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Herkströter F, Zahedi A, Standke I, Dannlowski U, Lencer R, Schubotz RI, Trempler I. Gray matter matters: Cognitive stability and flexibility in schizophrenia spectrum disorder. Psychophysiology 2024; 61:e14596. [PMID: 38691383 DOI: 10.1111/psyp.14596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/12/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
Cognitive dysfunction constitutes a core characteristic of schizophrenia spectrum disorders (SZ). Specifically, deficits in updating generative models (i.e., cognitive flexibility) and shielding against distractions (i.e., cognitive stability) are considered critical contributors to cognitive impairment in these patients. Here, we examined the structural integrity of frontostriatal networks and their associations with reduced cognitive stability and flexibility in SZ patients. In a sample of 21 patients diagnosed with SZ and 22 healthy controls, we measured gray matter volume (GMV) using structural MRI. Further, cognitive stability and flexibility were assessed using a switch-drift paradigm, quantifying the successful ignoring of distracters and detection of rule switches. Compared to controls, patients showed significantly smaller GMV in the whole brain and three predefined regions of interest: the medial prefrontal cortex (mPFC), inferior frontal gyrus (IFG), and caudate nucleus (CN). Notably, GMV in these areas positively correlated with correct rule-switch detection but not with ignoring rule-compatible drifts. Further, the volumetric differences between SZ patients and controls were statistically explainable by considering the behavioral performance in the switch-drift task. Our results indicate that morphological abnormalities in frontostriatal networks are associated with deficient flexibility in SZ patients and highlight the necessity of minimizing neurodevelopmental and progressive brain atrophy in this population.
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Affiliation(s)
- Florentine Herkströter
- Department of Neurology, Niels-Stensen-Kliniken, Marienhospital Osnabrück-Standort Natruper Holz, Osnabrueck, Germany
| | - Anoushiravan Zahedi
- Institute of Psychology, University of Muenster, Muenster, Germany
- Otto Creutzfeldt-Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | - Isabel Standke
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Udo Dannlowski
- Institute of Psychology, University of Muenster, Muenster, Germany
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Ricarda I Schubotz
- Institute of Psychology, University of Muenster, Muenster, Germany
- Otto Creutzfeldt-Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | - Ima Trempler
- Institute of Psychology, University of Muenster, Muenster, Germany
- Otto Creutzfeldt-Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
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Faden J, Ramirez C, Martinez V, Citrome L. An overview of the currently available and emerging long-acting formulations of risperidone for schizophrenia and bipolar disorder. Expert Rev Neurother 2024; 24:761-771. [PMID: 39044342 DOI: 10.1080/14737175.2024.2370349] [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] [Received: 04/29/2024] [Accepted: 06/16/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Long-acting injectable (LAI) antipsychotic medications can help improve treatment adherence in patients with schizophrenia and bipolar disorder. Despite this, they are underutilized. In 2003, intramuscular risperidone became the first available LAI atypical antipsychotic medication, and since then, a number of competing long-acting risperidone formulations have been brought to market, with additional options under active development. These include intramuscular, subcutaneous, long-acting oral, and implantable formulations. AREAS COVERED This review summarizes currently available and emerging long-acting risperidone formulations, including efficacy and safety data, and practical considerations aimed to help prescribers distinguish one formulation from another. EXPERT OPINION There is an expanding number of currently available LAI antipsychotic medications giving patients and providers an opportunity to personalize and individualize care. Rates of adherence to treatment in patients with schizophrenia and bipolar disorder are low, and individualizing care can help improve this. The risperidone LAI treatment landscape includes five options approved by the U.S. Food and Drug Administration, with others under clinical development. These options differ in regard to mode of administration, approved indications, available dose strengths, injection intervals, needle size, injection volume, storage, and other variables. Prescribers should be familiar with these differing options to help patients find the best fit for their individual needs.
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Affiliation(s)
- Justin Faden
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Camila Ramirez
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Vanessa Martinez
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
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Sfera A, Imran H, Sfera DO, Anton JJ, Kozlakidis Z, Hazan S. Novel Insights into Psychosis and Antipsychotic Interventions: From Managing Symptoms to Improving Outcomes. Int J Mol Sci 2024; 25:5904. [PMID: 38892092 PMCID: PMC11173215 DOI: 10.3390/ijms25115904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
For the past 70 years, the dopamine hypothesis has been the key working model in schizophrenia. This has contributed to the development of numerous inhibitors of dopaminergic signaling and antipsychotic drugs, which led to rapid symptom resolution but only marginal outcome improvement. Over the past decades, there has been limited research on the quantifiable pathological changes in schizophrenia, including premature cellular/neuronal senescence, brain volume loss, the attenuation of gamma oscillations in electroencephalograms, and the oxidation of lipids in the plasma and mitochondrial membranes. We surmise that the aberrant activation of the aryl hydrocarbon receptor by toxins derived from gut microbes or the environment drives premature cellular and neuronal senescence, a hallmark of schizophrenia. Early brain aging promotes secondary changes, including the impairment and loss of mitochondria, gray matter depletion, decreased gamma oscillations, and a compensatory metabolic shift to lactate and lactylation. The aim of this narrative review is twofold: (1) to summarize what is known about premature cellular/neuronal senescence in schizophrenia or schizophrenia-like disorders, and (2) to discuss novel strategies for improving long-term outcomes in severe mental illness with natural senotherapeutics, membrane lipid replacement, mitochondrial transplantation, microbial phenazines, novel antioxidant phenothiazines, inhibitors of glycogen synthase kinase-3 beta, and aryl hydrocarbon receptor antagonists.
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Affiliation(s)
- Adonis Sfera
- Patton State Hospital, 3102 Highland Ave., Patton, CA 92369, USA; (H.I.)
- University of California Riverside, Riverside 900 University Ave., Riverside, CA 92521, USA
- Loma Linda University, 11139 Anderson St., Loma Linda, CA 92350, USA
| | - Hassan Imran
- Patton State Hospital, 3102 Highland Ave., Patton, CA 92369, USA; (H.I.)
- University of California Riverside, Riverside 900 University Ave., Riverside, CA 92521, USA
- Loma Linda University, 11139 Anderson St., Loma Linda, CA 92350, USA
| | - Dan O. Sfera
- Patton State Hospital, 3102 Highland Ave., Patton, CA 92369, USA; (H.I.)
- University of California Riverside, Riverside 900 University Ave., Riverside, CA 92521, USA
- Loma Linda University, 11139 Anderson St., Loma Linda, CA 92350, USA
| | | | - Zisis Kozlakidis
- International Agency for Research on Cancer, 69372 Lyon, France;
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Yang Y, Jin X, Xue Y, Li X, Chen Y, Kang N, Yan W, Li P, Guo X, Luo B, Zhang Y, Liu Q, Shi H, Zhang L, Su X, Liu B, Lu L, Lv L, Li W. Right superior frontal gyrus: A potential neuroimaging biomarker for predicting short-term efficacy in schizophrenia. Neuroimage Clin 2024; 42:103603. [PMID: 38588618 PMCID: PMC11015154 DOI: 10.1016/j.nicl.2024.103603] [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] [Received: 01/11/2024] [Revised: 03/24/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024]
Abstract
Antipsychotic drug treatment for schizophrenia (SZ) can alter brain structure and function, but it is unclear if specific regional changes are associated with treatment outcome. Therefore, we examined the effects of antipsychotic drug treatment on regional grey matter (GM) density, white matter (WM) density, and functional connectivity (FC) as well as associations between regional changes and treatment efficacy. SZ patients (n = 163) and health controls (HCs) (n = 131) were examined by structural magnetic resonance imaging (sMRI) at baseline, and a subset of SZ patients (n = 77) were re-examined after 8 weeks of second-generation antipsychotic treatment to assess changes in regional GM and WM density. In addition, 88 SZ patients and 81 HCs were examined by resting-state functional MRI (rs-fMRI) at baseline and the patients were re-examined post-treatment to examine FC changes. The Positive and Negative Syndrome Scale (PANSS) and MATRICS Consensus Cognitive Battery (MCCB) were applied to measure psychiatric symptoms and cognitive impairments in SZ. SZ patients were then stratified into response and non-response groups according to PANSS score change (≥50 % decrease or <50 % decrease, respectively). The GM density of the right cingulate gyrus, WM density of the right superior frontal gyrus (SFG) plus 5 other WM tracts were reduced in the response group compared to the non-response group. The FC values between the right anterior cingulate and paracingulate gyrus and left thalamus were reduced in the entire SZ group (n = 88) after treatment, while FC between the right inferior temporal gyrus (ITG) and right medial superior frontal gyrus (SFGmed) was increased in the response group. There were no significant changes in regional FC among the non-response group after treatment and no correlations with symptom or cognition test scores. These findings suggest that the right SFG is a critical target of antipsychotic drugs and that WM density and FC alterations within this region could be used as potential indicators in predicting the treatment outcome of antipsychotics of SZ.
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Affiliation(s)
- Yongfeng Yang
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing 100191, China; Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang 453002, China; Henan Collaborative Innovation Center of Prevention and Treatment of Mental Disorder, Xinxiang 453002, China
| | - Xueyan Jin
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang 453002, China; Henan Collaborative Innovation Center of Prevention and Treatment of Mental Disorder, Xinxiang 453002, China
| | - Yongjiang Xue
- The Second Clinical College of Xinxiang Medical University, Xinxiang 453002, China
| | - Xue Li
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang 453002, China; Henan Collaborative Innovation Center of Prevention and Treatment of Mental Disorder, Xinxiang 453002, China
| | - Yi Chen
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang 453002, China; Henan Collaborative Innovation Center of Prevention and Treatment of Mental Disorder, Xinxiang 453002, China
| | - Ning Kang
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang 453002, China; Henan Collaborative Innovation Center of Prevention and Treatment of Mental Disorder, Xinxiang 453002, China
| | - Wei Yan
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing 100191, China
| | - Peng Li
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing 100191, China
| | - Xiaoge Guo
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang 453002, China; Henan Collaborative Innovation Center of Prevention and Treatment of Mental Disorder, Xinxiang 453002, China
| | - Binbin Luo
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang 453002, China; Henan Collaborative Innovation Center of Prevention and Treatment of Mental Disorder, Xinxiang 453002, China
| | - Yan Zhang
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang 453002, China; Henan Collaborative Innovation Center of Prevention and Treatment of Mental Disorder, Xinxiang 453002, China
| | - Qing Liu
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang 453002, China; Henan Collaborative Innovation Center of Prevention and Treatment of Mental Disorder, Xinxiang 453002, China
| | - Han Shi
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang 453002, China; Henan Collaborative Innovation Center of Prevention and Treatment of Mental Disorder, Xinxiang 453002, China
| | - Luwen Zhang
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang 453002, China; Henan Collaborative Innovation Center of Prevention and Treatment of Mental Disorder, Xinxiang 453002, China
| | - Xi Su
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang 453002, China; Henan Collaborative Innovation Center of Prevention and Treatment of Mental Disorder, Xinxiang 453002, China
| | - Bing Liu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China; Chinese Institute for Brain Research, Beijing 102206, China
| | - Lin Lu
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing 100191, China; National Institute on Drug Dependence, Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, China
| | - Luxian Lv
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang 453002, China; Henan Collaborative Innovation Center of Prevention and Treatment of Mental Disorder, Xinxiang 453002, China.
| | - Wenqiang Li
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang 453002, China; Henan Collaborative Innovation Center of Prevention and Treatment of Mental Disorder, Xinxiang 453002, China.
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Yamazaki R, Matsumoto J, Ito S, Nemoto K, Fukunaga M, Hashimoto N, Kodaka F, Takano H, Hasegawa N, Yasuda Y, Fujimoto M, Yamamori H, Watanabe Y, Miura K, Hashimoto R. Longitudinal reduction in brain volume in patients with schizophrenia and its association with cognitive function. Neuropsychopharmacol Rep 2024; 44:206-215. [PMID: 38348613 PMCID: PMC10932790 DOI: 10.1002/npr2.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 03/14/2024] Open
Abstract
Establishing a brain biomarker for schizophrenia is strongly desirable not only to support diagnosis by psychiatrists but also to help track the progressive changes in the brain over the course of the illness. A brain morphological signature of schizophrenia was reported in a recent study and is defined by clusters of brain regions with reduced volume in schizophrenia patients compared to healthy individuals. This signature was proven to be effective at differentiating patients with schizophrenia from healthy individuals, suggesting that it is a good candidate brain biomarker of schizophrenia. However, the longitudinal characteristics of this signature have remained unclear. In this study, we examined whether these changes occurred over time and whether they were associated with clinical outcomes. We found a significant change in the brain morphological signature in schizophrenia patients with more brain volume loss than the natural, age-related reduction in healthy individuals, suggesting that this change can capture a progressive morphological change in the brain. We further found a significant association between changes in the brain morphological signature and changes in the full-scale intelligence quotient (IQ). The patients with IQ improvement showed preserved brain morphological signatures, whereas the patients without IQ improvement showed progressive changes in the brain morphological signature, suggesting a link between potential recovery of intellectual abilities and the speed of brain pathology progression. We conclude that the brain morphological signature is a brain biomarker that can be used to evaluate progressive changes in the brain that are associated with cognitive impairment due to schizophrenia.
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Affiliation(s)
- Ryuichi Yamazaki
- Department of Pathology of Mental DiseasesNational Institute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
- Department of PsychiatryThe Jikei University School of MedicineTokyoJapan
| | - Junya Matsumoto
- Department of Pathology of Mental DiseasesNational Institute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
| | - Satsuki Ito
- Department of Pathology of Mental DiseasesNational Institute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
- Department of Developmental and Clinical Psychology, The Division of Human Developmental Sciences, Graduate School of Humanity and SciencesOchanomizu UniversityTokyoJapan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Institute of MedicineUniversity of TsukubaTsukubaJapan
| | - Masaki Fukunaga
- Section of Brain Function InformationNational Institute for Physiological SciencesOkazakiJapan
| | - Naoki Hashimoto
- Department of PsychiatryHokkaido University Graduate School of MedicineSapporoJapan
| | - Fumitoshi Kodaka
- Department of Pathology of Mental DiseasesNational Institute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
- Department of PsychiatryThe Jikei University School of MedicineTokyoJapan
| | - Harumasa Takano
- Department of Clinical Neuroimaging, Integrative Brain Imaging CenterNational Center of Neurology and PsychiatryKodairaJapan
| | - Naomi Hasegawa
- Department of Pathology of Mental DiseasesNational Institute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
| | - Yuka Yasuda
- Department of Pathology of Mental DiseasesNational Institute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
- Life Grow Brilliant Mental Clinic, Medical Corporation FosterOsakaJapan
| | - Michiko Fujimoto
- Department of Pathology of Mental DiseasesNational Institute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
- Department of PsychiatryOsaka University Graduate School of MedicineSuitaJapan
| | - Hidenaga Yamamori
- Department of Pathology of Mental DiseasesNational Institute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
- Department of PsychiatryOsaka University Graduate School of MedicineSuitaJapan
- Japan Community Health Care Organization Osaka HospitalOsakaJapan
| | | | - Kenichiro Miura
- Department of Pathology of Mental DiseasesNational Institute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
| | - Ryota Hashimoto
- Department of Pathology of Mental DiseasesNational Institute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
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Emsley R. Antipsychotics and structural brain changes: could treatment adherence explain the discrepant findings? Ther Adv Psychopharmacol 2023; 13:20451253231195258. [PMID: 37701891 PMCID: PMC10493054 DOI: 10.1177/20451253231195258] [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: 03/15/2023] [Accepted: 07/11/2023] [Indexed: 09/14/2023] Open
Abstract
Progressive structural brain changes are well documented in schizophrenia and have been linked to both illness progression and the extent of antipsychotic treatment exposure. Literature reporting longitudinal changes in brain structure in individuals with schizophrenia is selectively reviewed to assess the roles of illness, antipsychotic treatment, adherence and other factors in the genesis of these changes. This narrative review considers literature investigating longitudinal changes in brain structure in individuals with schizophrenia. The review focusses on structural changes in the cortex, basal ganglia and white matter. It also examines effects of medication non-adherence and relapse on the clinical course of the illness and on structural brain changes. Studies investigating structural magnetic resonance imaging changes in patients treated with long-acting injectable antipsychotics are reviewed. Temporal changes in brain structure in schizophrenia can be divided into those that are associated with antipsychotic treatment and those that are not. Changes associated with treatment include increases in basal ganglia and white matter volumes. Relapse episodes may be a critical factor in illness progression and brain volume reductions. Medication adherence may be an important factor that could explain the findings that brain volume reductions are associated with poor treatment response, higher intensity of antipsychotic treatment exposure and more time spent in relapse. Improved adherence via long-acting injectable antipsychotics and adherence focussed psychosocial interventions could maximize protective effects of antipsychotics against illness progression.
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Affiliation(s)
- Robin Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Tygerberg Campus, Cape Town 8000, South Africa
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Todd J, Salisbury D, Michie PT. Why mismatch negativity continues to hold potential in probing altered brain function in schizophrenia. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e144. [PMID: 38867817 PMCID: PMC11114358 DOI: 10.1002/pcn5.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 06/14/2024]
Abstract
The brain potential known as mismatch negativity (MMN) is one of the most studied indices of altered brain function in schizophrenia. This review looks at what has been learned about MMN in schizophrenia over the last three decades and why the level of interest and activity in this field of research remains strong. A diligent consideration of available evidence suggests that MMN can serve as a biomarker in schizophrenia, but perhaps not the kind of biomarker that early research supposed. This review concludes that MMN measurement is likely to be most useful as a monitoring and response biomarker enabling tracking of an underlying pathology and efficacy of interventions, respectively. The role of, and challenges presented by, pre-clinical models is discussed as well as the merits of different methodologies that can be brought to bear in pursuing a deeper understanding of pathophysiology that might explain smaller MMN in schizophrenia.
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Affiliation(s)
- Juanita Todd
- School of Psychological SciencesUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Dean Salisbury
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Patricia T. Michie
- School of Psychological SciencesUniversity of NewcastleNewcastleNew South WalesAustralia
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Chatterjee I, Chatterjee S. Investigating the symptomatic and morphological changes in the brain based on pre and post-treatment: A critical review from clinical to neuroimaging studies on schizophrenia. IBRO Neurosci Rep 2023. [DOI: 10.1016/j.ibneur.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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9
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Vita A, Fagiolini A, Maina G, Mencacci C, Spina E, Galderisi S. Achieving long-term goals through early personalized management of schizophrenia: expert opinion on the role of a new fast-onset long-acting injectable antipsychotic. Ann Gen Psychiatry 2023; 22:1. [PMID: 36650545 PMCID: PMC9843844 DOI: 10.1186/s12991-022-00430-1] [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: 11/29/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023] Open
Abstract
Definition of an appropriate and personalized treatment plan focused on long-term outcomes is crucial in the management of schizophrenia. Following review of the literature, a panel of six leading psychiatrists discussed the importance of clear and shared long-term goals when initiating antipsychotic treatment in light of their clinical experience. The importance of establishing shared and progressive treatment objectives was stressed, which should be tailored based on the patient's characteristics, goals, and preferences. Consensus emerged on the key role that therapeutic alliance and patient empowerment play throughout the course of treatment. Reduction in symptoms in the acute phase along with good efficacy and tolerability in the maintenance phase emerged as essential features of a therapy that can favor achievement of long-term outcomes. Long-acting injectable (LAI) antipsychotics enhance adherence to treatment compared to oral formulations and have been shown to be effective in the maintenance phase. Currently available LAIs are characterized by a delayed onset of action and require a loading dose or oral supplementation to achieve therapeutic concentrations. Risperidone ISM® is a novel LAI antipsychotic with fast and sustained release of antipsychotic, reaching therapeutic plasma levels within a few hours after administration without oral supplementation or loading doses. Risperidone ISM® has been shown to rapidly control symptoms in patients with an acute exacerbation of schizophrenia and to be effective and well tolerated as maintenance treatment irrespective of the severity of initial symptoms. It thus represents a valuable and novel therapeutic option in management of schizophrenia.
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Affiliation(s)
- Antonio Vita
- Department of Mental Health and Addiction Services, Spedali Civili of Brescia, University of Brescia, Brescia, Italy.
| | | | - Giuseppe Maina
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | | | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
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10
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Du Y, He X, Kochunov P, Pearlson G, Hong LE, van Erp TGM, Belger A, Calhoun VD. A new multimodality fusion classification approach to explore the uniqueness of schizophrenia and autism spectrum disorder. Hum Brain Mapp 2022; 43:3887-3903. [PMID: 35484969 PMCID: PMC9294304 DOI: 10.1002/hbm.25890] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/24/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Schizophrenia (SZ) and autism spectrum disorder (ASD) sharing overlapping symptoms have a long history of diagnostic confusion. It is unclear what their differences at a brain level are. Here, we propose a multimodality fusion classification approach to investigate their divergence in brain function and structure. Using brain functional network connectivity (FNC) calculated from resting-state fMRI data and gray matter volume (GMV) estimated from sMRI data, we classify the two disorders using the main data (335 SZ and 380 ASD patients) via an unbiased 10-fold cross-validation pipeline, and also validate the classification generalization ability on an independent cohort (120 SZ and 349 ASD patients). The classification accuracy reached up to 83.08% for the testing data and 72.10% for the independent data, significantly better than the results from using the single-modality features. The discriminative FNCs that were automatically selected primarily involved the sub-cortical, default mode, and visual domains. Interestingly, all discriminative FNCs relating to the default mode network showed an intermediate strength in healthy controls (HCs) between SZ and ASD patients. Their GMV differences were mainly driven by the frontal gyrus, temporal gyrus, and insula. Regarding these regions, the mean GMV of HC fell intermediate between that of SZ and ASD, and ASD showed the highest GMV. The middle frontal gyrus was associated with both functional and structural differences. In summary, our work reveals the unique neuroimaging characteristics of SZ and ASD that can achieve high and generalizable classification accuracy, supporting their potential as disorder-specific neural substrates of the two entwined disorders.
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Affiliation(s)
- Yuhui Du
- School of Computer and Information TechnologyShanxi UniversityTaiyuanShanxiChina
- Tri‐Institutional Center for Translational Research in Neuroimaging and Data ScienceGeorgia State University, Georgia Institute of Technology, Emory UniversityAtlantaGeorgiaUSA
| | - Xingyu He
- School of Computer and Information TechnologyShanxi UniversityTaiyuanShanxiChina
| | - Peter Kochunov
- Center for Brain Imaging ResearchUniversity of MarylandBaltimoreMarylandUSA
| | | | - L. Elliot Hong
- Center for Brain Imaging ResearchUniversity of MarylandBaltimoreMarylandUSA
| | - Theo G. M. van Erp
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCaliforniaUSA
- Center for the Neurobiology of Learning and MemoryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Aysenil Belger
- Department of PsychiatryUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Vince D. Calhoun
- Tri‐Institutional Center for Translational Research in Neuroimaging and Data ScienceGeorgia State University, Georgia Institute of Technology, Emory UniversityAtlantaGeorgiaUSA
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11
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de Bartolomeis A, Vellucci L, Barone A, Manchia M, De Luca V, Iasevoli F, Correll CU. Clozapine's multiple cellular mechanisms: What do we know after more than fifty years? A systematic review and critical assessment of translational mechanisms relevant for innovative strategies in treatment-resistant schizophrenia. Pharmacol Ther 2022; 236:108236. [PMID: 35764175 DOI: 10.1016/j.pharmthera.2022.108236] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 12/21/2022]
Abstract
Almost fifty years after its first introduction into clinical care, clozapine remains the only evidence-based pharmacological option for treatment-resistant schizophrenia (TRS), which affects approximately 30% of patients with schizophrenia. Despite the long-time experience with clozapine, the specific mechanism of action (MOA) responsible for its superior efficacy among antipsychotics is still elusive, both at the receptor and intracellular signaling level. This systematic review is aimed at critically assessing the role and specific relevance of clozapine's multimodal actions, dissecting those mechanisms that under a translational perspective could shed light on molecular targets worth to be considered for further innovative antipsychotic development. In vivo and in vitro preclinical findings, supported by innovative techniques and methods, together with pharmacogenomic and in vivo functional studies, point to multiple and possibly overlapping MOAs. To better explore this crucial issue, the specific affinity for 5-HT2R, D1R, α2c, and muscarinic receptors, the relatively low occupancy at dopamine D2R, the interaction with receptor dimers, as well as the potential confounder effects resulting in biased ligand action, and lastly, the role of the moiety responsible for lipophilic and alkaline features of clozapine are highlighted. Finally, the role of transcription and protein changes at the synaptic level, and the possibility that clozapine can directly impact synaptic architecture are addressed. Although clozapine's exact MOAs that contribute to its unique efficacy and some of its severe adverse effects have not been fully understood, relevant information can be gleaned from recent mechanistic understandings that may help design much needed additional therapeutic strategies for TRS.
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Affiliation(s)
- Andrea de Bartolomeis
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy.
| | - Licia Vellucci
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy
| | - Annarita Barone
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Felice Iasevoli
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
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12
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Chan SKW, Chan HYV, Liao Y, Suen YN, Hui CLM, Chang WC, Lee EHM, Chen EYH. Longitudinal relapse pattern of patients with first-episode schizophrenia-spectrum disorders and its predictors and outcomes: A 10-year follow-up study. Asian J Psychiatr 2022; 71:103087. [PMID: 35299139 DOI: 10.1016/j.ajp.2022.103087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/19/2021] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study explored the 10-year pattern of relapse of patients with first-episode schizophrenia-spectrum disorders (FES), predictors and outcomes of early and late relapse. METHODS Patients received EIS (N = 148) in Hong Kong between 1 July 2001 and 30 June 2002 were matched with those who entered standard care (N = 148) one year before. Relapse information over 10 years were obtained and 209 patients were interviewed at 10-year follow-up. Predictors of early relapse ([ER] relapse in initial three years) and late relapse group ([LR] relapse in year 4-10) and their differential outcomes were explored. RESULTS Fifty-six patients (26.8%) were relapse-free over 10 years with more EIS patients. Among the relapsed patients, 63.6% were ER patients who had the poorest longitudinal outcomes, including higher suicide attempts, violence episodes, more hospitalization and lower employment, whereas the LR patients do not differ much from the no relapse group. Relapse-free patients required less hospitalization in the first episode and lower antipsychotic dosage. The LR patients had less positive symptoms in year one but longer first-episode hospitalization and higher antipsychotic dosage. CONCLUSIONS Delaying the first relapse may help to improve the long-term outcomes. Good response to antipsychotic medications was associated with relapse-free over long-term. However, sufficient antipsychotic medications with good symptomatic control during the early stage of the illness is crucial for relapse prevention for other patients. These findings highlight illness heterogeneity and the importance in differential use of antipsychotics in relapse prevention.
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Affiliation(s)
- Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Hei Yan Veronica Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Yingqi Liao
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Yi Nam Suen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
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13
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Fountoulakis KN, Stahl SM. The effect of first- and second-generation antipsychotics on brain morphology in schizophrenia: A systematic review of longitudinal magnetic resonance studies with a randomized allocation to treatment arms. J Psychopharmacol 2022; 36:428-438. [PMID: 35395911 DOI: 10.1177/02698811221087645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Schizophrenia manifests as loss of brain volume in specific areas in a progressive nature and an important question concerns whether long-term treatment with medications contributes to this. The aim of the current PRISMA systematic review was to search for prospective studies involving randomization to treatment. PROSPERO ID: CRD42020197874. The MEDLINE/PUBMED was searched and it returned 2638 articles; 3 were fulfilling the inclusion criteria. A fourth was published later; they included 359 subjects, of whom 86 were healthy controls, while the rest were first-episode patients, with 91 under olanzapine, 93 under haloperidol, 48 under risperidone, 5 under paliperidone, 6 under ziprasidone, and 30 under placebo. Probably one-third of patients were suffering from a psychotic disorder other than schizophrenia. The consideration of their results suggested that there is no significant difference between these medications concerning their effects on brain structure and also in comparison to healthy subjects. There does not seem to be any strong support to the opinion that medications that treat psychosis cause loss of brain volume in patients with schizophrenia. On the contrary, the data might imply the possible presence of a protective effect for D2, 5-HT2, and NE alpha-2 antagonists (previously called SGAs). However, the literature is limited and focused research in large study samples is essential to clarify the issue, since important numerical differences do exist. The possibility of the results and their heterogeneity to be artifacts secondary to a modification of magnetic resonance imaging (MRI) signal by antipsychotics should not be easily rejected until relevant data are available.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stephen M Stahl
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,Department of Psychiatry, Cambridge University, Cambridge, UK
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14
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Krajner F, Hadaya L, McQueen G, Sendt KV, Gillespie A, Avila A, Lally J, Hedges EP, Diederen K, Howes OD, Barker GJ, Lythgoe DJ, Kempton MJ, McGuire P, MacCabe JH, Egerton A. Subcortical volume reduction and cortical thinning 3 months after switching to clozapine in treatment resistant schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:13. [PMID: 35236831 PMCID: PMC8891256 DOI: 10.1038/s41537-022-00230-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
The neurobiological effects of clozapine are under characterised. We examined the effects clozapine treatment on subcortical volume and cortical thickness and investigated whether macrostructural changes were linked to alterations in glutamate or N-acetylaspartate (NAA). Data were acquired in 24 patients with treatment-resistant schizophrenia before and 12 weeks after switching to clozapine. During clozapine treatment we observed reductions in caudate and putamen volume, lateral ventricle enlargement (P < 0.001), and reductions in thickness of the left inferior temporal cortex, left caudal middle frontal cortex, and the right temporal pole. Reductions in right caudate volume were associated with local reductions in NAA (P = 0.002). None of the morphometric changes were associated with changes in glutamate levels. These results indicate that clozapine treatment is associated with subcortical volume loss and cortical thinning and that at least some of these effects are linked to changes in neuronal or metabolic integrity.
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Affiliation(s)
- Fanni Krajner
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Laila Hadaya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Grant McQueen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Kyra-Verena Sendt
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Amy Gillespie
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Alessia Avila
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emily P Hedges
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Kelly Diederen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Gareth J Barker
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - David J Lythgoe
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - James H MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.
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15
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Ybarra ML, Rodriguez KM, Fehmie DA, Mojtabai R, Cullen B. Acceptability of Texting 4 Relapse Prevention, Text Messaging-Based Relapse Prevention Program for People With Schizophrenia and Schizoaffective Disorder. J Nerv Ment Dis 2022; 210:123-128. [PMID: 34570061 PMCID: PMC10069806 DOI: 10.1097/nmd.0000000000001421] [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: 11/26/2022]
Abstract
ABSTRACT We report process outcomes of the pilot randomized controlled trial of Texting 4 Relapse Prevention (T4RP), a text messaging-based relapse prevention program for people with schizophrenia or schizoaffective disorder (SAD). Forty people were randomized to either the intervention or treatment as usual control group at a 2:1 ratio. Process indicators were collected at 6 months post enrollment.Over 90% of patients agreed or strongly agreed that the text messages were easy to understand, easy to answer, positive, and helped them feel supported. Patient acceptability was positively associated with recovery (β = 0.29, p = <0.001) and patient-provider communication scores (β = 1.04, p < 0.001), and negatively associated with symptoms of the disorder (β = -0.27, p = 0.07). Acceptability was similar by diagnosis (β, SAD diagnosis = 0.40, p = 0.90) and age (β = 0.05, p = 0.67). Findings suggest that a text messaging intervention aimed at preventing relapse is feasible and perceived as beneficial in individuals with schizophrenia and SAD. Future research might include a targeted study of T4RP within the context of hospital discharge when people with schizophrenia/SAD are at highest risk of relapse.
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Affiliation(s)
- Michele L. Ybarra
- Center for Innovative Public Health Research, 555 N El Camino Real A347, San Clemente, CA 92672 USA
| | - Katrina M. Rodriguez
- Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21287 USA
| | - Desiree A. Fehmie
- Center for Innovative Public Health Research, 555 N El Camino Real A347, San Clemente, CA 92672 USA
| | - Ramin Mojtabai
- Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21287 USA
| | - Bernadette Cullen
- Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21287 USA
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins Medical Institutions, Baltimore, Maryland, 21287 USA
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16
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Kanahara N, Yamanaka H, Shiko Y, Kawasaki Y, Iyo M. The effects of cumulative antipsychotic dose on brain structures in patients with schizophrenia: Observational study of multiple CT scans over a long-term clinical course. Psychiatry Res Neuroimaging 2022; 319:111422. [PMID: 34856453 DOI: 10.1016/j.pscychresns.2021.111422] [Citation(s) in RCA: 2] [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: 05/31/2021] [Revised: 10/23/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
Multiple lines of evidence indicate that antipsychotic agents could affect brain structures of schizophrenia patients. However, the effect of antipsychotic dosage or type on brain structure is uncertain. The present study retrospectively analyzed brain computed tomography (CT) images from a psychiatric hospital to examine the relationship between cumulative dose of antipsychotics and brain volume reduction in schizophrenia patients. A total of 43 patients with repeated relapse episode of psychosis were included and CT scans that were performed an average of 3.2 times per patient during nearly 13 years of follow-up were analyzed. The results revealed significant positive relationships of expansion of cerebrospinal fluid space with cumulative dosage of all antipsychotics and that of typical antipsychotics. Patients treated with antipsychotics including typical antipsychotics exhibited a greater volume reduction compared to patients treated with only atypical antipsychotics. The present study was one of the longest longitudinal studies examining the effects of antipsychotics on brain volume in schizophrenia patients. These results suggest a relation between cumulative lifetime antipsychotic dosage and progressive brain volume reduction in patients with schizophrenia. However, the effects of specific agent on brain structure are still uncertain, and more detailed analysis is needed.
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Affiliation(s)
- Nobuhisa Kanahara
- Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, Chiba, Japan; Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Hiroshi Yamanaka
- Department of Psychiatry, Chiba Psychiatric Medical Center, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
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17
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Qi Y, Wei Y, Yu F, Lin Q, Yin J, Fu J, Xiong S, Lv D, Dai Z, Peng Q, Wang Y, Zhang D, Wang L, Ye X, Lin Z, Lin J, Ma G, Li K, Luo X. Association study of a genetic variant in the long intergenic noncoding RNA (linc01080) with schizophrenia in Han Chinese. BMC Psychiatry 2021; 21:613. [PMID: 34879837 PMCID: PMC8653569 DOI: 10.1186/s12888-021-03623-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 11/24/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Schizophrenia is currently considered to be a polygene-related disease with unknown etiology. This research will verify whether the single nucleotide polymorphism (SNP) of the long intergenic noncoding RNA01080 (linc01080) contributes to the susceptibility and phenotypic heterogeneity of schizophrenia, with a view to providing data support for the prevention and individualized treatment of this disease. METHOD The SNP rs7990916 in linc01080 were genotyped in 1139 schizophrenic and 1039 controls in a Southern Chinese Han population by the improved multiplex ligation detection reaction (imLDR) technique. Meanwhile, we assessed and analyzed the association between this SNP and schizophrenics' clinical symptoms, and the cognitive function. RESULT There was no significant difference in genotype distribution, allele frequency distribution, gender stratification analysis between the two groups. However, the SNP of rs7990916 was significantly associated with the age of onset in patients with schizophrenia (P = 8.22E-07), patients with T allele had earlier onset age compared with CC genotype carriers. In terms of cognitive function, patients with T allele scored lower than CC genotype carriers in the Tower of London score and symbol coding score in the Brief assessment of Cognition (BACS), and the difference was statistically significant (P = 0.014, P = 0.022, respectively). CONCLUSION Our data show for the first time that linc01080 polymorphism may affect the age of onset and neurocognitive function in patients with schizophrenia.
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Affiliation(s)
- Yi Qi
- grid.410560.60000 0004 1760 3078The Marine Biomedical Research Institute, Guangdong Medical University, Zhanjiang, 524023 China
| | - Yaxue Wei
- grid.410560.60000 0004 1760 3078Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001 China ,grid.410652.40000 0004 6003 7358Psychiatric and Psychological Clinical Rehabilitation Center, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021 China
| | - Fengyan Yu
- grid.410560.60000 0004 1760 3078The Second Clinical School, Guangdong Medical University, Dongguan, 523808 China
| | - Qianxing Lin
- grid.410560.60000 0004 1760 3078The Marine Biomedical Research Institute, Guangdong Medical University, Zhanjiang, 524023 China
| | - Jingwen Yin
- grid.410560.60000 0004 1760 3078Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001 China
| | - Jiawu Fu
- grid.410560.60000 0004 1760 3078Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001 China
| | - Susu Xiong
- grid.410560.60000 0004 1760 3078Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001 China
| | - Dong Lv
- grid.410560.60000 0004 1760 3078Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001 China
| | - Zhun Dai
- grid.410560.60000 0004 1760 3078Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001 China
| | - Qian Peng
- grid.410560.60000 0004 1760 3078Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001 China
| | - Ying Wang
- grid.410560.60000 0004 1760 3078Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001 China
| | - Dandan Zhang
- grid.410560.60000 0004 1760 3078Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001 China
| | - Lulu Wang
- grid.410560.60000 0004 1760 3078Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001 China
| | - Xiaoqing Ye
- grid.410560.60000 0004 1760 3078Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001 China
| | - Zhixiong Lin
- grid.410560.60000 0004 1760 3078Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001 China
| | - Juda Lin
- grid.410560.60000 0004 1760 3078Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001 China
| | - Guoda Ma
- grid.410560.60000 0004 1760 3078Maternal and Children’s Health Research Institute, Shunde Maternal and Children’s Hospital, Guangdong Medical University, Foshan, 528300 China
| | - Keshen Li
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China. .,Clinical Neuroscience Institute of Jinan University, Guangzhou, 510630, China.
| | - Xudong Luo
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China.
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18
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Jiang W, Rootes-Murdy K, Chen J, Bizzozero NIP, Calhoun VD, van Erp TGM, Ehrlich S, Agartz I, Jönsson EG, Andreassen OA, Wang L, Pearlson GD, Glahn DC, Hong E, Liu J, Turner JA. Multivariate alterations in insula - Medial prefrontal cortex linked to genetics in 12q24 in schizophrenia. Psychiatry Res 2021; 306:114237. [PMID: 34655926 PMCID: PMC8643340 DOI: 10.1016/j.psychres.2021.114237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022]
Abstract
The direct effect of genetic variations on clinical phenotypes within schizophrenia (SZ) remains elusive. We examined the previously identified association of reduced gray matter concentration in the insula - medial prefrontal cortex and a quantitative trait locus located in 12q24 in a SZ dataset. The main analysis was performed on 1461 SNPs and 830 participants. The highest contributing SNPs were localized in five genes including TMEM119, which encodes a microglial marker, that is associated with neuroinflammation and Alzheimer's disease. The gene set in 12q4 may partially explain brain alterations in SZ, but they may also relate to other psychiatric and developmental disorders.
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Affiliation(s)
- Wenhao Jiang
- Department of Psychology, Georgia State University, United States of America; Department of Psychosomatics and Psychiatry, Zhongda Hospital, Institute of Psychosomatics, Medical School, Southeast University, Nanjing, China
| | - Kelly Rootes-Murdy
- Department of Psychology, Georgia State University, United States of America
| | - Jiayu Chen
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology and Emory University, United States of America
| | | | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology and Emory University, United States of America
| | - Theo G M van Erp
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human Behavior, University of California Irvine, United States of America; Qureshey Research Laboratory, Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine, CA,United States of America
| | - Stefan Ehrlich
- Department of Psychiatry, Massachusetts General Hospital, United States of America; Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Germany
| | - Ingrid Agartz
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Erik G Jönsson
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway
| | - Lei Wang
- Psychiatry and Behavioral Health, Ohio State Wexner Medical Center, United States of America
| | | | - David C Glahn
- Boston Children's Hospital and Harvard Medical School, United States of America
| | - Elliot Hong
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, United States of America
| | - Jingyu Liu
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology and Emory University, United States of America
| | - Jessica A Turner
- Department of Psychology, Georgia State University, United States of America; Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology and Emory University, United States of America
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Cortical surface abnormalities are different depending on the stage of schizophrenia: A cross-sectional vertexwise mega-analysis of thickness, area and gyrification. Schizophr Res 2021; 236:104-114. [PMID: 34481405 DOI: 10.1016/j.schres.2021.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 05/28/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Brain magnetic resonance imaging studies have not investigated the cortical surface comprehensively in schizophrenia subjects by assessing thickness, surface area and gyrification separately during the first-episode of psychosis (FEP) or chronic schizophrenia (ChSch). METHODS We investigated cortical surface abnormalities in 137 FEP patients and 240 ChSch subjects compared to 297 Healthy Controls (HC) contributed by five cohorts. Maps showing results of vertexwise between-group comparisons of cortical thickness, area, and gyrification were produced using T1-weighted datasets processed using FreeSurfer 5.3, followed by validated quality control protocols. RESULTS FEP subjects showed large clusters of increased area and gyrification relative to HC in prefrontal and insuli cortices (Cohen's d: 0.049 to 0.28). These between-group differences occurred partially beyond the effect of sample. ChSch subjects displayed reduced cortical thickness relative to HC in smaller fronto-temporal foci (d: -0.73 to -0.35), but not beyond the effect of sample. Differences between FEP and HC subjects were associated with male gender, younger age, and earlier illness onset, while differences between ChSch and HC were associated with treatment-resistance and first-generation antipsychotic (FGA) intake independently of sample effect. CONCLUSIONS Separate assessments of FEP and ChSch revealed abnormalities that differed in regional distribution, phenotypes affected and effect size. In FEP, associations of greater cortical area and gyrification abnormalities with earlier age of onset suggest an origin on anomalous neurodevelopment, while thickness reductions in ChSch are at least partially explained by treatment-resistance and FGA intake. Associations of between-group differences with clinical variables retained statistical significance beyond the effect of sample.
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20
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Vandevelde A, Métivier L, Dollfus S. Impact cérébral structurel et fonctionnel de la Clozapine chez les patients souffrant de schizophrénie : revue systématique des études longitudinales en neuroimagerie. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:683-700. [PMID: 33131322 PMCID: PMC8329901 DOI: 10.1177/0706743720966459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIF L'objectif de cette revue est d'identifier les corrélats anatomo-fonctionnels cérébraux lors d'un traitement par clozapine (CLZ) ainsi que les marqueurs anatomo-fonctionnels prédictifs de la réponse à la CLZ. MÉTHODES Nous avons réalisé une revue systématique de la littérature avec les bases de données MEDLINE et Web of Science afin d'identifier et d'examiner toutes les études longitudinales en neuroimagerie investiguant l'impact cérébral de la CLZ. RÉSULTATS 30 études ont été incluses et analysées. La CLZ induit une diminution du volume et de la perfusion dans les noyaux gris centraux chez les patients répondeurs. Un plus grand volume de substance grise et perfusion dans ces structures avant l'instauration de la CLZ étaient associés à une meilleure réponse au traitement. La diminution de volume et de perfusion au niveau du cortex préfrontal (CPF) est observée malgré l'instauration de CLZ mais de façon moins importante chez les patients sous CLZ que chez les patients sous antipsychotiques typiques. Un plus grand volume au niveau du CPF avant l'instauration de la CLZ est associé à une meilleure réponse clinique dans la majorité des études. Enfin, la CLZ semble induire une réduction des altérations au niveau de la substance blanche. CONCLUSION Les corrélats anatomo-fonctionnels de la CLZ différent de ceux des autres antipsychotiques avec une action spécifique de la CLZ au niveau des ganglions de la base et du CPF pouvant participer à sa supériorité en termes de réponse clinique. Plusieurs données cliniques et d'imagerie conduisent à l'hypothèse d'un meilleur pronostic associé à une instauration plus rapide de la CLZ.
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Affiliation(s)
- Anaïs Vandevelde
- Normandie Univ, UNICAEN, ISTS, EA 7466, GIP 55388Cyceron, boulevard Henri-Becquerel, 14000 Caen, France.,26962Normandie Univ, UNICAEN, UFR de médecine (Medical School), 14000 Caen, France.,Anaïs Vandevelde et Lucie Métivier ont participé de la même façon à ce travail et sont co-premier auteurs
| | - Lucie Métivier
- 26962Normandie Univ, UNICAEN, UFR de médecine (Medical School), 14000 Caen, France.,CHU de Caen, centre Esquirol, service de psychiatrie, 14000 Caen, France.,Anaïs Vandevelde et Lucie Métivier ont participé de la même façon à ce travail et sont co-premier auteurs
| | - Sonia Dollfus
- Normandie Univ, UNICAEN, ISTS, EA 7466, GIP 55388Cyceron, boulevard Henri-Becquerel, 14000 Caen, France.,26962Normandie Univ, UNICAEN, UFR de médecine (Medical School), 14000 Caen, France.,CHU de Caen, centre Esquirol, service de psychiatrie, 14000 Caen, France
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21
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The progression of disorder-specific brain pattern expression in schizophrenia over 9 years. NPJ SCHIZOPHRENIA 2021; 7:32. [PMID: 34127678 PMCID: PMC8203625 DOI: 10.1038/s41537-021-00157-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022]
Abstract
Age plays a crucial role in the performance of schizophrenia vs. controls (SZ-HC) neuroimaging-based machine learning (ML) models as the accuracy of identifying first-episode psychosis from controls is poor compared to chronic patients. Resolving whether this finding reflects longitudinal progression in a disorder-specific brain pattern or a systematic but non-disorder-specific deviation from a normal brain aging (BA) trajectory in schizophrenia would help the clinical translation of diagnostic ML models. We trained two ML models on structural MRI data: an SZ-HC model based on 70 schizophrenia patients and 74 controls and a BA model (based on 561 healthy individuals, age range = 66 years). We then investigated the two models’ predictions in the naturalistic longitudinal Northern Finland Birth Cohort 1966 (NFBC1966) following 29 schizophrenia and 61 controls for nine years. The SZ-HC model’s schizophrenia-specificity was further assessed by utilizing independent validation (62 schizophrenia, 95 controls) and depression samples (203 depression, 203 controls). We found better performance at the NFBC1966 follow-up (sensitivity = 75.9%, specificity = 83.6%) compared to the baseline (sensitivity = 58.6%, specificity = 86.9%). This finding resulted from progression in disorder-specific pattern expression in schizophrenia and was not explained by concomitant acceleration of brain aging. The disorder-specific pattern’s progression reflected longitudinal changes in cognition, outcomes, and local brain changes, while BA captured treatment-related and global brain alterations. The SZ-HC model was also generalizable to independent schizophrenia validation samples but classified depression as control subjects. Our research underlines the importance of taking account of longitudinal progression in a disorder-specific pattern in schizophrenia when developing ML classifiers for different age groups.
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22
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Teeuw J, Ori APS, Brouwer RM, de Zwarte SMC, Schnack HG, Hulshoff Pol HE, Ophoff RA. Accelerated aging in the brain, epigenetic aging in blood, and polygenic risk for schizophrenia. Schizophr Res 2021; 231:189-197. [PMID: 33882370 DOI: 10.1016/j.schres.2021.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/02/2021] [Accepted: 04/07/2021] [Indexed: 02/07/2023]
Abstract
Schizophrenia patients show signs of accelerated aging in cognitive and physiological domains. Both schizophrenia and accelerated aging, as measured by MRI brain images and epigenetic clocks, are correlated with increased mortality. However, the association between these aging measures have not yet been studied in schizophrenia patients. In schizophrenia patients and healthy subjects, accelerated aging was assessed in brain tissue using a longitudinal MRI (N = 715 scans; mean scan interval 3.4 year) and in blood using two epigenetic age clocks (N = 172). Differences ('gaps') between estimated ages and chronological ages were calculated, as well as the acceleration rate of brain aging. The correlations between these aging measures as well as with polygenic risk scores for schizophrenia (PRS; N = 394) were investigated. Brain aging and epigenetic aging were not significantly correlated. Polygenic risk for schizophrenia was significantly correlated with brain age gap, brain age acceleration rate, and negatively correlated with DNAmAge gap, but not with PhenoAge gap. However, after controlling for disease status and multiple comparisons correction, these effects were no longer significant. Our results imply that the (accelerated) aging observed in the brain and blood reflect distinct biological processes. Our findings will require replication in a larger cohort.
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Affiliation(s)
- Jalmar Teeuw
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Anil P S Ori
- Center for Neurobehavioral Genetics, University of California, Los Angeles, United States
| | - Rachel M Brouwer
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sonja M C de Zwarte
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hugo G Schnack
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hilleke E Hulshoff Pol
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Roel A Ophoff
- Center for Neurobehavioral Genetics, University of California, Los Angeles, United States; Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
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23
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Lo WA, Ki‐Yan Mak D, Ming‐Cheuk Wong M, Chan O, Mo‐Ching Chui E, Wai‐Sau Chung D, Suk‐Han Ip G, Lau K, Lee C, Mui J, Tam K, Tse S, Wong K. Achieving better outcomes for schizophrenia patients in Hong Kong: Strategies for improving treatment adherence. CNS Neurosci Ther 2021; 27 Suppl 1:12-19. [PMID: 33555616 PMCID: PMC7869929 DOI: 10.1111/cns.13375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Recent research on second-generation long-acting injectable antipsychotics (LAI SGAs) has proven its effectiveness in minimizing medication nonadherence problem and reducing relapses. Administered by medical professionals, making quick detection of nonadherence possible, long-acting injectable antipsychotics (LAIs) facilitate immediate intervention and recovery process, and thus are favored by psychiatrists. Despite a higher initial cost with LAIs, the subsequent schizophrenia-related health costs for hospitalizations and outpatients are greatly reduced. With reference to guidelines published by psychiatric associations around the globe, this article looks at scenarios in Hong Kong on the management of severe mentally ill patients with regard to the use of a host of psychosocial interventions as well as LAI SGAs as a preferable treatment. In particular, it examines the benefits of using LAI SGAs for Hong Kong patients who demonstrated high nonadherence treatment rates due to their social environment. It assesses the rationale behind the early usages of LAI SGAs, which help to provide better recovery outcomes for patients.
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Affiliation(s)
| | | | | | - Oi‐Wah Chan
- New Territories East Cluster (NTEC)Hong KongChina
| | - Eileena Mo‐Ching Chui
- Department of Social Work and Social AdministrationThe University of Hong KongHong KongChina
| | | | | | - Ka‐Shing Lau
- Hong Kong Society of Professional TrainingHong KongChina
| | - Che‐Kin Lee
- Department of PsychiatryThe Chinese University of Hong KongHong KongChina
| | - Jolene Mui
- Department of PsychiatryCastle Peak HospitalHong KongChina
| | | | - Samson Tse
- Department of Social Work and Social AdministrationThe University of Hong KongHong KongChina
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24
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Kong LY, Huang YY, Lei BY, Ke PF, Li HH, Zhou J, Xiong DS, Li GX, Chen J, Li XB, Xiang ZM, Ning YP, Wu FC, Wu K. Divergent Alterations of Structural-Functional Connectivity Couplings in First-episode and Chronic Schizophrenia Patients. Neuroscience 2021; 460:1-12. [PMID: 33588002 DOI: 10.1016/j.neuroscience.2021.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
Emerging evidence suggests that the coupling relating the structural connectivity (SC) of the brain to its functional connectivity (FC) exhibits remarkable changes during development, normal aging, and diseases. Although altered structural-functional connectivity couplings (SC-FC couplings) have been previously reported in schizophrenia patients, the alterations in SC-FC couplings of different illness stages of schizophrenia (SZ) remain largely unknown. In this study, we collected structural and resting-state functional MRI data from 73 normal controls (NCs), 61 first-episode (FeSZ) and 78 chronic (CSZ) schizophrenia patients. Positive and negative syndrome scale (PANSS) scores were assessed for all patients. Structural and functional brain networks were constructed using gray matter volume (GMV) and resting-state magnetic resonance imaging (rs-fMRI) time series measurements. At the connectivity level, the CSZ patients showed significantly increased SC-FC coupling strength compared with the FeSZ patients. At the node strength level, significant decreased SC-FC coupling strength was observed in the FeSZ patients compared to that of the NCs, and the coupling strength was positively correlated with negative PANSS scores. These results demonstrated divergent alterations of SC-FC couplings in FeSZ and CSZ patients. Our findings provide new insight into the neuropathological mechanisms underlying the developmental course of SZ.
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Affiliation(s)
- Ling-Yin Kong
- Department of Biomedical Engineering, School of Material Science and Engineering, South China University of Technology, Guangzhou 510006, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China; National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China
| | - Yuan-Yuan Huang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China
| | - Bing-Ye Lei
- Department of Biomedical Engineering, School of Material Science and Engineering, South China University of Technology, Guangzhou 510006, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China; National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China
| | - Peng-Fei Ke
- Department of Biomedical Engineering, School of Material Science and Engineering, South China University of Technology, Guangzhou 510006, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China; National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China
| | - He-Hua Li
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China
| | - Jing Zhou
- Department of Biomedical Engineering, School of Material Science and Engineering, South China University of Technology, Guangzhou 510006, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China; National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China
| | - Dong-Sheng Xiong
- Department of Biomedical Engineering, School of Material Science and Engineering, South China University of Technology, Guangzhou 510006, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China; National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China
| | - Gui-Xiang Li
- Guangdong Engineering Technology Research Center for Diagnosis and Rehabilitation of Dementia, Guangzhou 510500, China; National Engineering Research Center for Healthcare Devices, Guangzhou 510500, China
| | - Jun Chen
- Guangdong Engineering Technology Research Center for Diagnosis and Rehabilitation of Dementia, Guangzhou 510500, China; National Engineering Research Center for Healthcare Devices, Guangzhou 510500, China
| | - Xiao-Bo Li
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Zhi-Ming Xiang
- Guangdong Engineering Technology Research Center for Diagnosis and Rehabilitation of Dementia, Guangzhou 510500, China; Department of Radiology, Panyu Central Hospital of Guangzhou, Guangzhou 511400, China
| | - Yu-Ping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China
| | - Feng-Chun Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China.
| | - Kai Wu
- Department of Biomedical Engineering, School of Material Science and Engineering, South China University of Technology, Guangzhou 510006, China; The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China; Guangdong Engineering Technology Research Center for Diagnosis and Rehabilitation of Dementia, Guangzhou 510500, China; National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, China; National Engineering Research Center for Healthcare Devices, Guangzhou 510500, China; Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan.
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25
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Ma CF, Chan SKW, Chung YL, Ng SM, Hui CLM, Suen YN, Chen EYH. The predictive power of expressed emotion and its components in relapse of schizophrenia: a meta-analysis and meta-regression. Psychol Med 2021; 51:365-375. [PMID: 33568244 DOI: 10.1017/s0033291721000209] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Schizophrenia is a longstanding condition and most patients experience multiple relapse in the course of the condition. High expressed emotion (HEE) has been found to be a predictor of relapse. This meta-analysis and meta-regression examined the association of global EE and relapse specifically focusing on timing of relapse and EE domains. METHODS Random-effects model was used to pool the effect estimates. Multiple random-effects meta-regression was used to compute the moderator analysis. Putative effect moderators including culture, EE measurements, age, length of condition and study quality were included. RESULTS Thirty-three prospective cohort studies comprising 2284 patients were included in the descriptive review and 30 studies were included for meta-analysis and meta-regression. Findings revealed that global HEE significantly predicted more on early relapse (⩽12 months) [OR 4.87 (95% CI 3.22-7.36)] than that on late relapse (>12 months) [OR 2.13 (95% CI 1.36-3.35)]. Higher level of critical comments (CC) significantly predicted relapse [OR 2.22 (95% CI 1.16-4.26)], whereas higher level of warmth significantly protected patients from relapse [OR 0.35 (95% CI 0.15-0.85)]. None of the moderators included significantly change the results. CONCLUSIONS These findings indicate that there is a dynamic interaction between EE-relapse association with time, and CC and warmth are the two important EE domains to influence relapse among patients with schizophrenia. Results also confirmed the foci of family interventions on reducing CC and improving warmth in relationship.
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Affiliation(s)
- Chak Fai Ma
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong SAR
| | - Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR
| | - Yik Ling Chung
- Department of Psychiatry, Kowloon Hospital, Hong Kong SAR
| | - Siu Man Ng
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Yi Nam Suen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR
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26
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Akudjedu TN, Tronchin G, McInerney S, Scanlon C, Kenney JPM, McFarland J, Barker GJ, McCarthy P, Cannon DM, McDonald C, Hallahan B. Progression of neuroanatomical abnormalities after first-episode of psychosis: A 3-year longitudinal sMRI study. J Psychiatr Res 2020; 130:137-151. [PMID: 32818662 DOI: 10.1016/j.jpsychires.2020.07.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/09/2020] [Accepted: 07/22/2020] [Indexed: 02/08/2023]
Abstract
The location, extent and progression of longitudinal morphometric changes after first-episode of psychosis (FEP) remains unclear. We investigated ventricular and cortico-subcortical regions over a 3-year period in FEP patients compared with healthy controls. High resolution 1.5T T1-weighted MR images were obtained at baseline from 28 FEP patients at presentation and 28 controls, and again after 3-years. The longitudinal FreeSurfer pipeline (v.5.3.0) was used for regional volumetric and cortical reconstruction image analyses. Repeated-measures ANCOVA and vertex-wise linear regression analyses compared progressive changes between groups in subcortical structures and cortical thickness respectively. Compared with controls, patients displayed progressively reduced volume of the caudate [F (1,51)=5.86, p=0.02, Hedges' g=0.66], putamen [F (1,51)=6.06, p=0.02, g=0.67], thalamus [F (1,51)=6.99, p=0.01, g=0.72] and increased right lateral ventricular volume [F (1, 51)=4.03, p=0.05], and significantly increased rate of cortical thinning [F (1,52)=5.11, p=0.028)] at a mean difference of 0.84% [95% CI (0.10, 1.59)] in the left lateral orbitofrontal region over the 3-year period. In patients, greater reduction in putamen volume over time was associated with lower cumulative antipsychotic medication dose (r=0.49, p=0.01), and increasing lateral ventricular volume over time was associated with worsening negative symptoms (r=0.41, p=0.04) and poorer global functioning (r= -0.41, p=0.04). This study demonstrates localised progressive structural abnormalities in the cortico-striato-thalamo-cortical circuit after the onset of psychosis, with increasing ventricular volume noted as a neuroanatomical marker of poorer clinical and functional outcome.
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Affiliation(s)
- Theophilus N Akudjedu
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33, Galway, Ireland; Institute of Medical Imaging & Visualisation, Department of Medical Science and Public Health, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK.
| | - Giulia Tronchin
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33, Galway, Ireland
| | - Shane McInerney
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33, Galway, Ireland; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Canada
| | - Cathy Scanlon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33, Galway, Ireland
| | - Joanne P M Kenney
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - John McFarland
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33, Galway, Ireland
| | - Gareth J Barker
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, UK
| | - Peter McCarthy
- Department of Radiology, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33, Galway, Ireland
| | - Dara M Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33, Galway, Ireland
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33, Galway, Ireland
| | - Brian Hallahan
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33, Galway, Ireland
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27
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Hori H, Atake K, Katsuki A, Yoshimura R. Effects of the number of hospitalizations on cognitive function in Japanese patients with stable schizophrenia. CNS Spectr 2020; 26:1-6. [PMID: 32883397 DOI: 10.1017/s1092852920001728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The present study aimed to determine whether the number of hospitalizations in schizophrenia patients is associated with reduced cognitive performance, which may in turn imply that recurrences indirectly lead to a worsening in the disorder's progression. METHODS Cognitive performance in stable schizophrenia patients was assessed using the Brief Assessment of Cognition in Schizophrenia, Japanese-language version, on 30 patients who had not experienced any hospitalizations (G0), 57 patients who had experienced only one hospitalization (G1), 47 patients with two hospitalizations (G2), and 59 patients with three or more hospitalizations (G3). RESULTS Significant differences in motor function and attention and processing speed were found between patients with G0 and those with G1. Significant differences in working memory and verbal fluency were found between patients with G1 and those with G2. Patients with G3 performed even more poorly in comparison with those with G1, showing deficits in verbal memory, working memory, executive function, and composite score. The patients with G3 displayed a greater range of impairment and demonstrated deficits in executive function compared with patients with G2. Finally, G2 and G3 performed more poorly than G0, with deficits in the various cognitive areas. CONCLUSION The number of hospitalizations predicted cognitive performance, which suggests that relapse or recurrence may have a long-term neuropsychological impact. Prospective follow-up studies must be completed to explore this effect further because better treatment adherence may have a protective effect on neurocognitive function.
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Affiliation(s)
- Hikaru Hori
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Kiyokazu Atake
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Asuka Katsuki
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Reiji Yoshimura
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
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Rodrigues-Amorim D, Rivera-Baltanás T, Del Carmen Vallejo-Curto M, Rodriguez-Jamardo C, de Las Heras E, Barreiro-Villar C, Blanco-Formoso M, Fernández-Palleiro P, Álvarez-Ariza M, López M, García-Caballero A, Olivares JM, Spuch C. Plasma β-III tubulin, neurofilament light chain and glial fibrillary acidic protein are associated with neurodegeneration and progression in schizophrenia. Sci Rep 2020; 10:14271. [PMID: 32868793 PMCID: PMC7459108 DOI: 10.1038/s41598-020-71060-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 08/10/2020] [Indexed: 12/29/2022] Open
Abstract
Schizophrenia is a progressive disorder characterized by multiple psychotic relapses. After every relapse, patients may not fully recover, and this may lead to a progressive loss of functionality. Pharmacological treatment represents a key factor to minimize the biological, psychological and psychosocial impact of the disorder. The number of relapses and the duration of psychotic episodes induce a potential neuronal damage and subsequently, neurodegenerative processes. Thus, a comparative study was performed, including forty healthy controls and forty-two SZ patients divided into first-episode psychosis (FEP) and chronic SZ (CSZ) subgroups, where the CSZ sub group was subdivided by antipsychotic treatment. In order to measure the potential neuronal damage, plasma levels of β-III tubulin, neurofilament light chain (Nf-L), and glial fibrillary acidic protein (GFAP) were performed. The results revealed that the levels of these proteins were increased in the SZ group compared to the control group (P < 0.05). Moreover, multiple comparison analysis showed highly significant levels of β-III tubulin (P = 0.0002), Nf-L (P = 0.0403) and GFAP (P < 0.015) in the subgroup of CSZ clozapine-treated. In conclusion, β-III tubulin, Nf-L and GFAP proteins may be potential biomarkers of neurodegeneration and progression in SZ.
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Affiliation(s)
- Daniela Rodrigues-Amorim
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute, University of Vigo, CIBERSAM, Vigo, Spain
| | - Tania Rivera-Baltanás
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute, University of Vigo, CIBERSAM, Vigo, Spain
| | - María Del Carmen Vallejo-Curto
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute, University of Vigo, CIBERSAM, Vigo, Spain
| | - Cynthia Rodriguez-Jamardo
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute, University of Vigo, CIBERSAM, Vigo, Spain
| | - Elena de Las Heras
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute, University of Vigo, CIBERSAM, Vigo, Spain
| | - Carolina Barreiro-Villar
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute, University of Vigo, CIBERSAM, Vigo, Spain
| | - María Blanco-Formoso
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute, University of Vigo, CIBERSAM, Vigo, Spain
| | - Patricia Fernández-Palleiro
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute, University of Vigo, CIBERSAM, Vigo, Spain
| | - María Álvarez-Ariza
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute, University of Vigo, CIBERSAM, Vigo, Spain
| | - Marta López
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute, University of Vigo, CIBERSAM, Vigo, Spain
| | | | - José Manuel Olivares
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute, University of Vigo, CIBERSAM, Vigo, Spain.
- Hospital Álvaro Cunqueiro, Bloque Técnico, Galicia Sur Health Research Institute - IISGS, Planta 2, Sala de Investigación, Estrada Clara Campoamor, 341, 36212, Vigo, Spain.
| | - Carlos Spuch
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute, University of Vigo, CIBERSAM, Vigo, Spain.
- Hospital Álvaro Cunqueiro, Bloque Técnico, Galicia Sur Health Research Institute - IISGS, Planta 2, Sala de Investigación, Estrada Clara Campoamor, 341, 36212, Vigo, Spain.
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Luo C, Lencer R, Hu N, Xiao Y, Zhang W, Li S, Lui S, Gong Q. Characteristics of White Matter Structural Networks in Chronic Schizophrenia Treated With Clozapine or Risperidone and Those Never Treated. Int J Neuropsychopharmacol 2020; 23:799-810. [PMID: 32808036 PMCID: PMC7770521 DOI: 10.1093/ijnp/pyaa061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/24/2020] [Accepted: 08/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Despite its benefits, a major concern regarding antipsychotic treatment is its possible impact on the brain's structure and function. This study sought to explore the characteristics of white matter structural networks in chronic never-treated schizophrenia and those treated with clozapine or risperidone, and its potential association with cognitive function. METHODS Diffusion tensor imaging was performed on a unique sample of 34 schizophrenia patients treated with antipsychotic monotherapy for over 5 years (17 treated with clozapine and 17 treated with risperidone), 17 never-treated schizophrenia patients with illness duration over 5 years, and 27 healthy control participants. Graph theory and network-based statistic approaches were employed. RESULTS We observed a disrupted organization of white matter structural networks as well as decreased nodal and connectivity characteristics across the schizophrenia groups, mainly involving thalamus, prefrontal, and occipital regions. Alterations in nodal and connectivity characteristics were relatively milder in risperidone-treated patients than clozapine-treated patients and never-treated patients. Altered global network measures were significantly associated with cognitive performance levels. Structural connectivity as reflected by network-based statistic mediated the difference in cognitive performance levels between clozapine-treated and risperidone-treated patients. LIMITATIONS These results are constrained by the lack of random assignment to different types of antipsychotic treatment. CONCLUSION These findings provide insight into the white matter structural network deficits in patients with chronic schizophrenia, either being treated or untreated, and suggest white matter structural networks supporting cognitive function may benefit from antipsychotic treatment, especially in those treated with risperidone.
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Affiliation(s)
- Chunyan Luo
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Na Hu
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Yuan Xiao
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Wenjing Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Siyi Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Su Lui
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China,Correspondence: Dr Su Lui, MD, Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Chengdu 610041, China ()
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
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30
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Chwa WJ, Tishler TA, Raymond C, Tran C, Anwar F, Villablanca JP, Ventura J, Subotnik KL, Nuechterlein KH, Ellingson BM. Association between cortical volume and gray-white matter contrast with second generation antipsychotic medication exposure in first episode male schizophrenia patients. Schizophr Res 2020; 222:397-410. [PMID: 32487466 PMCID: PMC7572538 DOI: 10.1016/j.schres.2020.03.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/06/2020] [Accepted: 03/31/2020] [Indexed: 01/19/2023]
Abstract
This cross-sectional study examines the differences in cortical volume and gray-to-white matter contrast (GWC) in first episode schizophrenia patients (SCZ) compared to healthy control participants (HC) and in SCZ patients as a function of exposure to second generation antipsychotic medication. We hypothesize 1) SCZ exhibit regionally lower cortical volumes relative to HCs, 2) cortical volume will be greater with longer exposure to second generation antipsychotics prior to the MRI scan, and 3) lower GWC with longer exposure to second generation antipsychotics prior to the MRI scan, suggesting more blurring from greater intracortical myelin. To accomplish this, MRI scans from 71 male SCZ patients treated with second generation oral risperidone and 42 male HCs were examined. 3D T1-weighted MPRAGE images collected at 1.5T were used to estimate cortical volume and GWC by sampling signal intensity at 30% within the cortical ribbon. Average cortical volume and GWC were calculated and compared between SCZ and HC. Cortical volume and GWC in SCZ patients were correlated with duration of medication exposure for the time period prior to the scan. First-episode SCZ patients had significantly lower cortical volume compared to HCs in bilateral temporal, superior and rostral frontal, postcentral gyral, and parahippocampal regions. In SCZ patients, greater cortical volume was associated with (log-transformed) duration of second-generation antipsychotic medication exposure in bilateral precuneus, right lingual, and right superior parietal regions. Lower GWC was correlated with longer duration of medication exposure bilaterally in the superior frontal lobes. In summary, second generation antipsychotics may increase cortical volume and decrease GWC in first episode SCZ patients.
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Affiliation(s)
- Won Jong Chwa
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Todd A. Tishler
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Catalina Raymond
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Cathy Tran
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Faizan Anwar
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - J. Pablo Villablanca
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Kenneth L. Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | - Benjamin M. Ellingson
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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31
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Tronchin G, Akudjedu TN, Ahmed M, Holleran L, Hallahan B, Cannon DM, McDonald C. Progressive subcortical volume loss in treatment-resistant schizophrenia patients after commencing clozapine treatment. Neuropsychopharmacology 2020; 45:1353-1361. [PMID: 32268345 PMCID: PMC7298040 DOI: 10.1038/s41386-020-0665-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023]
Abstract
The association of antipsychotic medication with abnormal brain morphometry in schizophrenia remains uncertain. This study investigated subcortical morphometric changes 6 months after switching treatment to clozapine in patients with treatment-resistant schizophrenia compared with healthy volunteers, and the relationships between longitudinal volume changes and clinical variables. In total, 1.5T MRI images were acquired at baseline before commencing clozapine and again after 6 months of treatment for 33 patients with treatment-resistant schizophrenia and 31 controls, and processed using the longitudinal pipeline of Freesurfer v.5.3.0. Two-way repeated MANCOVA was used to assess group differences in subcortical volumes over time and partial correlations to determine association with clinical variables. Whereas no significant subcortical volume differences were found between patients and controls at baseline (F(8,52) = 1.79; p = 0.101), there was a significant interaction between time, group and structure (F(7,143) = 52.54; p < 0.001). Corrected post-hoc analyses demonstrated that patients had significant enlargement of lateral ventricles (F(1,59) = 48.89; p < 0.001) and reduction of thalamus (F(1,59) = 34.85; p < 0.001), caudate (F(1,59) = 59.35; p < 0.001), putamen (F(1,59) = 87.20; p < 0.001) and hippocampus (F(1,59) = 14.49; p < 0.001) volumes. Thalamus and putamen volume reduction was associated with improvement in PANSS (r = 0.42; p = 0.021, r = 0.39; p = 0.033), SANS (r = 0.36; p = 0.049, r = 0.40; p = 0.027) and GAF (r = -0.39; p = 0.038, r = -0.42; p = 0.024) scores. Reduced thalamic volume over time was associated with increased serum clozapine level at follow-up (r = -0.44; p = 0.010). Patients with treatment-resistant schizophrenia display progressive subcortical volume deficits after switching to clozapine despite experiencing symptomatic improvement. Thalamo-striatal progressive volumetric deficit associated with symptomatic improvement after clozapine exposure may reflect an adaptive response related to improved outcome rather than a harmful process.
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Affiliation(s)
- Giulia Tronchin
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland.
| | - Theophilus N Akudjedu
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
- Institute of Medical Imaging & Visualisation, Faculty of Health & Social Science, Department of Medical Science & Public Science, Bournemouth University, Bournemouth, UK
| | - Mohamed Ahmed
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Laurena Holleran
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Brian Hallahan
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Dara M Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
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32
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Fountoulakis KN, Moeller HJ, Kasper S, Tamminga C, Yamawaki S, Kahn R, Tandon R, Correll CU, Javed A. The report of the joint WPA/CINP workgroup on the use and usefulness of antipsychotic medication in the treatment of schizophrenia. CNS Spectr 2020; 26:1-25. [PMID: 32594935 DOI: 10.1017/s1092852920001546] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This is a report of a joint World Psychiatric Association/International College of Neuropsychopharmacology (WPA/CINP) workgroup concerning the risk/benefit ratio of antipsychotics in the treatment of schizophrenia. It utilized a selective but, within topic, comprehensive review of the literature, taking into consideration all the recently discussed arguments on the matter and avoiding taking sides when the results in the literature were equivocal. The workgroup's conclusions suggested that antipsychotics are efficacious both during the acute and the maintenance phase, and that the current data do not support the existence of a supersensitivity rebound psychosis. Long-term treated patients have better overall outcome and lower mortality than those not taking antipsychotics. Longer duration of untreated psychosis and relapses are modestly related to worse outcome. Loss of brain volume is evident already at first episode and concerns loss of neuropil volume rather than cell loss. Progression of volume loss probably happens in a subgroup of patients with worse prognosis. In humans, antipsychotic treatment neither causes nor worsens volume loss, while there are some data in favor for a protective effect. Schizophrenia manifests 2 to 3 times higher mortality vs the general population, and treatment with antipsychotics includes a number of dangers, including tardive dyskinesia and metabolic syndrome; however, antipsychotic treatment is related to lower mortality, including cardiovascular mortality. In conclusion, the literature strongly supports the use of antipsychotics both during the acute and the maintenance phase without suggesting that it is wise to discontinue antipsychotics after a certain period of time. Antipsychotic treatment improves long-term outcomes and lowers overall and specific-cause mortality.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Hans-Jurgen Moeller
- Department of Psychiatry, Ludwig Maximilian University of Munich, Munich, Germany
| | - Siegfried Kasper
- Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Vienna, Austria
| | - Carol Tamminga
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Shigeto Yamawaki
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Hiroshima, Japan
| | - Rene Kahn
- Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rajiv Tandon
- Department of Psychiatry, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Christoph U Correll
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Afzal Javed
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
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33
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Duan L, Zhu G. Mapping Theme Trends and Knowledge Structure of Magnetic Resonance Imaging Studies of Schizophrenia: A Bibliometric Analysis From 2004 to 2018. Front Psychiatry 2020; 11:27. [PMID: 32116844 PMCID: PMC7019376 DOI: 10.3389/fpsyt.2020.00027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recently, magnetic resonance imaging (MRI) technology has been widely used to quantitatively analyze brain structure, morphology, and functional activities, as well as to clarify the neuropathological and neurobiological mechanisms of schizophrenia. However, although there have been many relevant results and conclusions, there has been no systematic assessment of this field. AIM To analyze important areas of research utilizing MRI in studies of schizophrenia and explore major trends and the knowledge structure using bibliometric analysis. METHODS Literature related to MRI studies of schizophrenia published in PubMed between January 1, 2004 and December 31, 2018 were retrieved in 5-year increments. The extracted major Medical Subject Headings (MeSH) terms/MeSH subheadings were analyzed quantitatively. Bi-clu-stering analysis, social network analysis (SNA), and strategic diagrams were employed to analyze the word matrix and co-occurrence matrix of high-frequency MeSH terms. RESULTS For the periods of 2004 to 2008, 2009 to 2013, and 2014 to 2018, the number of relevant retrieved publications were 916, 1,344, and 1,512 respectively, showing an overall growth trend. 26, 34, and 36 high-frequency major MeSH terms/MeSH subheadings were extracted in each period, respectively. In line with strategic diagrams, the main undeveloped theme clusters in 2004-2008 were effects of antipsychotics on brain structure and their curative efficacy. These themes were replaced in 2009-2013 by physiopathology mechanisms of schizophrenia, etiology of cognitive disorder, research on default mode network and schizophrenic psychology, and were partially replaced in 2014-2018 by studies of differences in the neurobiological basis for schizophrenia and other mental disorders. Based on SNA, nerve net/physiopathology and psychotic disorder/pathology were considered the emerging hotspots of research in 2009-2013 and 2014-2018. CONCLUSIONS MRI studies on schizophrenia were relatively diverse, but the theme clusters derived from each period may reflect the publication trends to some extent. Bibliometric research over a 15-year period may be helpful in depicting the overall scope of research interest and may generate novel ideas for researchers initiating new projects.
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Affiliation(s)
- Li Duan
- Department of Psychiatry, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Gang Zhu
- Department of Psychiatry, the First Affiliated Hospital of China Medical University, Shenyang, China
- Central Laboratory, the First Affiliated Hospital of China Medical University, Shenyang, China
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34
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Nakamura R, Asami T, Yoshimi A, Kato D, Fujita E, Takaishi M, Yoshida H, Yamaguchi H, Shiozaki K, Kase A, Hirayasu Y. Clinical and brain structural effects of the Illness Management and Recovery program in middle-aged and older patients with schizophrenia. Psychiatry Clin Neurosci 2019; 73:731-737. [PMID: 31353759 DOI: 10.1111/pcn.12919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 01/11/2023]
Abstract
AIMS In this study, we implemented the Illness Management and Recovery (IMR) program for middle-aged and older patients with schizophrenia hospitalized for long periods and assessed the effect of the IMR program on psychiatric symptoms and psychosocial function. The effects of the IMR program on brain structure were also evaluated. METHODS The IMR program was implemented for 19 patients with schizophrenia; 17 patients with schizophrenia receiving treatment as usual (TAU) were also recruited as controls. In all patients, mean age was 61.4 years (range, 50-77 years) and mean hospitalization duration was 13.1 years (range, 1-31 years) at enrollment. Structural magnetic resonance images and Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scores as clinical variables were obtained at the beginning and end of the IMR program. Longitudinal analyses were performed to compare the effects of the IMR program on clinical symptoms and cortical thickness in the superior temporal gyrus (STG) between the IMR and TAU groups. RESULTS Significant improvements in GAF scores and the total, Insight and Judgment, and Positive components of the PANSS were found in the IMR group compared with the TAU group. Cortical thickness in the left STG was preserved in the IMR group compared with the TAU group. CONCLUSIONS This is the first report demonstrating the effectiveness of the IMR program for improving psychotic symptoms and psychosocial function and protecting brain structure in middle-aged and older inpatients with schizophrenia hospitalized for long periods.
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Affiliation(s)
- Ryota Nakamura
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.,Department of Psychiatry, Yokohama Maioka Hospital, Yokohama, Japan
| | - Takeshi Asami
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Asuka Yoshimi
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.,Department of Psychiatry, Yokohama Maioka Hospital, Yokohama, Japan
| | - Daiji Kato
- Totsuka Nishiguchi Rindou Clinic, Yokohama, Japan
| | - Emi Fujita
- Division of Clinical Psychology, Yokohama City University Hospital, Yokohama, Japan
| | - Masao Takaishi
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Haruhisa Yoshida
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Yamaguchi
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kazumasa Shiozaki
- Department of Psychiatry, Yokohama Comprehensive Care Continuum, Yokohama, Japan
| | - Akihiko Kase
- Department of Psychiatry, Yokohama Maioka Hospital, Yokohama, Japan
| | - Yoshio Hirayasu
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.,Department of Psychiatry, Hirayasu Hospital, Urasoe, Japan
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35
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Developing Texting for Relapse Prevention: A Scalable mHealth Program for People With Schizophrenia and Schizoaffective Disorder. J Nerv Ment Dis 2019; 207:854-862. [PMID: 31503175 PMCID: PMC7189625 DOI: 10.1097/nmd.0000000000001037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Symptom relapse in people with schizophrenia and schizoaffective disorder is common and has a negative impact on the course of illness. Here, we describe the development of Texting for Relapse Prevention, a scalable, cost-effective text messaging relapse prevention program that queries patients' "early warning signs" daily. Results of development focus groups and content advisory teams with 25 patients and 19 providers suggest that patients were enthusiastic about the program and thought that receiving daily messages about their symptoms would help them feel supported. Providers also were positive about the idea but worried that the program might interfere with patient-provider communication if patients thought that the messages were coming from providers. Patients found the content positive and actionable. The program was improved to address this feedback. This iterative development process that included multiple stakeholders ensured that the program is feasible and acceptable to both patients and providers.
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36
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Striatum-related functional activation during reward- versus punishment-based learning in psychosis risk. Neuropsychopharmacology 2019; 44:1967-1974. [PMID: 31272104 PMCID: PMC6784983 DOI: 10.1038/s41386-019-0455-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 01/10/2023]
Abstract
Psychosis is strongly related to increased striatal dopamine. However, the neural consequences of increased striatal dopamine in psychosis risk are still not fully understood. Consistent with an increase in striatal dopamine, in previous research, psychosis risk has been associated with neural EEG evidence of a greater response to unexpected reward than unexpected punishment feedback on a reversal-learning task. However, previous research has not directly examined whether psychosis risk is associated with altered striatal activation when receiving unexpected feedback on this task. There were two groups of participants: an antipsychotic medication-naive psychosis risk group (n = 21) who had both (a) extreme levels of self-reported psychotic-like beliefs and experiences and (b) interview-rated current-attenuated psychotic symptoms; and a comparison group (n = 20) who had average levels of self-reported psychotic-like beliefs and experiences. Participants completed a reversal-leaning task during fMRI scanning. As expected, in both ROI and whole-brain analyses, the psychosis risk group exhibited greater striatal activation (for whole-brain analyses, the peak was located in the right caudate) to unexpected reward than unexpected punishment feedback relative to the comparison group. These results indicate that psychosis risk is associated with a relatively increased neural sensitivity to unexpected reward than unexpected punishment outcomes and appears consistent with increased striatal dopamine. The results may help us better understand and detect striatal dysfunction in psychosis risk.
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Li N, Zhuo JM, Turkoz I, Mathews M, Feng Y, Tan W. A post hoc analysis on hospitalization risk in Asian patients with schizophrenia switching to once-monthly paliperidone palmitate from oral antipsychotics. Expert Opin Pharmacother 2019; 20:2033-2039. [PMID: 31393186 DOI: 10.1080/14656566.2019.1650022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: In this post hoc analysis in patients recently diagnosed (≤5 years) with schizophrenia, the effect on hospitalization risk after switching from oral antipsychotic to once-monthly paliperidone palmitate (PP1M) was evaluated. Research design and methods: Change in hospitalization risk following PP1M initiation among patients switching from oral antipsychotics was assessed using prescription sequence symmetry analysis. Hospitalization risk was expressed as an adjusted sequence ratio (ASR) of the number of patients hospitalized prior to PP1M initiation/post PP1M initiation. Cumulative distribution of the time to hospitalization was estimated by the Kaplan-Meier method and symmetry of distribution was assessed using log-rank test. Hazard ratio and 95% CI were calculated using the Cox proportional hazard model. Results: The number of patients hospitalized after switching to PP1M: no change, 203/300 (67.7%); increase, 18/300 (6.0%); and decrease, 79/300 (26.3%). Following PP1M initiation, ASR (95% CI) was 3.56 (2.67, 5.33) suggesting asymmetry and a significant decline in hospitalization risk. Asymmetry in distribution of hospitalization events with significant (p ≤ 0.001) delay in time to hospitalization was also observed. Conclusion: Switching to PP1M treatment from oral antipsychotics is likely to be associated with a significant reduction in hospitalization risk along with a delay in time to hospitalization and rehospitalization.
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Affiliation(s)
- Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital , Beijing , China
| | - Jian Min Zhuo
- Janssen China Research & Development, Johnson & Johnson (China) Investment Ltd ., Shanghai , China
| | - Ibrahim Turkoz
- Janssen Research & Development, LLC , Titusville , NJ , USA
| | - Maju Mathews
- Janssen Research & Development, LLC , Titusville , NJ , USA
| | - Yu Feng
- Janssen Pharmaceutical Companies of Johnson and Johnson , Singapore , Singapore
| | - Wilson Tan
- Janssen Pharmaceutical Companies of Johnson and Johnson , Singapore , Singapore
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EEG correlates of face recognition in patients with schizophrenia spectrum disorders: A systematic review. Clin Neurophysiol 2019; 130:986-996. [DOI: 10.1016/j.clinph.2019.03.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 02/17/2019] [Accepted: 03/11/2019] [Indexed: 12/22/2022]
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Vornholt E, Luo D, Qiu W, McMichael GO, Liu Y, Gillespie N, Ma C, Vladimirov VI. Postmortem brain tissue as an underutilized resource to study the molecular pathology of neuropsychiatric disorders across different ethnic populations. Neurosci Biobehav Rev 2019; 102:195-207. [PMID: 31028758 DOI: 10.1016/j.neubiorev.2019.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/27/2019] [Accepted: 04/23/2019] [Indexed: 12/14/2022]
Abstract
In recent years, large scale meta-analysis of genome-wide association studies (GWAS) have reliably identified genetic polymorphisms associated with neuropsychiatric disorders such as schizophrenia (SCZ), bipolar disorder (BPD) and major depressive disorder (MDD). However, the majority of disease-associated single nucleotide polymorphisms (SNPs) appear within functionally ambiguous non-coding genomic regions. Recently, increased emphasis has been placed on identifying the functional relevance of disease-associated variants via correlating risk polymorphisms with gene expression levels in etiologically relevant tissues. For neuropsychiatric disorders, the etiologically relevant tissue is brain, which requires robust postmortem sample sizes from varying genetic backgrounds. While small sample sizes are of decreasing concern, postmortem brain databases are composed almost exclusively of Caucasian samples, which significantly limits study design and result interpretation. In this review, we highlight the importance of gene expression and expression quantitative loci (eQTL) studies in clinically relevant postmortem tissue while addressing the current limitations of existing postmortem brain databases. Finally, we introduce future collaborations to develop postmortem brain databases for neuropsychiatric disorders from Chinese and Asian subpopulations.
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Affiliation(s)
- Eric Vornholt
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, 800 E. Leigh St., Biotech One, Suite 100, Richmond, VA 23219, USA.
| | - Dan Luo
- National Key Laboratory of Medical Molecular Biology & Department of Immunology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005, China
| | - Wenying Qiu
- Institute of Basic Medical Sciences, Department of Human Anatomy, Histology and Embryology, Neuroscience Center, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, 100005, China
| | - Gowon O McMichael
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, 800 E. Leigh St., Biotech One, Suite 100, Richmond, VA 23219, USA
| | - Yangyang Liu
- School of Education, Tianjin University, 92 Weijin Road, Tianjin, 300072, China
| | - Nathan Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, 800 E. Leigh St., Biotech One, Suite 100, Richmond, VA 23219, USA; Department Psychiatry, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA 23298, USA
| | - Chao Ma
- Institute of Basic Medical Sciences, Department of Human Anatomy, Histology and Embryology, Neuroscience Center, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, 100005, China; Joint Laboratory of Anesthesia and Pain, Peking Union Medical College. Beijing, 100730, China.
| | - Vladimir I Vladimirov
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, 800 E. Leigh St., Biotech One, Suite 100, Richmond, VA 23219, USA; Department Psychiatry, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA 23298, USA; Center for Biomarker Research, Virginia Commonwealth University, Richmond, 410 North 12th Street, Richmond, VA 23298, USA; Department of Physiology & Biophysics, Virginia Commonwealth University, 1101 East Marshall Street, Richmond, VA 23298, USA; Lieber Institute for Brain Development, Johns Hopkins University, 855 North Wolfe Street, Suite 300, 3rd Floor, Baltimore, MD 21205, USA.
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Di Lorenzo R, Ferri P, Cameli M, Rovesti S, Piemonte C. Effectiveness of 1-year treatment with long-acting formulation of aripiprazole, haloperidol, or paliperidone in patients with schizophrenia: retrospective study in a real-world clinical setting. Neuropsychiatr Dis Treat 2019; 15:183-198. [PMID: 30662264 PMCID: PMC6328290 DOI: 10.2147/ndt.s189245] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Schizophrenia is a chronic mental illness that requires lifelong antipsychotic treatment. Therapy discontinuation, often due to poor adherence, increases the risk of relapses after both first and subsequent psychotic episodes. Long-acting injectable (LAI) antipsychotic drugs (APDs) have been introduced to increase therapeutic adherence, reducing blood-level variability compared to corresponding oral preparations. PURPOSE To compare the effectiveness of three LAI-APDs: aripiprazole (Apr) prolonged release once monthly (OM) haloperidol decanoate (Hal-D) and paliperidone palmitate (PP-OM). METHODS We retrospectively collected data for all patients with schizophrenia or other psychoses (n=217) treated with the three LAI-APDs for the first time from January 1, 2012 to October 31, 2016: n=48 with Apr-OM, n=55 with Hal-D, and n=114 with PP-OM. After 6 and 12 months of LAI treatments, we assessed clinical and functioning improvement, urgent consultations, psychiatric hospitalizations, adverse effects, and dropout. We compared urgent consultations and psychiatric hospitalizations required by the same patient 6 and 12 months before and after LAI implementation. Data were statistically analyzed. RESULTS The three LAI groups differed significantly only for "need for economic support from social service" (more frequent in the Hal-D group) and "schizoaffective disorder" (prevalent in the Apr-OM group). Apr-OM was prescribed at the maximum dose required by the official guidelines, whereas the other two LAIs were prescribed at lower doses. After 6 and 12 months' treatment with the three LAI-APDs, we registered similar and significant reductions in both urgent consultations and psychiatric hospitalizations (P<0.001) and overlapping clinical and functioning improvement-scale scores (P<0.001), and 14.28% of patients dropped out, with no difference among the three LAI-APDs. Different kinds of adverse effects, though similar for number and severity, were reported in the three LAI groups. CONCLUSION Our results suggest that both first- and second-generation LAI-APDs represent important therapeutic options, useful for improving schizophrenia's clinical course and its economic burden. Our study, which offers a wide and comprehensive observation of real-world clinical settings, combined an effectiveness evaluation through mirror analysis performed for each individual patient to a subsequent comparison among the three LAI-APDs, allowing us a more complete evaluation of clinical efficacy.
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Affiliation(s)
- Rosaria Di Lorenzo
- Psychiatric Intensive Treatment Facility, Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy,
| | - Paola Ferri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Michela Cameli
- Private Accredited Psychiatric Hospital, Villa degli Ulivi, Caserta, Italy
| | - Sergio Rovesti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Piemonte
- Private Accredited Psychiatric Hospital, Villa Igea, Modena, Italy
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Lawrie SM. Are structural brain changes in schizophrenia related to antipsychotic medication? A narrative review of the evidence from a clinical perspective. Ther Adv Psychopharmacol 2018; 8:319-326. [PMID: 30344998 PMCID: PMC6180375 DOI: 10.1177/2045125318782306] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/20/2018] [Indexed: 01/28/2023] Open
Abstract
Some observational studies and literature reviews suggest that antipsychotic drug use is associated with loss of grey or white matter in patients with schizophrenia, whereas others have contradicted this finding. Here, I summarize and critique the available evidence and put it in the context of clinical practice. This narrative review pools evidence from observational and experimental studies in humans and animals on the relationship between antipsychotic medication use and brain structure and function in patients with schizophrenia. To summarize, the observational evidence in patients with schizophrenia and the experimental evidence in animals suggest that antipsychotic drugs can cause reductions in brain volume, but differ as to where those effects are manifest. The experimental evidence in patients is inconclusive. There is stronger and more consistent evidence that other factors, such as alcohol and cannabis use, are likely causes of progressive brain changes in schizophrenia. Overall, I argue the case against antipsychotics is not proven and the jury is out on any significance of putative antipsychotic-induced brain changes. Taken in the context of strong evidence from clinical trials that antipsychotic drugs have beneficial effects on symptoms, function, relapse and cognition, and observational evidence that treatment normalizes other imaging indices and reduces mortality, the balance of probabilities is that antipsychotic drugs do not cause adverse structural brain changes in schizophrenia.
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Affiliation(s)
- Stephen M Lawrie
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK
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42
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Rund BR. The research evidence for schizophrenia as a neurodevelopmental disorder. Scand J Psychol 2018; 59:49-58. [PMID: 29356007 DOI: 10.1111/sjop.12414] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/26/2017] [Indexed: 01/27/2023]
Abstract
Schizophrenia is a neurodevelopmental disorder that starts very early. In this review we describe the empirical evidence for the neurodevelopmental model. First, by outlining the roots of psychological research that laid the foundation of the model. Thereafter, describing cognitive dysfunction observed in schizophrenia, and the course of cognitive functioning in the illness. Then, research findings that speak for and studies that speak against the view that schizophrenia is a degenerative process is discussed. We find that there is ample evidence that cognitive disturbance is a core element in schizophrenia. However, we have limited understanding of what initiates the abnormal development. This the paper ends with pointing out some of the factors that may trigger the deviant neurocognitive development in schizophrenia.
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Affiliation(s)
- Bjorn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway.,Vestre Viken Hospital Trust, Drammen, Norway
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Chin R, You AX, Meng F, Zhou J, Sim K. Recognition of Schizophrenia with Regularized Support Vector Machine and Sequential Region of Interest Selection using Structural Magnetic Resonance Imaging. Sci Rep 2018; 8:13858. [PMID: 30218016 PMCID: PMC6138658 DOI: 10.1038/s41598-018-32290-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 09/05/2018] [Indexed: 12/17/2022] Open
Abstract
Structural brain abnormalities in schizophrenia have been well characterized with the application of univariate methods to magnetic resonance imaging (MRI) data. However, these traditional techniques lack sensitivity and predictive value at the individual level. Machine-learning approaches have emerged as potential diagnostic and prognostic tools. We used an anatomically and spatially regularized support vector machine (SVM) framework to categorize schizophrenia and healthy individuals based on whole-brain gray matter densities estimated using voxel-based morphometry from structural MRI scans. The regularized SVM model yielded recognition accuracy of 86.6% in the training set of 127 individuals and validation accuracy of 83.5% in an independent set of 85 individuals. A sequential region-of-interest (ROI) selection step was adopted for feature selection, improving recognition accuracy to 92.0% in the training set and 89.4% in the validation set. The combined model achieved 96.6% sensitivity and 74.1% specificity. Seven ROIs were identified as the optimal discriminatory subset: the occipital fusiform gyrus, middle frontal gyrus, pars opercularis of the inferior frontal gyrus, anterior superior temporal gyrus, superior frontal gyrus, left thalamus and left lateral ventricle. These findings demonstrate the utility of spatial and anatomical priors in SVM for neuroimaging analyses in conjunction with sequential ROI selection in the recognition of schizophrenia.
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Affiliation(s)
- Rowena Chin
- Research Division, Institute of Mental Health, Singapore, 10 Buangkok View, Singapore, 539747, Singapore
| | - Alex Xiaobin You
- Health Services & Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, Singapore, 138543, Singapore
| | - Fanwen Meng
- Health Services & Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, Singapore, 138543, Singapore
| | - Juan Zhou
- Neuroscience & Behavioral Disorders Program, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Kang Sim
- Research Division, Institute of Mental Health, Singapore, 10 Buangkok View, Singapore, 539747, Singapore.
- West Region, Institute of Mental Health/Woodbridge Hospital, Singapore, 10 Buangkok View, Singapore, 539747, Singapore.
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Harvey PD, Rosenthal JB. Cognitive and functional deficits in people with schizophrenia: Evidence for accelerated or exaggerated aging? Schizophr Res 2018; 196:14-21. [PMID: 28506706 DOI: 10.1016/j.schres.2017.05.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/05/2017] [Accepted: 05/07/2017] [Indexed: 10/19/2022]
Abstract
Cognitive and functional deficits are commonly seen in people with schizophrenia. The profile of these impairments has a resemblance to the cognitive changes seen in healthy aging. In specific, many of the cognitive ability domains that change the most with aging in healthy people are the most salient of these deficits seen in people with schizophrenia, including prominent deficits in processing speed, working memory, and episodic memory. Functional deficits seen in schizophrenia are also similar to those seen in healthy aging. There is a relationship between multiple psychotic relapses and treatment resistance and longitudinal cognitive and functional changes in schizophrenia, with this relationship starting early in the course of illness. Cognitive performance in people with schizophrenia may be consistent with accelerated or premature aging. People with schizophrenia perform similarly to healthy people who are 3 or more decades older on indices of both cognition and their everyday functional skills. Some people with schizophrenia show exaggerated cognitive changes as well. Cognitive and functional performance worsens at the outset of the illness in schizophrenia compared to premorbid functioning, meaning that these deficits are not due to development disabilities. There are multiple medical and substance abuse comorbidities in schizophrenia and although these comorbidities affect cognitive functioning, they are not completely responsible for age-related changes.
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Affiliation(s)
- Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA; Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA.
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Banaj N, Piras F, Piras F, Ciullo V, Iorio M, Battaglia C, Pantoli D, Ducci G, Spalletta G. Cognitive and psychopathology correlates of brain white/grey matter structure in severely psychotic schizophrenic inpatients. Schizophr Res Cogn 2018; 12:29-36. [PMID: 29527507 PMCID: PMC5842307 DOI: 10.1016/j.scog.2018.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 01/09/2023]
Abstract
The brain structural correlates of cognitive and psychopathological symptoms within the active phase in severely psychotic schizophrenic inpatients have been rarely investigated. Twenty-eight inpatients with a DSM-5 diagnosis of Schizophrenia (SZ), admitted for acute psychotic decompensation, were assessed through a comprehensive neuropsychological and psychopathological battery. All patients underwent a high-resolution T1-weighted magnetic resonance imaging investigation. Increased psychotic severity was related to reduced grey matter volumes in the medial portion of the right superior frontal cortex, the superior orbitofrontal cortex bilaterally and to white matter volume reduction in the medial portion of the left superior frontal area. Immediate verbal memory performance was related to left insula and inferior parietal cortex volume, while long-term visuo-spatial memory was related to grey matter volume of the right middle temporal cortex, and the right (lobule VII, CRUS1) and left (lobule VI) cerebellum. Moreover, psychotic severity correlated with cognitive inflexibility and negative symptom severity was related to visuo-spatial processing and reasoning disturbances. These findings indicate that a disruption of the cortical-subcortical-cerebellar circuit, and distorted memory function contribute to the development and maintenance of psychotic exacerbation.
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Affiliation(s)
- Nerisa Banaj
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, 00179 Rome, Italy
| | - Federica Piras
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, 00179 Rome, Italy
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, 00179 Rome, Italy
- Museo Storico della Fisica e Centro Studi e Ricerche “Enrico Fermi”, 00184 Rome, Italy
| | - Valentina Ciullo
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, 00179 Rome, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50139 Florence, Italy
| | - Mariangela Iorio
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, 00179 Rome, Italy
| | | | - Donatella Pantoli
- Department of Radiology, S. Filippo Neri Hospital, ASL, Roma, 1, 00135 Rome, Italy
| | - Giuseppe Ducci
- Department of Mental Health, ASL, Roma 1, 00135 Rome, Italy
| | - Gianfranco Spalletta
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, 00179 Rome, Italy
- Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
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Kishimoto T, Hagi K, Nitta M, Leucht S, Olfson M, Kane JM, Correll CU. Effectiveness of Long-Acting Injectable vs Oral Antipsychotics in Patients With Schizophrenia: A Meta-analysis of Prospective and Retrospective Cohort Studies. Schizophr Bull 2018; 44:603-619. [PMID: 29868849 PMCID: PMC5890463 DOI: 10.1093/schbul/sbx090] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Compared with oral antipsychotics (OAPs), long-acting injectable antipsychotics (LAIs) should improve medication adherence and reduce relapses in schizophrenia. However, meta-analyses of randomized trials and mirror-image studies yielded inconsistent results. Nonrandomized cohort studies with parallel comparisons of LAIs and OAPs offer a third design to examine this issue. We meta-analyzed cohort studies with ≥24 weeks duration and hospitalization data. Primary outcome was hospitalization rate, ie, number of hospitalizations per person-year. Secondary outcomes included hospitalization risk, ie, proportion of patients experiencing ≥1 hospitalizations, all-cause discontinuation, and total hospitalization days. Patient severity and/or chronicity at baseline was also meta-analyzed and explored as a potential effect size moderator. Altogether, 42 studies (n = 101 624; follow-up = 18.6 ± 10.0 mo) were meta-analyzed. LAIs were superior to OAPs regarding hospitalization rate (studies = 15, person-years = 68 009, rate ratio = 0.85, 95% CI = 0.78-0.93, P < .001) and all-cause discontinuations (studies = 10, n = 37 293, risk ratio = 0.78, 95% CI = 0.67-0.91, P = .001), but not regarding hospitalization risk (studies = 33, n = 51 733, risk ratio = 0.92, 95% CI = 0.84-1.00, P = .06), and hospitalization days (studies = 11, n = 21 328, Hedges' g = -0.05, 95% CI = -0.16 to 0.06, P = .39). Illness severity/chronicity was significantly greater in patients prescribed LAIs vs OAPs when all available information was pooled together (studies = 23, n = 61 806, Hedges' g = 0.15, 95% CI = 0.03-0.26, P = .01), but not when examined separately. In summary, this meta-analysis of cohort studies, which included patients that are broadly representative of clinical practice, indicates that LAIs are superior to OAPs. The lack of significant superiority of LAIs for hospitalization risk and hospital days needs to be interpreted in the context of naturalistic treatment selection with subsequently greater illness severity/chronicity in LAI-treated patients.
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Affiliation(s)
- Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY
- Center of Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY
| | - Katsuhiko Hagi
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Sumitomo Dainippon Pharma Co., Ltd., Medical Affairs, Tokyo, Japan
| | - Masahiro Nitta
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Sumitomo Dainippon Pharma Co., Ltd., Medical Affairs, Tokyo, Japan
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Mark Olfson
- New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY
- Center of Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY
- Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY
- Center of Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY
- Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Bronx, NY
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Kolenic M, Franke K, Hlinka J, Matejka M, Capkova J, Pausova Z, Uher R, Alda M, Spaniel F, Hajek T. Obesity, dyslipidemia and brain age in first-episode psychosis. J Psychiatr Res 2018; 99:151-158. [PMID: 29454222 DOI: 10.1016/j.jpsychires.2018.02.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Obesity and dyslipidemia may negatively affect brain health and are frequent medical comorbidities of schizophrenia and related disorders. Despite the high burden of metabolic disorders, little is known about their effects on brain structure in psychosis. We investigated, whether obesity or dyslipidemia contributed to brain alterations in first-episode psychosis (FEP). METHODS 120 participants with FEP, who were undergoing their first psychiatric hospitalization, had <24 months of untreated psychosis and were 18-35 years old and 114 controls within the same age range participated in the study. We acquired 3T brain structural MRI, fasting lipids and body mass index. We used machine learning trained on an independent sample of 504 controls to estimate the individual brain age of study participants and calculated the BrainAGE score by subtracting the chronological from the estimated brain age. RESULTS In a multiple regression model, the diagnosis of FEP (B = 1.15, SE B = 0.31, p < 0.001) and obesity/overweight (B = 0.92, SE B = 0.35, p = 0.008) were each additively associated with BrainAGE scores (R2 = 0.22, F(3, 230) = 21.92, p < 0.001). BrainAGE scores were highest in participants with FEP and obesity/overweight (3.83 years, 95%CI = 2.35-5.31) and lowest in normal weight controls (-0.27 years, 95%CI = -1.22-0.69). LDL-cholesterol, HDL-cholesterol or triglycerides were not associated with BrainAGE scores. CONCLUSIONS Overweight/obesity may be an independent risk factor for diffuse brain alterations manifesting as advanced brain age already early in the course of psychosis. These findings raise the possibility that targeting metabolic health and intervening already at the level of overweight/obesity could slow brain ageing in FEP.
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Affiliation(s)
- Marian Kolenic
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic; 3rd School of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic
| | - Katja Franke
- Structural Brain Mapping Group, Department of Neurology, Jena University Hospital, Erlanger Alle 101, D - 07747, Jena, Germany
| | - Jaroslav Hlinka
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic; Institute of Computer Science, Czech Academy of Sciences, Pod Vodarenskou Vezi 271/2, 182 07, Prague, Czech Republic
| | - Martin Matejka
- 3rd School of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic; Psychiatric Hospital Bohnice, Ústavní 91, 181 00, Prague, Czech Republic; Psychiatric Hospital Kosmonosy, Lípy 15, 293 06, Kosmonosy, Czech Republic
| | - Jana Capkova
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic; 3rd School of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic
| | - Zdenka Pausova
- The Hospital for Sick Children, University of Toronto, 686 Bay Street, 10-9705, Toronto, ON M5G 0A4, Canada
| | - Rudolf Uher
- Dalhousie University, Department of Psychiatry, 5909, Veteran's Memorial Lane, Halifax, NS B3H 2E2, Canada
| | - Martin Alda
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic; Dalhousie University, Department of Psychiatry, 5909, Veteran's Memorial Lane, Halifax, NS B3H 2E2, Canada
| | - Filip Spaniel
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Tomas Hajek
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic; Dalhousie University, Department of Psychiatry, 5909, Veteran's Memorial Lane, Halifax, NS B3H 2E2, Canada.
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Response to Targeted Cognitive Training Correlates with Change in Thalamic Volume in a Randomized Trial for Early Schizophrenia. Neuropsychopharmacology 2018; 43:590-597. [PMID: 28895568 PMCID: PMC5770762 DOI: 10.1038/npp.2017.213] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/20/2017] [Accepted: 09/05/2017] [Indexed: 01/08/2023]
Abstract
Reduced thalamic volume is consistently observed in schizophrenia, and correlates with cognitive impairment. Targeted cognitive training (TCT) of auditory processing in schizophrenia drives improvements in cognition that are believed to result from functional neuroplasticity in prefrontal and auditory cortices. In this study, we sought to determine whether response to TCT is also associated with structural neuroplastic changes in thalamic volume in patients with early schizophrenia (ESZ). Additionally, we examined baseline clinical, cognitive, and neural characteristics predictive of a positive response to TCT. ESZ patients were randomly assigned to undergo either 40 h of TCT (N=22) or a computer games control condition (CG; N=22 s). Participants underwent MRI, clinical, and neurocognitive assessments before and after training (4-month interval). Freesurfer automated segmentation of the subcortical surface was carried out to measure thalamic volume at both time points. Left thalamic volume at baseline correlated with baseline global cognition, while a similar trend was observed in the right thalamus. The relationship between change in cognition and change in left thalamus volume differed between groups, with a significant positive correlation in the TCT group and a negative trend in the CG group. Lower baseline symptoms were related to improvements in cognition and left thalamic volume preservation following TCT. These findings suggest that the cognitive gains induced by TCT in ESZ are associated with structural neuroplasticity in the thalamus. Greater symptom severity at baseline reduced the likelihood of response to TCT both with respect to improved cognition and change in thalamic volume.
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Huang JY, Liu CM, Hwang TJ, Chen YJ, Hsu YC, Hwu HG, Lin YT, Hsieh MH, Liu CC, Chien YL, Tseng WYI. Shared and distinct alterations of white matter tracts in remitted and nonremitted patients with schizophrenia. Hum Brain Mapp 2018; 39:2007-2019. [PMID: 29377322 DOI: 10.1002/hbm.23982] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/13/2018] [Accepted: 01/16/2018] [Indexed: 01/01/2023] Open
Abstract
Patients with schizophrenia do not usually achieve remission state even after adequate antipsychotics treatment. Previous studies found significant difference in white matter integrity between patients with good outcomes and those with poor outcomes, but difference is still unclear at individual tract level. This study aimed to use a systematic approach to identify the tracts that were associated with remission state in patients with schizophrenia. We evaluated 91 patients with schizophrenia (remitted, 50; nonremitted, 41) and 50 healthy controls through diffusion spectrum imaging. White matter tract integrity was assessed through an automatic tract-specific analysis method to determine the mean generalized fractional anisotropy (GFA) values of the 76 white matter tract bundles in each participant. Analysis of covariance among the 3 groups revealed 12 tracts that were significantly different in GFA values. Post-hoc analysis showed that compared with the healthy controls, the nonremission group had reduced integrity in all 12 tracts, whereas the remission group had reduced integrity in only 4 tracts. Comparison between the remission and nonremission groups revealed 4 tracts with significant difference (i.e., the right fornix, bilateral uncinate fasciculi, and callosal fibers connecting the temporal poles) even after adjusting age, sex, education year, illness duration, and medication dose. Furthermore, all the 4 tracts were correlated with negative symptoms scores of the positive and negative syndrome scale. In conclusion, our study identified the tracts that were associated with remission state of schizophrenia. These tracts might be a potential prognostic marker for the symptomatic remission in patients with schizophrenia.
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Affiliation(s)
- Jing-Ying Huang
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Radiology, Wei Gong Memorial Hospital, Miaoli, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzung-Jeng Hwang
- Department of Psychiatry, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Jen Chen
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yung-Chin Hsu
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hai-Gwo Hwu
- Department of Psychiatry, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Tin Lin
- Department of Psychiatry, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Hsien Hsieh
- Department of Psychiatry, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Yih Isaac Tseng
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.,Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
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50
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Parker EM, Sweet RA. Stereological Assessments of Neuronal Pathology in Auditory Cortex in Schizophrenia. Front Neuroanat 2018; 11:131. [PMID: 29375326 PMCID: PMC5767177 DOI: 10.3389/fnana.2017.00131] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/18/2017] [Indexed: 12/21/2022] Open
Abstract
It has long been known that auditory processing is disrupted in schizophrenia. More recently, postmortem studies have provided direct evidence that morphological alterations to neurons in auditory cortex are implicated in the pathophysiology of this illness, confirming previous predictions. Potential neural substrates for auditory impairment and gray matter loss in auditory cortex in schizophrenia have been identified, described, and are the focus of this review article. Pyramidal cell somal volume is reduced in auditory cortex, as are dendritic spine density and number in schizophrenia. Pyramidal cells are not lost in this region in schizophrenia, indicating that dendritic spine reductions reflect fewer spines per pyramidal cell, consistent with the reduced neuropil hypothesis of schizophrenia. Stereological methods have aided in the proper collection, reporting and interpretation of this data. Mechanistic studies exploring relationships between genetic risk for schizophrenia and altered dendrite morphology represent an important avenue for future research in order to further elucidate cellular pathology in auditory cortex in schizophrenia.
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Affiliation(s)
- Emily M Parker
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Robert A Sweet
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States.,VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
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