper provides a critical overview of the literature concerning the trajectories and emerging correlates of cognitive functioning in BD. It is a narrative review in which we provide a qualitative synthesis of current evidence concerning clinical, molecular, neural and lifestyle correlates of cognitive impairment in BD across the lifespan (in premorbid, prodromal, early onset, post-onset, elderly cohorts). RESULTS There is emerging evidence of empirical links between cognitive impairment and an increased inflammatory state, brain structural abnormalities and reduced neuroprotection in BD. However, evidence regarding the progressive nature of cognitive impairment is mixed, since consensus between different cross-sectional data is lacking and does not align to the outcomes of the limited longitudinal studies available. Increased recognition of cognitive heterogeneity in BD may help to explain some inconsistencies in the extant literature. CONCLUSIONS Large, longitudinally focussed studies of cognition and its covariation alongside biological and lifestyle factors are required to better define cognitive trajectories in BD, and eventually pave the way for the application of a precision medicine approach for individual patients in clinical practice.
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Affiliation(s)
- Tamsyn E Van Rheenen
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia.,Faculty of Health, Arts and Design, School of Health Sciences, Centre for Mental Health, Swinburne University, Melbourne, Australia
| | - Kathryn E Lewandowski
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Isabelle E Bauer
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioral Neurosciences, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada.,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
| | - Kamilla Miskowiak
- Neurocognition and Emotion in Affective Disorders Group, Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Katherine E Burdick
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,James J Peters VA Medical Center, Bronx, NY, USA
| | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
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26
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Anteraper SA, Collin G, Guell X, Scheinert T, Molokotos E, Henriksen MT, Mesholam-Gately R, Thermenos HW, Seidman LJ, Keshavan MS, Gabrieli JDE, Whitfield-Gabrieli S. Altered resting-state functional connectivity in young children at familial high risk for psychotic illness: A preliminary study. Schizophr Res 2020; 216:496-503. [PMID: 31801673 PMCID: PMC7239744 DOI: 10.1016/j.schres.2019.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 01/05/2023]
Abstract
Multiple lines of evidence suggest that illness development in schizophrenia and other psychotic disorders predates the first psychotic episode by many years. In this study, we examined a sample of 15 pre-adolescent children, ages 7 through 12 years, who are at familial high-risk (FHR) because they have a parent or sibling with a history of schizophrenia or related psychotic disorder. Using multi-voxel pattern analysis (MVPA), a data-driven fMRI analysis, we assessed whole-brain differences in functional connectivity in the FHR sample as compared to an age- and sex-matched control (CON) group of 15 children without a family history of psychosis. MVPA analysis yielded a single cluster in right posterior superior temporal gyrus (pSTG/BA 22) showing significant group-differences in functional connectivity. Post-hoc characterization of this cluster through seed-to-voxel analysis revealed mostly reduced functional connectivity of the pSTG seed to a set of language and default mode network (DMN) associated brain regions including Heschl's gyrus, inferior temporal gyrus extending into fusiform gyrus, (para)hippocampus, thalamus, and a cerebellar cluster encompassing mainly Crus I/II. A height-threshold of whole-brain p < .001 (two-sided), and FDR-corrected cluster-threshold of p < .05 (non-parametric statistics) was used for post-hoc characterization. These findings suggest that abnormalities in functional communication in a network encompassing right STG and associated brain regions are present before adolescence in at-risk children and may be a risk marker for psychosis. Subsequent changes in this functional network across development may contribute to either disease manifestation or resilience in children with a familial vulnerability for psychosis.
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Affiliation(s)
- Sheeba Arnold Anteraper
- McGovern Institute for Brain Research, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Psychology, Northeastern University, Boston, MA, USA; Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, Boston, MA, USA.
| | - Guusje Collin
- McGovern Institute for Brain Research, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA,Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Corresponding author
| | - Xavier Guell
- McGovern Institute for Brain Research, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA,Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Timothy Scheinert
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elena Molokotos
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Maria Toft Henriksen
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Raquelle Mesholam-Gately
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Heidi W. Thermenos
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Larry J Seidman
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Matcheri S. Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John D. E. Gabrieli
- McGovern Institute for Brain Research, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Susan Whitfield-Gabrieli
- McGovern Institute for Brain Research, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA,Department of Psychology, Northeastern University, Boston, MA, USA
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Individual Alpha Peak Frequency Moderates Transfer of Learning in Cognitive Remediation of Schizophrenia. J Int Neuropsychol Soc 2020; 26:19-30. [PMID: 31983373 PMCID: PMC7000127 DOI: 10.1017/s1355617719001243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Meta-analyses report moderate effects across cognitive remediation (CR) trials in schizophrenia. However, individual responses are variable, with some participants showing no appreciable gain in cognitive performance. Furthermore, reasons for heterogeneous outcome are undetermined. We examine the extent to which CR outcome is attributable to near learning-direct gains in trained cognitive tasks-while also exploring factors influencing far transfer of gains during training to external cognitive measures. METHOD Thirty-seven schizophrenia outpatients were classified as CR responders and non-responders according to change in MATRICS Consensus Cognitive Battery composite score following 20 sessions of computer-based training. Metrics of near learning during training, as well as baseline demographic, clinical, cognitive, and electroencephalographic (EEG) measures, were examined as predictors of responder status. RESULTS Significant post-training improvement in cognitive composite score (Cohen's d = .41) was observed across the sample, with n = 21 and n = 16 classified as responders and non-responders, respectively. Near learning was evidenced by significant improvement on each training exercise with practice; however, learning did not directly predict responder status. Group-wise comparison of responders and non-responders identified two factors favoring responders: higher EEG individual alpha frequency (IAF) and lower antipsychotic dosing. Tested in moderation analyses, IAF interacted with learning to predict improvement in cognitive outcome. CONCLUSION CR outcome in schizophrenia is not directly explained by learning during training and appears to depend on latent factors influencing far transfer of trained abilities. Further understanding of factors influencing transfer of learning is needed to optimize CR efficacy.
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Lee YH, Cherkerzian S, Seidman LJ, Papandonatos GD, Savitz DA, Tsuang MT, Goldstein JM, Buka SL. Maternal Bacterial Infection During Pregnancy and Offspring Risk of Psychotic Disorders: Variation by Severity of Infection and Offspring Sex. Am J Psychiatry 2020; 177:66-75. [PMID: 31581799 PMCID: PMC6939139 DOI: 10.1176/appi.ajp.2019.18101206] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Previous studies suggest that prenatal immune challenges may elevate the risk of schizophrenia and related psychoses in offspring, yet there has been limited research focused on maternal bacterial infection. The authors hypothesized that maternal bacterial infection during pregnancy increases offspring risk of psychotic disorders in adulthood, and that the magnitude of this association varies as a function of severity of infectious exposure and offspring sex. METHODS The authors analyzed prospectively collected data from 15,421 pregnancies among women enrolled between 1959 and 1966 at two study sites through the Collaborative Perinatal Project. The sample included 116 offspring with confirmed psychotic disorders. The authors estimated associations between maternal bacterial infection during pregnancy and psychosis risk over the subsequent 40 years, stratified by offspring sex and presence of reported parental mental illness, with adjustment for covariates. RESULTS Maternal bacterial infection during pregnancy was strongly associated with psychosis in offspring (adjusted odds ratio=1.8, 95% CI=1.2-2.7) and varied by severity of infection and offspring sex. The effect of multisystemic bacterial infection (adjusted odds ratio=2.9, 95% CI=1.3-5.9) was nearly twice that of less severe localized bacterial infection (adjusted odds ratio=1.6, 95% CI=1.1-2.3). Males were significantly more likely than females to develop psychosis after maternal exposure to any bacterial infection during pregnancy. CONCLUSIONS The study findings suggest that maternal bacterial infection during pregnancy is associated with an elevated risk for psychotic disorders in offspring and that the association varies by infection severity and offspring sex. These findings call for additional investigation and, if the findings are replicated, public health and clinical efforts that focus on preventing and managing bacterial infection in pregnant women.
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Affiliation(s)
- Younga H. Lee
- Brown University, Department of Epidemiology, Providence, RI 02912, USA
| | - Sara Cherkerzian
- Brigham and Women’s Hospital, Department of Pediatric Newborn Medicine, Boston, MA 02115, USA,Harvard Medical School, Department of Medicine, Boston, MA 02115, USA
| | - Larry J. Seidman
- Massachusetts Mental Health Center, Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA,Massachusetts General Hospital, Department of Psychiatry, Boston, MA 02114, USA,Harvard Medical School, Department of Psychiatry, Boston, MA 02115, USA
| | | | - David A. Savitz
- Brown University, Department of Epidemiology, Providence, RI 02912, USA
| | - Ming T. Tsuang
- University of California at San Diego, Department of Psychiatry, La Jolla, CA 92093, USA
| | - Jill M. Goldstein
- Harvard Medical School, Department of Medicine, Boston, MA 02115, USA,Massachusetts General Hospital, Department of Psychiatry, Boston, MA 02114, USA,Harvard Medical School, Department of Psychiatry, Boston, MA 02115, USA,Brigham and Women’s Hospital, Division of Women’s Health, Department of Medicine, Boston, MA 02115, USA
| | - Stephen L. Buka
- Brown University, Department of Epidemiology, Providence, RI 02912, USA,Corresponding Author: Stephen L. Buka, ScD., Mailing address: 121 South Main Street, Providence, RI 02912, ; Telephone: +1 401-863-6224; Fax: +1 401-863-5715
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Lee YH, Papandonatos GD, Savitz DA, Heindel WC, Buka SL. Effects of prenatal bacterial infection on cognitive performance in early childhood. Paediatr Perinat Epidemiol 2020; 34:70-79. [PMID: 31837043 DOI: 10.1111/ppe.12603] [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: 06/12/2019] [Revised: 08/20/2019] [Accepted: 09/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous epidemiologic studies have reported adverse neurodevelopmental sequelae following prenatal infectious exposure, yet long-term effects estimated from these observational studies are often subject to biases due to confounding and loss to follow-up. OBJECTIVES We demonstrate the joint use of inverse probability (IP) treatment and censoring weights when evaluating neurotoxic effects of prenatal bacterial infection. METHODS We applied IP weighting for both treatment and censoring to estimate the effects of maternal bacterial infection during pregnancy on mean intelligence quotient (IQ) scores measured at age 7 using the Wechsler Intelligence Scale for Children. Participants were members of a population-based pregnancy cohort recruited in the Boston and Providence sites of the Collaborative Perinatal Project between 1959 and 1966 (n = 11 984). We calculated average treatment effects (ATE) and average treatment effects on the treated (ATT) using IP weights estimated via generalized boosted models. RESULTS ATE- and ATT-weighted mean IQ scores were lowest among offspring exposed to multi-systemic bacterial infection during pregnancy and highest for those unexposed. The effects of prenatal bacterial infection were greater among male offspring, particularly on performance IQ scores. Offspring who were exposed to multi-systemic bacterial infection in the third trimester displayed the largest reduction in mean full-scale, verbal, and performance IQ scores at age 7 compared to those unexposed or exposed in earlier trimesters. CONCLUSIONS We find that prenatal bacterial infection is associated with cognitive impairments at age 7. Associations are strongest for more severe infections, that occur in the third trimester, and among males. Public health intervention targeting bacterial infection in pregnant women may help enhance the cognitive development of offspring.
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Affiliation(s)
- Younga H Lee
- Department of Epidemiology, Brown University, Providence, RI, USA
| | | | - David A Savitz
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - William C Heindel
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, RI, USA
| | - Stephen L Buka
- Department of Epidemiology, Brown University, Providence, RI, USA
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30
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Kim SJ, Jung D, Shim JC, Moon JJ, Jeon DW, Kim YN, Seo YS, Jung SS, Seo BJ, Kim JE. The effect of anticholinergic burden on cognitive and daily living functions in patients with schizophrenia. Asian J Psychiatr 2019; 46:111-117. [PMID: 31654923 DOI: 10.1016/j.ajp.2019.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to explore the association between medication-associated anticholinergic burden and cognitive and daily living functions in patients with schizophrenia. METHODS Sixty patients with schizophrenia were recruited. We used the Anticholinergic Drug Scale (ADS) for evaluating medication-associated anticholinergic burden. The MATRICS Consensus Cognitive Battery (MCCB) and the University of California San Diego Performance-based Skills Assessment (UPSA) were used for evaluating cognitive and daily living functions. To assess clinical symptoms, psychiatrists conducted interviews using the Positive and Negative Syndrome Scale and the Calgary Depression Scale for Schizophrenia. RESULTS Subjects were divided into low (n = 31) and high (n = 29) anticholinergic burden based on ADS scores of 3 or more. The "high ADS" group had poorer cognitive (composite MCCB score, p < 0.001) and daily living functions (total UPSA score, p = 0.001) than the "low ADS" group. Medication-associated anticholinergic burden was negatively correlated with cognitive functions (composite MCCB score, r = -0.512, p < 0.001) and daily living functions (total UPSA score, r = -0.355, p = 0.005). A regression analysis showed that anticholinergic burden significantly explained the decline in cognitive functions (composite MCCB score, R2 = 0.262, p < 0.001) and daily living functions (total UPSA score, R2 = 0.126, p = 0.005). Explanatory power was reduced after a covariate adjustment, but the effects of the composite MCCB score (p = 0.013) and of the transportation domain score of the UPSA (p = 0.048) remained significant. CONCLUSIONS Our analysis shows that anticholinergic burden reduces cognitive and daily living functions in patients with schizophrenia. A drug strategy with minimal anticholinergic burden may be helpful to patients if it does not adversely affect clinical symptoms.
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Affiliation(s)
- Sung-Jin Kim
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Doun Jung
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
| | - Joo-Cheol Shim
- Shim Joo Cheol Psychiatry Clinic, Busan, Republic of Korea
| | - Jung-Joon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong-Wook Jeon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - You-Na Kim
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young-Soo Seo
- Department of Psychiatry, Sharing and Happiness Hospital, Busan, Republic of Korea
| | - Sung-Soo Jung
- Department of Psychiatry, Sharing and Happiness Hospital, Busan, Republic of Korea
| | - Beom-Joo Seo
- Department of Psychiatry, Busan Metropolitan Mental Hospital, Busan, Republic of Korea
| | - Jeong-Eun Kim
- Department of Psychiatry, Busan Metropolitan Mental Hospital, Busan, Republic of Korea
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31
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Toulopoulou T, Zhang X, Cherny S, Dickinson D, Berman KF, Straub RE, Sham P, Weinberger DR. Polygenic risk score increases schizophrenia liability through cognition-relevant pathways. Brain 2019; 142:471-485. [PMID: 30535067 DOI: 10.1093/brain/awy279] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/19/2018] [Indexed: 02/02/2023] Open
Abstract
Cognitive deficit is thought to represent, at least in part, genetic mechanisms of risk for schizophrenia, with recent evidence from statistical modelling of twin data suggesting direct causality from the former to the latter. However, earlier evidence was based on inferences from twin not molecular genetic data and it is unclear how much genetic influence 'passes through' cognition on the way to diagnosis. Thus, we included direct measurements of genetic risk (e.g. schizophrenia polygenic risk scores) in causation models to assess the extent to which cognitive deficit mediates some of the effect of polygenic risk scores on the disorder. Causal models of family data tested relationships among key variables and allowed parsing of genetic variance components. Polygenic risk scores were calculated from summary statistics from the current largest genome-wide association study of schizophrenia and were represented as a latent trait. Cognition was also modelled as a latent trait. Participants were 1313 members of 1078 families: 416 patients with schizophrenia, 290 unaffected siblings, and 607 controls. Modelling supported earlier findings that cognitive deficit has a putatively causal role in schizophrenia. In total, polygenic risk score explained 8.07% [confidence interval (CI) 5.45-10.74%] of schizophrenia risk in our sample. Of this, more than a third (2.71%, CI 2.41-3.85%) of the polygenic risk score influence was mediated through cognition paths, exceeding the direct influence of polygenic risk score on schizophrenia risk (1.43%, CI 0.46-3.08%). The remainder of the polygenic risk score influence (3.93%, CI 2.37-4.48%) reflected reciprocal causation between schizophrenia liability and cognition (e.g. mutual influences in a cyclical manner). Analysis of genetic variance components of schizophrenia liability indicated that 26.87% (CI 21.45-32.57%) was associated with cognition-related pathways not captured by polygenic risk score. The remaining variance in schizophrenia was through pathways other than cognition-related and polygenic risk score. Although our results are based on inference through statistical modelling and do not provide an absolute proof of causality, we find that cognition pathways mediate a significant part of the influence of cumulative genetic risk on schizophrenia. We estimate from our model that 33.51% (CI 27.34-43.82%) of overall genetic risk is mediated through influences on cognition, but this requires further studies and analyses as the genetics of schizophrenia becomes better characterized.
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Affiliation(s)
- Timothea Toulopoulou
- Department of Psychology, Bilkent University, Bilkent, Ankara, Turkey.,The State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong SAR, China.,Department of Psychology, the University of Hong Kong, Hong Kong SAR, China.,Department of Basic and Clinical Neuroscience, Institute of Psychiatry Psychology and Neuroscience at King's College London, London, UK
| | - Xiaowei Zhang
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Stacey Cherny
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry Psychology and Neuroscience at King's College London, London, UK.,Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Dwight Dickinson
- Clinical and Translational Neuroscience Branch, National Institute of Mental Health, USA
| | - Karen F Berman
- Clinical and Translational Neuroscience Branch, National Institute of Mental Health, USA
| | - Richard E Straub
- Lieber Institute for Brain Development, Johns Hopkins University, USA
| | - Pak Sham
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry Psychology and Neuroscience at King's College London, London, UK.,Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Daniel R Weinberger
- Lieber Institute for Brain Development, Johns Hopkins University, USA.,Departments of Psychiatry, Neurology, Neuroscience, The McKusick Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, USA
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32
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Mathur N, Dawes C, Moran PM. Olfactory threshold selectively predicts positive psychometric schizotypy. Schizophr Res 2019; 209:80-87. [PMID: 31160166 DOI: 10.1016/j.schres.2019.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/27/2019] [Accepted: 05/05/2019] [Indexed: 11/29/2022]
Abstract
Olfactory impairment might be useful as a non-invasive pre-morbid biological marker of psychosis. People with schizophrenia show consistent impairments, but an association between olfaction and schizotypy in non-clinical populations is inconclusive and has been somewhat controversial. This is important as impairment in patients may be artefacts of antipsychotic medication. Meta-analyses indicate small effect sizes in non-clinical populations, suggesting prior negative studies may have been underpowered to demonstrate them. We measured olfaction and psychometrically-defined schizotypy in a sample of 739 non-clinical volunteers [mean age 23.1]. Subsets reported whether they had a history of mental illness in the family or smoked. We used (sniffin' sticks) to measure threshold detection, discrimination and identification of odours. O-LIFE was used to measure schizotypy. Lower olfactory-threshold selectively predicted higher scores on the positive dimension, unusual experiences. This association was most evident in sub-groups reporting history of mental illness in the family and/or smoking. There was a weak trend for an association between identification and introvertive anhedonia and discrimination and cognitive disorganisation in those with a history of mental illness in the family. These data support the idea that olfaction merits further investigation as a biomarker for psychosis and that olfactory-threshold detection in particular has potential to selectively predict unusual experiences. Variability in previous studies may have been exacerbated by including different proportions of participants with history of mental illness in the family and/or smoking. We propose that non-clinical participants be stratified by these factors in future studies of olfaction and potentially any study that measures psychometric schizotypy.
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Affiliation(s)
- Naina Mathur
- School of Psychology, University of Nottingham, Nottingham NG72RD, UK
| | - Christopher Dawes
- School of Psychology, University of Nottingham, Nottingham NG72RD, UK
| | - Paula M Moran
- School of Psychology, University of Nottingham, Nottingham NG72RD, UK.
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33
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Neurocognitive profiles in the prodrome to psychosis in NAPLS-1. Schizophr Res 2019; 204:311-319. [PMID: 30078717 PMCID: PMC6359987 DOI: 10.1016/j.schres.2018.07.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 05/15/2018] [Accepted: 07/24/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Most studies of neurocognitive functioning in Clinical High Risk (CHR) cohorts have examined group averages, likely concealing heterogeneous subgroups. We aimed to identify neurocognitive subgroups and to explore associated outcomes. METHODS Data were acquired from 324 participants (mean age 18.4) in the first phase of the North American Prodrome Longitudinal Study (NAPLS-1), a multi-site consortium following individuals for up to 2 1/2 years. We applied Ward's method for hierarchical clustering data to 8 baseline neurocognitive measures, in 166 CHR individuals, 49 non-CHR youth with a family history of psychosis, and 109 healthy controls. We tested whether cluster membership was associated with conversion to psychosis, social and role functioning, and follow-up diagnosis. Analyses were repeated after data were clustered based on independently developed clinical decision rules. RESULTS Four neurocognitive clusters were identified: Significantly Impaired (n = 33); Mildly Impaired (n = 82); Normal (n = 145) and High (n = 64). The Significantly Impaired subgroup demonstrated the largest deviations on processing speed and memory tasks and had a conversion rate of 58%, a 40% chance of developing a schizophrenia spectrum diagnosis (compared to 24.4% in the Mildly Impaired, and 10.3% in the other two groups combined), and significantly worse functioning at baseline and 12-months. Data clustered using clinical decision rules yielded similar results, pointing to high convergent validity. CONCLUSION Neurocognitive profiles vary substantially in their severity and are associated with diagnostic and functional outcome, underscoring neurocognition as a predictor of illness outcomes. These findings, if replicated, are a first step toward personalized treatment for individuals at-risk for psychosis.
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García-de la Cruz DD, Juárez-Rojop IE, Tovilla-Zárate CA, Martínez-Magaña JJ, Genis-Mendoza AD, Nicolini H, González-Castro TB, Guzmán-Priego CG, López-Martínez NA, Hernández-Cisneros JA, Caballero-Prado F. Association between mitochondrial DNA and cognitive impairment in schizophrenia: study protocol for a Mexican population. Neuropsychiatr Dis Treat 2019; 15:1717-1722. [PMID: 31388301 PMCID: PMC6607197 DOI: 10.2147/ndt.s208587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/23/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Circulating cell-free mitochondrial DNA (cf-mtDNA) fragments in blood plasma have been reported in patients with schizophrenia (SZ). Although the relationship of cf-mtDNA to the cognitive status of patients with SZ has not yet been explored, it is known that cognitive impairment in SZ compromises the functional and social capacity of these patients and diminishes their quality of life. In this sense, the assessment of the severity of cognitive impairment in a Mexican population with SZ and its association with cf-mtDNA levels in blood plasma may provide the possibility of using cf-mtDNA as a biomarker to determine the status of the disease and the possible ensuing changes over time. METHODS Subjects for a case-control study will be recruited. cf-mtDNA obtained from blood plasma will be quantified by real-time polymerase chain reaction, using melting curve technology with SYBR green as amplification marker. Patients with SZ will be grouped into those with severe, mild, and no cognitive impairment according to Montreal Cognitive Assessment scale scores, to determine differences between cognitive performance and cf-mtDNA levels in blood plasma. ETHICS AND COMMUNICATION This study has been approved by the ethics and investigation committees of the High Specialty Regional Hospital of Mental Health (Hospital Regional de Alta Especialidad de Salud Mental); project No. HRAESM/DG/RP/1128/2018. We plan to communicate our research findings in scientific conferences and in peer-reviewed journals. CONCLUSION It is known that cognitive dysfunction provokes negative effects in an SZ patient´s life. This project aims to provide better knowledge about the role of cf-mtDNA in the pathogenesis of cognitive impairment in SZ, as an attempt to achieve improvements to the existing treatments, thereby helping to prevent major cognitive deterioration.
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Affiliation(s)
- Dulce Dajheanne García-de la Cruz
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, Mexico.,Investigación y Enseñanza, Hospital Regional de Alta Especialidad de Salud Mental, Villahermosa, Tabasco, Mexico
| | - Isela Esther Juárez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, Mexico
| | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, Mexico
| | - José Jaime Martínez-Magaña
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, Mexico.,Laboratorio de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | - Alma Delia Genis-Mendoza
- Laboratorio de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Mexico City, Mexico.,Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro", Mexico City, Mexico
| | - Humberto Nicolini
- Laboratorio de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | - Thelma Beatriz González-Castro
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, Mexico.,División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez, Tabasco, Mexico
| | | | - Nancy Adanelly López-Martínez
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, Mexico.,Investigación y Enseñanza, Hospital Regional de Alta Especialidad de Salud Mental, Villahermosa, Tabasco, Mexico
| | | | - Francisco Caballero-Prado
- Servicio de Salud Mental, Hospital Regional de Alta Especialidad "Dr. Juan Graham Casasús", Villahermosa, Tabasco, Mexico
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Abstract
PURPOSE OF REVIEW We review recent developments on risk factors in schizophrenia. RECENT FINDINGS The way we think about schizophrenia today is profoundly different from the way this illness was seen in the twentieth century. We now know that the etiology of schizophrenia is multifactorial and reflects an interaction between genetic vulnerability and environmental contributors. Environmental risk factors such as pregnancy and birth complications, childhood trauma, migration, social isolation, urbanicity, and substance abuse, alone and in combination, acting at a number of levels over time, influence the individual's likelihood to develop the disorder. Environmental risk factors together with the identification of a polygenic risk score for schizophrenia, research on gene-environment interaction and environment-environment interaction have hugely increased our knowledge of the disorder.
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Affiliation(s)
- Simona A Stilo
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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36
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Sheffield JM, Karcher NR, Barch DM. Cognitive Deficits in Psychotic Disorders: A Lifespan Perspective. Neuropsychol Rev 2018; 28:509-533. [PMID: 30343458 DOI: 10.1007/s11065-018-9388-2] [Citation(s) in RCA: 237] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/15/2018] [Indexed: 12/15/2022]
Abstract
Individuals with disorders that include psychotic symptoms (i.e. psychotic disorders) experience broad cognitive impairments in the chronic state, indicating a dimension of abnormality associated with the experience of psychosis. These impairments negatively impact functional outcome, contributing to the disabling nature of schizophrenia, bipolar disorder, and psychotic depression. The robust and reliable nature of cognitive deficits has led researchers to explore the timing and profile of impairments, as this may elucidate different neurodevelopmental patterns in individuals who experience psychosis. Here, we review the literature on cognitive deficits across the life span of individuals with psychotic disorder and psychotic-like experiences, highlighting the dimensional nature of both psychosis and cognitive ability. We identify premorbid generalized cognitive impairment in schizophrenia that worsens throughout development, and stabilizes by the first-episode of psychosis, suggesting a neurodevelopmental course. Research in affective psychosis is less clear, with mixed evidence regarding premorbid deficits, but a fairly reliable generalized deficit at first-episode, which appears to worsen into the chronic state. In general, cognitive impairments are most severe in schizophrenia, intermediate in bipolar disorder, and the least severe in psychotic depression. In all groups, cognitive deficits are associated with poorer functional outcome. Finally, while the generalized deficit is the clearest and most reliable signal, data suggests specific deficits in verbal memory across all groups, specific processing speed impairments in schizophrenia and executive functioning impairments in bipolar disorder. Cognitive deficits are a core feature of psychotic disorders that provide a window into understanding developmental course and risk for psychosis.
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Affiliation(s)
- Julia M Sheffield
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave S, Nashville, TN, 37212, USA.
| | - Nicole R Karcher
- Department of Psychological & Brain Sciences, Washington University St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA.,Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA.,Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
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37
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Gómez‐Benito J, Berrío ÁI, Guilera G, Rojo E, Purdon S, Pino O. The Screen for Cognitive Impairment in Psychiatry: Proposal for a polytomous scoring system. Int J Methods Psychiatr Res 2018; 27:e1598. [PMID: 29110352 PMCID: PMC6877218 DOI: 10.1002/mpr.1598] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 01/02/2023] Open
Abstract
The Screen for Cognitive Impairment in Psychiatry is a simple, fast, and easy to administer scale that has been validated in clinical and community samples. The aim of this study was to propose a polytomous scoring system for the Screen for Cognitive Impairment in Psychiatry and to demonstrate its functioning, thus providing new and complementary information regarding the utility and precision of this screening tool. Three hundred seventy-six Spanish patients diagnosed with schizophrenia spectrum disorder were evaluated. A polytomous scoring system was generated and analyzed by means of the partial credit model. Category assessment revealed optimal functioning after collapsing the 7-category system to 1 with either 5 or 4 categories, depending on the item. The proposed polytomous scoring system shows good psychometric properties and an adequate fit to the partial credit model. These results provide further confirmation of the test's utility in clinical settings and of its suitability for detecting cognitive impairment.
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Affiliation(s)
- Juana Gómez‐Benito
- Quantitative Psychology Unit, Faculty of PsychologyUniversity of BarcelonaBarcelonaSpain
- Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neurosciences (NeuroUB)University of BarcelonaBarcelonaSpain
| | - Ángela I. Berrío
- Quantitative Psychology Unit, Faculty of PsychologyUniversity of BarcelonaBarcelonaSpain
| | - Georgina Guilera
- Quantitative Psychology Unit, Faculty of PsychologyUniversity of BarcelonaBarcelonaSpain
- Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neurosciences (NeuroUB)University of BarcelonaBarcelonaSpain
| | - Emilio Rojo
- Benito Menni CASMGermanes HospitalàriesBarcelonaSpain
- Department of PsychiatryInternational University of CataloniaBarcelonaSpain
| | - Scot Purdon
- Department of PsychiatryUniversity of AlbertaEdmontonAlbertaCanada
| | - Oscar Pino
- Quantitative Psychology Unit, Faculty of PsychologyUniversity of BarcelonaBarcelonaSpain
- Benito Menni CASMHospital General de GranollersGranollersSpain
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Teigset CM, Mohn C, Brunborg C, Juuhl-Langseth M, Holmén A, Rund BR. Do clinical characteristics predict the cognitive course in early-onset schizophrenia-spectrum disorders? J Child Psychol Psychiatry 2018; 59:1012-1023. [PMID: 29573345 DOI: 10.1111/jcpp.12896] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Being in a period with extensive brain maturation, adolescents with early-onset schizophrenia-spectrum disorders (EOS) provide unique neurodevelopmental data that may contribute to a better understanding of schizophrenia at all ages. Cognitive dysfunction is a central feature of schizophrenia and is more pronounced in EOS than in later onset illness. However, there is limited research on both the long-term course of global cognition in EOS, and how cognition over time is influenced by clinical characteristics during the early illness period. METHODS Thirty-one EOS patients and 73 controls (age 12-18) were assessed on clinical variables at baseline (PANSS, duration of untreated psychosis [DUP], hospitalizations, suicide attempts, and remission). Neuropsychological assessments with the MATRICS Consensus Cognitive Battery (MCCB) were conducted at baseline and after both 1 and 2 years, and composite scores of total performances were calculated. The analyses were performed with a linear mixed model. RESULTS The present study found that global cognition followed a stable course over the first years of the disease in EOS, though at a significantly lower level in EOS compared with the controls. We did not detect a relationship between DUP, remission, positive/negative symptoms, and hospitalizations on one hand, and long-term cognition on the other hand, but PANSS-general and suicide attempt history at baseline were identified as risk factors of longitudinal cognitive function. CONCLUSIONS Though at different levels, the EOS group and the controls had a similar cognitive course over 2 years. Some baseline characteristics (psychotic symptoms, DUP, remission, and hospitalization) had no influence on cognition within the first 2 years of illness. In contrast, general symptoms and a history of suicide attempts at baseline were more potent risk factors of the cognitive course than the psychotic-specific symptoms, and should, therefore, be subject to specific attention in the evaluation and treatment of patients with early-onset psychosis.
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Affiliation(s)
| | - Christine Mohn
- Research Department, Vestre Viken Hospital Trust, Drammen, Norway
| | | | | | - Aina Holmén
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Bjørn Rishovd Rund
- Research Department, Vestre Viken Hospital Trust, Drammen, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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39
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Hemager N, Plessen KJ, Thorup A, Christiani C, Ellersgaard D, Spang KS, Burton BK, Gregersen M, Søndergaard A, Greve AN, Gantriis DL, Poulsen G, Seidman LJ, Mors O, Nordentoft M, Jepsen JRM. Assessment of Neurocognitive Functions in 7-Year-Old Children at Familial High Risk for Schizophrenia or Bipolar Disorder: The Danish High Risk and Resilience Study VIA 7. JAMA Psychiatry 2018; 75:844-852. [PMID: 29926086 PMCID: PMC6143091 DOI: 10.1001/jamapsychiatry.2018.1415] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
IMPORTANCE Children at familial high risk of schizophrenia spectrum disorders (FHR-SZ) or bipolar disorder (FHR-BP) exhibit neurocognitive impairments. Large studies of neurocognition in young children at familial high risk at the same age are important to differentiate the pathophysiology and developmental trajectory of these 2 groups. OBJECTIVE To characterize neurocognitive functions in 7-year-old children with FHR-SZ or FHR-BP and a control population. DESIGN, SETTING, AND PARTICIPANTS This multisite population-based cohort study collected data from January 1, 2013, to January 31, 2016, in the first wave of the Danish High Risk and Resilience Study VIA 7 at 2 university hospital research sites in Copenhagen and Aarhus using Danish registries. Participants (n = 514) included 197 children with FHR-SZ, 118 with FHR-BP, and 199 controls matched with the FHR-SZ group for age, sex, and municipality. Assessors were blinded to risk status. EXPOSURES Parents with schizophrenia, bipolar disorder, or neither diagnosis. MAIN OUTCOMES AND MEASURES Neurocognitive functions were measured across 23 tests. Four neurocognitive domains were derived by principal component analysis, including processing speed and working memory, verbal functions, executive and visuospatial functions, and declarative memory and attention. RESULTS A total of 514 children aged 7 years were included in the analysis (46.3% girls), consisting of 197 children with FHR-SZ (46.2% girls), 118 with FHR-BP (46.6% girls), and 199 controls (46.2% girls). Children with FHR-SZ were significantly impaired compared with controls on processing speed and working memory (Cohen d = 0.50; P < .001), executive and visuospatial functions (Cohen d = 0.28; P = .03), and declarative memory and attention (Cohen d = 0.29; P = .02). Compared with children with FHR-BP, children with FHR-SZ performed significantly poorer in processing speed and working memory (Cohen d = 0.40; P = .002), executive and visuospatial functions (Cohen d = 0.35; P = .008), and declarative memory and attention (Cohen d = 0.31; P = .03). Children with FHR-BP and controls did not differ. CONCLUSIONS AND RELEVANCE Children with FHR-SZ had widespread neurocognitive impairments, supporting the hypothesis of neurocognitive functions as endophenotypes of schizophrenia. The absence of neurocognitive deficits in children with FHR-BP suggests distinct neurodevelopmental manifestations in these familial high-risk groups at this age. Early detection of children with FHR-SZ and cognitive impairments is warranted to investigate associations of neurocognition with transition to psychosis, add to the knowledge of their developmental pathophysiology, and inform early intervention programs.
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Affiliation(s)
- Nicoline Hemager
- Mental Health Centre Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen,Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Kerstin J. Plessen
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,Service of Child and Adolescent Psychiatry, Department of Psychiatry, University Medical Center, University of Lausanne, Lausanne, Switzerland
| | - Anne Thorup
- Mental Health Centre Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Camilla Christiani
- Mental Health Centre Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Ditte Ellersgaard
- Mental Health Centre Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Katrine Søborg Spang
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Birgitte Klee Burton
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Maja Gregersen
- Mental Health Centre Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Anne Søndergaard
- Mental Health Centre Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Aja Neergaard Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Ditte Lou Gantriis
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Gry Poulsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Larry J. Seidman
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- Mental Health Centre Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen,Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,Center for Neuropsychiatric Schizophrenia Research, Mental Health Services, Capital Region of Denmark, Copenhagen,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Services, Capital Region of Denmark, Copenhagen
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Jeon DW, Jung DU, Kim SJ, Shim JC, Moon JJ, Seo YS, Jung SS, Seo BJ, Kim JE, Oh M, Kim YN. Adjunct transcranial direct current stimulation improves cognitive function in patients with schizophrenia: A double-blind 12-week study. Schizophr Res 2018; 197:378-385. [PMID: 30955702 DOI: 10.1016/j.schres.2017.12.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 12/15/2017] [Accepted: 12/16/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cognitive impairment is a common symptom of schizophrenia that has significant effects on quality of life and the activities of daily living. The present study examined the ability of transcranial direct current stimulation (tDCS) to improve cognitive function and clinical symptoms in patients with schizophrenia. METHODS Fifty-six patients with schizophrenia were randomized to real-tDCS and sham-tDCS groups. The participants were stable for a period of 3months before study enrollment. Each group received 30min of active 2-mA tDCS or sham stimulation over the left dorsolateral prefrontal cortex (anode F3, cathode F4) once per day for 10 consecutive weekdays. The Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB) and Wisconsin Card Sorting Test (WCST) were used to evaluate cognitive function, and the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Schizophrenia scale (CGI-SCH), and Calgary Depression Scale for Schizophrenia (CDSS) were used to evaluate symptoms at baseline, after 10 sessions, and at 3-month follow-up. RESULTS There was a significant time×group interaction, indicating that MCCB working memory (P=0.008) and overall scores (P=0.031) improved over time in the real-tDCS group compared to the sham-tDCS group. There was also a significant time×group interaction for depressive symptoms as evaluated by the CGI-SCH, which decreased over time in the real-tDCS group (P=0.041). tDCS treatment combined with antipsychotic medication was generally well-tolerated and safe. CONCLUSIONS Adjunct tDCS treatment is safe and effective for improving cognitive status in patients with schizophrenia.
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Affiliation(s)
- Dong-Wook Jeon
- Department of Psychiatry, Busan Paik Hospital, Inje University, Busan, Republic of Korea
| | - Do-Un Jung
- Department of Psychiatry, Busan Paik Hospital, Inje University, Busan, Republic of Korea.
| | - Sung-Jin Kim
- Department of Psychiatry, Busan Paik Hospital, Inje University, Busan, Republic of Korea
| | - Joo-Cheol Shim
- Shim Joo Cheol Psychiatry Clinic, Busan, Republic of Korea
| | - Jung-Joon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University, Busan, Republic of Korea
| | - Young-Soo Seo
- Department of Psychiatry, Sharing and Happiness Hospital, Busan, Republic of Korea
| | - Sung-Soo Jung
- Department of Psychiatry, Sharing and Happiness Hospital, Busan, Republic of Korea
| | - Beom-Joo Seo
- Department of Psychiatry, Busan Metropolitan Mental Hospital, Busan, Republic of Korea
| | - Jeong-Eun Kim
- Department of Psychiatry, Busan Metropolitan Mental Hospital, Busan, Republic of Korea
| | - Minkyung Oh
- Department of Pharmacology, Busan Paik Hospital, Inje University, Busan, Republic of Korea
| | - You-Na Kim
- Department of Psychiatry, Busan Paik Hospital, Inje University, Busan, Republic of Korea
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Abstract
Schizophrenia patients commonly exhibit substantial and diffuse cognitive impairment. Evidence suggests that subtle cognitive deficits are already apparent in childhood and adolescence, many years prior to onset of psychosis. While there is almost unequivocal evidence of some degree of cognitive impairment in individuals who later develop schizophrenia, the literature remains inconclusive regarding the exact nature of this impairment and warrants careful review and interpretation. Meta-analytic findings suggest that individuals who later develop schizophrenia, but not related disorders, such as bipolar disorder, exhibit a premorbid IQ deficit of around 8 points. Several studies have also found evidence for premorbid deficits across most cognitive domains, such as language, processing speed and executive functions. Longitudinal studies, although rare, suggest that individuals who go on to develop schizophrenia may show a course of increasing cognitive impairment prior to onset of psychosis. While evidence regarding the etiology of premorbid deficits is scarce, common and rare genetic variants, as well as environmental factors such as obstetric complications and cannabis use may play an important role and warrant further examination. In this selected review, we give an overview of population-based studies on premorbid cognitive deficits in schizophrenia, with a special focus on evidence regarding the specificity, profile and course of these deficits.
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Affiliation(s)
- J Mollon
- Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - A Reichenberg
- Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
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42
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Intellectual Functioning in Offspring of Parents with Bipolar Disorder: A Review of the Literature. Brain Sci 2017; 7:brainsci7110143. [PMID: 29143763 PMCID: PMC5704150 DOI: 10.3390/brainsci7110143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/12/2017] [Accepted: 10/20/2017] [Indexed: 11/17/2022] Open
Abstract
Impaired intellectual functioning is an important risk factor for the emergence of severe mental illness. Unlike many other forms of mental disorder however, the association between bipolar disorder and intellectual deficits is unclear. In this narrative review, we examine the current evidence on intellectual functioning in children and adolescents at risk for developing bipolar disorder. The results are based on 18 independent, peer-reviewed publications from 1980 to 2017 that met criteria for this study. The findings yielded no consistent evidence of lower or higher intellectual quotient (IQ) in offspring of parents diagnosed with bipolar disorder. Some tentative evidence was found for lower performance IQ in offspring of bipolar parents as compared to controls. It is recommended that future research examine variability in intellectual functioning and potential moderators. These findings demonstrate the need to examine how intellectual functioning unfolds across development given the potential role of IQ as a marker of vulnerability or resilience in youth at high risk for affective disorders.
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43
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Abstract
We review the changing conceptions of schizophrenia over the past 50 years as it became understood as a disorder of brain function and structure in which neurocognitive dysfunction was identified at different illness phases. The centrality of neurocognition has been recognized, especially because neurocognitive deficits are strongly related to social and role functioning in the illness, and as a result neurocognitive measures are used routinely in clinical assessment of individuals with schizophrenia. From the original definitions of the syndrome of schizophrenia in the early 20th century, impaired cognition, especially attention, was considered to be important. Neurocognitive impairments are found in the vast majority of individuals with schizophrenia, and they vary from mild, relatively restricted deficits, to dementia-like syndromes, as early as the first psychotic episode. Neurocognitive deficits are found in the premorbid phase in a substantial minority of pre-teenage youth who later develop schizophrenia, and they apparently worsen by the prodromal, high-risk phase in a majority of those who develop the illness. While there is limited evidence for reversibility of impairments from pharmacological interventions in schizophrenia, promising results have emerged from cognitive remediation studies. Thus, we expect cognitive interventions to play a larger role in schizophrenia in the coming years. Moreover, because youth at risk for schizophrenia can be identified by an emergent high-risk syndrome, earlier interventions might be applied in a pre-emptive way to reduce disability and improve adaptation. The notion of schizophrenia as a developmental neurocognitive disorder with stages opens up a window of possibilities for earlier interventions. (JINS, 2017, 23, 881-892).
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44
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Sugranyes G, de la Serna E, Borras R, Sanchez-Gistau V, Pariente JC, Romero S, Baeza I, Díaz-Caneja CM, Rodriguez-Toscano E, Moreno C, Bernardo M, Moreno D, Vieta E, Castro-Fornieles J. Clinical, Cognitive, and Neuroimaging Evidence of a Neurodevelopmental Continuum in Offspring of Probands With Schizophrenia and Bipolar Disorder. Schizophr Bull 2017; 43:1208-1219. [PMID: 28180904 PMCID: PMC5737486 DOI: 10.1093/schbul/sbx002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies in child and adolescent offspring of patients with schizophrenia or bipolar disorders may help understand the influence of neurodevelopmental factors on the premorbid phenotype of these disorders. AIMS To assess whether a combination of neurodevelopmental factors discriminates between young offspring of patients with schizophrenia (SzO) or bipolar disorder (BpO) and community controls (CcO). To assess the association between these factors and rates of psychiatric diagnoses in high risk (HR) youth. METHODS One hundred thirty-three HR offspring (47 SzO and 86 BpO) and 84 CcO, aged 6-17, underwent cross-sectional clinical, neurocognitive, and structural neuroimaging assessment. Information on perinatal events and early childhood development was also obtained. General linear mixed models were performed to assess group discrimination and association with lifetime axis I psychiatric disorders. RESULTS Multivariate analyses revealed that greater neurological soft signs (NSS), less total grey matter volume (GMV) and a higher frequency of obstetric complications discriminated HR offspring from CcO. When comparing each group individually, greater NSS and a higher frequency of obstetric complications discriminated SzO from CcO, and BpO from CcO, while lower intelligence also discriminated SzO from CcO and from BpO. Within HR offspring, lower intelligence and less total GMV were associated with lifetime incidence of psychiatric disorders. CONCLUSIONS Both SzO and BpO showed evidence of neurodevelopmental insult, although this may have a greater impact in SzO. Lower intelligence and less total GMV hold potential as biomarkers of risk for psychiatric disorders in HR youth.
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Affiliation(s)
- Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, 2014SGR489, Institut Clinic de Neurociències, Hospital Clínic i Provincial, Barcelona, Spain,Institut d′Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,To whom correspondence should be addressed; Department of Child and Adolescent Psychiatry and Psychology, 2014SGR489, Institut Clinic de Neurociències, Hospital Clínic i Provincial, c. Villarroel 170, 08036 Barcelona, Spain; tel: +34-93-227-9974/9970, fax: +34-93-227-9974, e-mail:
| | - Elena de la Serna
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Roger Borras
- Institut d′Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Vanessa Sanchez-Gistau
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Early Intervention Team, Pere Mata Institute of Reus, Health Research Institute Pere Virgili (IISPV), Reus, Spain
| | - Jose C Pariente
- Institut d′Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Soledad Romero
- Institut d′Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, 2014SGR489, Institut Clinic de Neurociències, Hospital Clínic i Provincial, Barcelona, Spain,Institut d′Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Elisa Rodriguez-Toscano
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Carmen Moreno
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Miguel Bernardo
- Department of Child and Adolescent Psychiatry and Psychology, 2014SGR489, Institut Clinic de Neurociències, Hospital Clínic i Provincial, Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain,Department of Psychiatry and Psychology, Hospital Clinic, Barcelona, Spain
| | - Dolores Moreno
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Eduard Vieta
- Department of Child and Adolescent Psychiatry and Psychology, 2014SGR489, Institut Clinic de Neurociències, Hospital Clínic i Provincial, Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain,Department of Psychiatry and Psychology, Hospital Clinic, Barcelona, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, 2014SGR489, Institut Clinic de Neurociències, Hospital Clínic i Provincial, Barcelona, Spain,Institut d′Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
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Parellada M, Gomez-Vallejo S, Burdeus M, Arango C. Developmental Differences Between Schizophrenia and Bipolar Disorder. Schizophr Bull 2017; 43:1176-1189. [PMID: 29045744 PMCID: PMC5737496 DOI: 10.1093/schbul/sbx126] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Ample evidence supports a neurodevelopmental origin in some cases of schizophrenia (SZ). More inconsistent information is available for bipolar disorder (BD). We herein review studies with a focus on premorbid (adjustment and functionality) and early developmental milestones that include both SZ and BD patients. A search was performed in the PubMed electronic database, retrieving 619 abstracts; 30 were ultimately included in this systematic review. Eight prospective cohorts, 15 retrospective studies, and 7 studies based on national registries. Psychomotor developmental deviations and general adjustment problems characterize the childhood of subjects later diagnosed with SZ or BD; they are more marked in those later diagnosed with SZ vs BD, earlier onset vs later onset, and psychotic vs nonpsychotic disorders. Cognitive impairment follows a linear risk trend for SZ and a U-shaped trend for BD. Social isolation and visuoperceptual/reading anomalies more frequently antecede SZ. Pervasive developmental disorders increase the risk for both SZ and BD, more so in cases with normal intelligence. The predictive risk of each isolated developmental marker is low, but a significant percentage of subjects with SZ and a minority of adults with BD showed signs of premorbid abnormalities in childhood. The great limitation is still the lack of studies comparing SZ and BD that include psychotic and nonpsychotic bipolar cases separately. There are many cases, even in childhood/adolescent SZ, where no premorbid anomalies are found, and immunological disorders or other etiologies should be searched for. At least in cases with clear neurodevelopmental markers, rare genetic variants should be investigated.
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Affiliation(s)
- Mara Parellada
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain,IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain,To whom correspondence should be addressed; Mara Parellada, Hospital General Universitario Gregorio Marañón, Ibiza 43, Madrid 28009, Spain; tel: +34-91-5868133, fax: +34-91-4265004, e-mail:
| | - Sandra Gomez-Vallejo
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Monica Burdeus
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain,IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
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46
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Toulopoulou T, Picchioni M, Mortensen PB, Petersen L. IQ, the Urban Environment, and Their Impact on Future Schizophrenia Risk in Men. Schizophr Bull 2017; 43:1056-1063. [PMID: 28338769 PMCID: PMC5581890 DOI: 10.1093/schbul/sbw147] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Exposure to an urban environment during early life and low IQ are 2 well-established risk factors for schizophrenia. It is not known, however, how these factors might relate to one another. Data were pooled from the North Jutland regional draft board IQ assessments and the Danish Conscription Registry for men born between 1955 and 1993. Excluding those who were followed up for less than 1 year after the assessment yielded a final cohort of 153170 men of whom 578 later developed a schizophrenia spectrum disorder. We found significant effects of having an urban birth, and also experiencing an increase in urbanicity before the age of 10 years, on adult schizophrenia risk. The effect of urban birth was independent of IQ. However, there was a significant interaction between childhood changes in urbanization in the first 10 years and IQ level on the future adult schizophrenia risk. In short, those subjects who moved to more or less urban areas before their 10th birthday lost the protective effect of IQ. When thinking about adult schizophrenia risk, the critical time window of childhood sensitivity to changes in urbanization seems to be linked to IQ. Given the prediction that by 2050, over 80% of the developed world's population will live in an urban environment, this represents a major future public health issue.
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Affiliation(s)
- Timothea Toulopoulou
- Department of Psychology, Bilkent University, Ankara, Turkey;,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Department of Psychology, The University of Hong Kong, Hong Kong SAR, China;,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China;,To whom correspondence should be addressed; Department of Psychology, Bilkent University, Bilkent 06800, Ankara, Turkey; Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London SE5 8AF, UK; tel: +44-(0)20-7848-0100, fax: +44-(0)20-7848-0287, e-mail:
| | - Marco Picchioni
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Preben Bo Mortensen
- National Centre for Register-based Research, Aarhus University, Aarhus V, Denmark
| | - Liselotte Petersen
- National Centre for Register-based Research, Aarhus University, Aarhus V, Denmark
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47
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Forsyth JK, Lewis DA. Mapping the Consequences of Impaired Synaptic Plasticity in Schizophrenia through Development: An Integrative Model for Diverse Clinical Features. Trends Cogn Sci 2017; 21:760-778. [PMID: 28754595 DOI: 10.1016/j.tics.2017.06.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/13/2017] [Accepted: 06/09/2017] [Indexed: 01/19/2023]
Abstract
Schizophrenia is associated with alterations in sensory, motor, and cognitive functions that emerge before psychosis onset; identifying pathogenic processes that can account for this multi-faceted phenotype remains a challenge. Accumulating evidence suggests that synaptic plasticity is impaired in schizophrenia. Given the role of synaptic plasticity in learning, memory, and neural circuit maturation, impaired plasticity may underlie many features of the schizophrenia syndrome. Here, we summarize the neurobiology of synaptic plasticity, review evidence that plasticity is impaired in schizophrenia, and explore a framework in which impaired synaptic plasticity interacts with brain maturation to yield the emergence of sensory, motor, cognitive, and psychotic features at different times during development in schizophrenia. Key gaps in the literature and future directions for testing this framework are discussed.
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Affiliation(s)
- Jennifer K Forsyth
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA.
| | - David A Lewis
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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48
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Agnew-Blais J, Seidman LJ, Fitzmaurice GM, Smoller JW, Goldstein JM, Buka SL. The interplay of childhood behavior problems and IQ in the development of later schizophrenia and affective psychoses. Schizophr Res 2017; 184:45-51. [PMID: 28062262 PMCID: PMC6140330 DOI: 10.1016/j.schres.2016.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/07/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
Schizophrenia and affective psychoses are both associated with impaired social functioning, but the extent to which childhood behavioral impairments are present prior to onset of illness is less well studied. Moreover, the concurrent relationship of childhood behavior problems and premorbid IQ with subsequent psychotic disorder has not been established. We investigated whether childhood behavior problems are associated with increased risk for adult schizophrenia or affective psychosis, independently and in combination with IQ. The study included individuals with schizophrenia (N=47), affective psychoses (N=45) and non-psychotic controls (N=1496) from the New England Family Study. Behavior problems were prospectively assessed from standardized clinician observations at ages 4 and 7. IQ was assessed with the Stanford-Binet at age 4 and the Wechsler Intelligence Scale for Children at age 7. We found externalizing problems at age 4 and externalizing and internalizing problems at age 7 were associated with later schizophrenia, and both internalizing and externalizing problems at ages 4 and 7 were associated with later development of affective psychoses. Lower IQ at ages 4 and 7 was associated with schizophrenia, while lower IQ was associated with affective psychoses at age 7 only. Examined simultaneously, both lower IQ and behavior problems remained associated with risk of schizophrenia, while only behavior problems remained associated with affective psychoses. Behavior problems appear to be a general marker of risk of adult psychotic disorder, while lower childhood IQ is more specific to risk of schizophrenia. Future research should clarify the premorbid evolution of behavior and cognitive problems into adult psychosis.
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Affiliation(s)
- Jessica Agnew-Blais
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
| | - Larry J. Seidman
- Harvard Medical School, Department of Psychiatry, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA,Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Garrett M. Fitzmaurice
- Harvard Medical School, Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA 02478,Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115
| | - Jordan W. Smoller
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA,Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital, Boston, MA 02114
| | - Jill M. Goldstein
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA,Harvard Medical School, Department of Psychiatry, Division of Women’s Health, Connors Center for Women’s Health & Gender Biology, Boston, MA 02120
| | - Stephen L. Buka
- Brown University, Department of Epidemiology, Providence, RI 02912
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49
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de la Serna E, Sugranyes G, Sanchez-Gistau V, Rodriguez-Toscano E, Baeza I, Vila M, Romero S, Sanchez-Gutierrez T, Penzol MJ, Moreno D, Castro-Fornieles J. Neuropsychological characteristics of child and adolescent offspring of patients with schizophrenia or bipolar disorder. Schizophr Res 2017; 183:110-115. [PMID: 27847227 DOI: 10.1016/j.schres.2016.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/07/2016] [Accepted: 11/09/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Schizophrenia (SZ) and bipolar disorder (BD) are considered neurobiological disorders which share some clinical, cognitive and neuroimaging characteristics. Studying child and adolescent offspring of patients diagnosed with bipolar disorder (BDoff) or schizophrenia (SZoff) is regarded as a reliable method for investigating early alterations and vulnerability factors for these disorders. This study compares the neuropsychological characteristics of SZoff, BDoff and a community control offspring group (CC) with the aim of examining shared and differential cognitive characteristics among groups. METHODS 41 SZoff, 90 BDoff and 107 CC were recruited. They were all assessed with a complete neuropsychological battery which included intelligence quotient, working memory (WM), processing speed, verbal memory and learning, visual memory, executive functions and sustained attention. RESULTS SZoff and BDoff showed worse performance in some cognitive areas compared with CC. Some of these difficulties (visual memory) were common to both offspring groups, whereas others, such as verbal learning and WM in SZoff or PSI in BDoff, were group-specific. CONCLUSIONS The cognitive difficulties in visual memory shown by both the SZoff and BDoff groups might point to a common endophenotype in the two disorders. Difficulties in other cognitive functions would be specific depending on the family diagnosis.
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Affiliation(s)
- Elena de la Serna
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry and Psychology, Clinical Institute for the Neurosciences, Hospital Clinic of Barcelona, 2014SGR489, Spain.
| | - Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, Clinical Institute for the Neurosciences, Hospital Clinic of Barcelona, 2014SGR489, Spain; August Pi i Sunyer Institute for Biomedical Research (IDIBAPS), Barcelona, Spain
| | - Vanessa Sanchez-Gistau
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Early Intervention Psychosis Service, Pere Mata Institute and University Hospital, IISPV, Rovira i Virgili University, Reus, Spain
| | - Elisa Rodriguez-Toscano
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, School of Medicine, Gregorio Marañón University Hospital, Complutense University, IiSGM, Madrid, Spain
| | - Immaculada Baeza
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry and Psychology, Clinical Institute for the Neurosciences, Hospital Clinic of Barcelona, 2014SGR489, Spain
| | - Montserrat Vila
- Department of Child and Adolescent Psychiatry and Psychology, Clinical Institute for the Neurosciences, Hospital Clinic of Barcelona, 2014SGR489, Spain
| | - Soledad Romero
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry and Psychology, Clinical Institute for the Neurosciences, Hospital Clinic of Barcelona, 2014SGR489, Spain
| | - Teresa Sanchez-Gutierrez
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, School of Medicine, Gregorio Marañón University Hospital, Complutense University, IiSGM, Madrid, Spain
| | - Mª José Penzol
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, School of Medicine, Gregorio Marañón University Hospital, Complutense University, IiSGM, Madrid, Spain
| | - Dolores Moreno
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, School of Medicine, Gregorio Marañón University Hospital, Complutense University, IiSGM, Madrid, Spain
| | - Josefina Castro-Fornieles
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry and Psychology, Clinical Institute for the Neurosciences, Hospital Clinic of Barcelona, 2014SGR489, Spain; August Pi i Sunyer Institute for Biomedical Research (IDIBAPS), Barcelona, Spain; Department of Psychiatry and Clinical Psychology, University of Barcelona, Spain
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50
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Tsapekos D, Taylor R, Cella M. Feasibility and acceptability of brief cognitive remediation targeting metacognition in acute inpatients with psychosis: a case series. Neuropsychol Rehabil 2017; 29:361-375. [PMID: 28316273 DOI: 10.1080/09602011.2017.1301263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Cognitive remediation (CR) is an intensive intervention targeting cognitive impairment with the aim of improving functioning in people with psychotic disorders. Shorter forms of CR based on metacognition and targeting awareness of cognitive problems may be more appropriate for acute inpatient settings where time is limited. The objective of the study was to evaluate the feasibility and acceptability of a new brief course of CR targeting cognitive and metacognitive difficulties within an acute inpatient psychiatric setting. Thirteen male service users with psychosis received a three-week course of CR. Participants were assessed at baseline and post-treatment on cognitive measures, subjective cognitive complaints, functional impairment, and symptom severity. Feasibility was assessed based on engagement, attendance, and attrition. Acceptability was evaluated through treatment satisfaction. Eight participants completed therapy, with 81% session attendance. Therapy was considered acceptable, with the majority of participants considering it satisfactory. Potential benefit analysis showed a significant post-treatment improvement in global cognition and memory. Subjective cognitive complaints did not change over time. It was concluded that it is feasible to deliver brief CR in an acute inpatient setting. Context of delivery and engagement are challenges for optimal therapy implementation. CR protocol adaptations made to promote metacognitive competencies may compensate for lack of intensive practice.
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Affiliation(s)
- Dimosthenis Tsapekos
- a Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience , King's College London , London , UK
| | - Rumina Taylor
- b Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience , King's College London , London , UK.,c South London and Maudsley NHS Foundation Trust , London , UK
| | - Matteo Cella
- b Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience , King's College London , London , UK
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