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Liu W, Jiang X, Deng Z, Xie Y, Guo Y, Wu Y, Sun Q, Kong L, Wu F, Tang Y. Functional and structural alterations in different durations of untreated illness in the frontal and parietal lobe in major depressive disorder. Eur Arch Psychiatry Clin Neurosci 2024; 274:629-642. [PMID: 37542558 PMCID: PMC10995069 DOI: 10.1007/s00406-023-01625-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/22/2023] [Indexed: 08/07/2023]
Abstract
Major depressive disorder (MDD) is one of the most disabling illnesses that profoundly restricts psychosocial functions and impairs quality of life. However, the treatment rate of MDD is surprisingly low because the availability and acceptability of appropriate treatments are limited. Therefore, identifying whether and how treatment delay affects the brain and the initial time point of the alterations is imperative, but these changes have not been thoroughly explored. We investigated the functional and structural alterations of MDD for different durations of untreated illness (DUI) using regional homogeneity (ReHo) and voxel-based morphometry (VBM) with a sample of 125 treatment-naïve MDD patients and 100 healthy controls (HCs). The MDD patients were subgrouped based on the DUI, namely, DUI ≤ 1 M, 1 < DUI ≤ 6 M, 6 < DUI ≤ 12 M, and 12 < DUI ≤ 48 M. Subgroup comparison (MDD with different DUIs) was applied to compare ReHo and grey matter volume (GMV) extracted from clusters of regions with significant differences (the pooled MDD patients relative to HCs). Correlations and mediation effects were analysed to estimate the relationships between the functional and structural neuroimaging changes and clinical characteristics. MDD patients exhibited decreased ReHo in the left postcentral gyrus and precentral gyrus and reduced GMV in the left middle frontal gyrus and superior frontal gyrus relative to HCs. The initial functional abnormalities were detected after being untreated for 1 month, whereas this duration was 3 months for GMV reduction. Nevertheless, a transient increase in ReHo was observed after being untreated for 3 months. No significant differences were discovered between HCs and MDD patients with a DUI less than 1 month or among MDD patients with different DUIs in either ReHo or GMV. Longer DUI was related to reduced ReHo with GMV as mediator in MDD patients. We identified disassociated functional and anatomical alterations in treatment-naïve MDD patients at different time points in distinct brain regions at the early stage of the disease. Additionally, we also discovered that GMV mediated the relationship between a longer DUI and diminished ReHo in MDD patients, disclosing the latent deleterious and neuro-progressive implications of DUI on both the structure and function of the brain and indicating the necessity of early treatment of MDD.
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Affiliation(s)
- Wen Liu
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Xiaowei Jiang
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Radiology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Zijing Deng
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yu Xie
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yingrui Guo
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yifan Wu
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Qikun Sun
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Lingtao Kong
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Feng Wu
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yanqing Tang
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China.
- Department of Gerontology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China.
- Department of Psychiatry and Geriatric Medicine, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, People's Republic of China.
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Hitczenko K, Segal Y, Keshet J, Goldrick M, Mittal VA. Speech characteristics yield important clues about motor function: Speech variability in individuals at clinical high-risk for psychosis. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:60. [PMID: 37717025 PMCID: PMC10505148 DOI: 10.1038/s41537-023-00382-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/24/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND AND HYPOTHESIS Motor abnormalities are predictive of psychosis onset in individuals at clinical high risk (CHR) for psychosis and are tied to its progression. We hypothesize that these motor abnormalities also disrupt their speech production (a highly complex motor behavior) and predict CHR individuals will produce more variable speech than healthy controls, and that this variability will relate to symptom severity, motor measures, and psychosis-risk calculator risk scores. STUDY DESIGN We measure variability in speech production (variability in consonants, vowels, speech rate, and pausing/timing) in N = 58 CHR participants and N = 67 healthy controls. Three different tasks are used to elicit speech: diadochokinetic speech (rapidly-repeated syllables e.g., papapa…, pataka…), read speech, and spontaneously-generated speech. STUDY RESULTS Individuals in the CHR group produced more variable consonants and exhibited greater speech rate variability than healthy controls in two of the three speech tasks (diadochokinetic and read speech). While there were no significant correlations between speech measures and remotely-obtained motor measures, symptom severity, or conversion risk scores, these comparisons may be under-powered (in part due to challenges of remote data collection during the COVID-19 pandemic). CONCLUSION This study provides a thorough and theory-driven first look at how speech production is affected in this at-risk population and speaks to the promise and challenges facing this approach moving forward.
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Affiliation(s)
- Kasia Hitczenko
- Laboratoire de Sciences Cognitives et Psycholinguistique, Département d'Études Cognitives, ENS, EHESS, CNRS, PSL University, Paris, France.
| | - Yael Segal
- Faculty of Electrical and Computer Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Joseph Keshet
- Faculty of Electrical and Computer Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Matthew Goldrick
- Department of Linguistics, Northwestern University, Evanston, IL, USA
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Cognitive Science Program, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Cognitive Science Program, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
- Department of Psychiatry, Northwestern University, Evanston, IL, USA
- Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Evanston/Chicago, IL, USA
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3
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Chiang SK, Lai SM, Hu TM. Social cognition and apathy between two cognitive subtypes of schizophrenia: Are there the same or different profiles? Schizophr Res Cogn 2023; 33:100287. [PMID: 37214255 PMCID: PMC10196718 DOI: 10.1016/j.scog.2023.100287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/30/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023]
Abstract
Objective Cognitive impairment is an essential feature of schizophrenia, and it involves a broad array of nonsocial and social cognitive domains. This study aimed to examine whether there are the same or different social cognition profiles between two cognitive subtypes of schizophrenia. Method There were one hundred and two chronic and institutionalized patients with schizophrenia from two referral tracks. One group is "Cognitively Normal Range" (CNR) (N = 52), and another group is "Below Normal Range" (BNR) (N = 50). We assessed or collected their apathy, emotional perception judgment, facial expression judgment, and empathy by the Apathy Evaluation Scale, the International Affective Picture System, the Japanese and Caucasian Facial Expression of Emotion, and the Interpersonal Reactivity Index, respectively. Results We found different impairment profiles depending on the cognitive subtypes of the patient with schizophrenia. Surprisingly, the CNR presented impairments in apathy, emotional perception judgment, facial expression judgment, and empathy and feature impairment in empathy and affective apathy. In contrast, even though the BNR had significant neurocognition impairments, they had almost intact empathy with significantly impaired cognitive apathy. Both groups' global deficit scores (GDSs) were comparable, and all reached at least a mild impairment level. Conclusions The CNR and the BNR had similar abilities in emotional perception judgment and facial emotion recognition. They also had differentiable deficits in apathy and empathy. Our findings provide important clinical implications for neuropsychological pathology and treatment in schizophrenia.
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Affiliation(s)
- Shih-Kuang Chiang
- Department of Counselling and Clinical Psychology, National Dong Hwa University, No. 1, Sec. 2, Da Hsueh Rd., Shoufeng, Hualien county 974301, Taiwan, ROC
| | - Shih-Min Lai
- Department of Counselling and Clinical Psychology, National Dong Hwa University, No. 1, Sec. 2, Da Hsueh Rd., Shoufeng, Hualien county 974301, Taiwan, ROC
| | - Tsung-Ming Hu
- Department of Psychiatry, Taipei Veterans General Hospital Yuli Branch, No. 91, Xinxing St., Yuli Township, Hualien County 98142, Taiwan, ROC
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Sağlam Y, Ermiş Ç, Tunçtürk M, Turan S, Karakuş OB, Alarslan S, Karaçetin G. Neurocognitive and social cognitive impairments in remission and symptomatic states of early-onset schizophrenia spectrum disorders. Eur Child Adolesc Psychiatry 2023; 32:1621-1631. [PMID: 35316416 DOI: 10.1007/s00787-022-01977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 03/11/2022] [Indexed: 11/30/2022]
Abstract
Previous studies demonstrated neurocognitive impairments in early-onset schizophrenia (EOS) and other psychotic spectrum disorders (PSD). This study aimed to compare remitted and symptomatic cases in terms of neurocognition and theory of mind (ToM). 50 healthy controls (HC) and 106 patients diagnosed schizophrenia in remission (EOS-R, n = 38), symptomatic schizophrenia (EOS-S, n = 34), and other PSD (n = 34) were included in our study. The Positive and Negative Symptom Scale, Columbia-Suicide Severity Rating Scale, Reactive and Proactive Aggression Questionnaire were used to evaluate psychopathology. A cognitive battery was conducted to measure verbal learning/memory, visual learning/memory, executive functions (EF), inhibition, processing speed (PS), verbal fluency skills. Reading Mind in Eyes Test (RMET) and Faux-Pas tests were implemented to assess ToM. Principal Component Analysis was used to identify cognitive domain scores. Patient groups had poorer performance in cognitive domains than the HC group. The cognitive impairment and psychopathology levels of EOS-R and the PSD groups were comparable for all cognitive domains. The EOS-S group also had poorer scores in Rey verbal learning score (d = 0.87), RMET (d = 0.72), verbal fluency (d = 0.66), PS/EF (d = 0.82) and visual learning/memory (d = 0.83) test scores than the PSD group. Only RMET (d = 0.72) and executive function/processing speed domain (d = 0.63) were significantly impaired in the EOS-S group than the EOS-R group Cognitive impairments seen in remitted psychotic disorders were on the same continuum. Impaired EF/PS and ToM skills could be a cognitive marker for symptomatic illness in youth.
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Affiliation(s)
- Yeşim Sağlam
- Department of Child and Adolescent Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| | - Çağatay Ermiş
- Department of Child and Adolescent Psychiatry, Diyarbakir Children's Hospital, Diyarbakir, Turkey
| | - Mustafa Tunçtürk
- Department of Child and Adolescent Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| | - Serkan Turan
- Department of Child and Adolescent Psychiatry, Uludag University School of Medicine, 16400, Bursa, Turkey.
| | - Oğuz Bilal Karakuş
- Department of Child and Adolescent Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| | - Sezen Alarslan
- Department of Child and Adolescent Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| | - Gül Karaçetin
- Department of Child and Adolescent Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
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5
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Haug E, Øie MG, Svendsen IH, Møller P, Nelson B, Melle I. A seven-year longitudinal study of the association between neurocognitive function and basic self-disorders in schizophrenia. Front Psychol 2023; 14:1124859. [PMID: 36923145 PMCID: PMC10008929 DOI: 10.3389/fpsyg.2023.1124859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/08/2023] [Indexed: 03/03/2023] Open
Abstract
Introduction Basic self-disorders (SDs) and neurocognitive impairments are fundamental trait-like aspects of schizophrenia spectrum disorders. There has been little research on the association between SDs and neurocognitive impairments in schizophrenia, and no longitudinal studies have investigated if they are related. The aim of this study was to investigate the association between SDs and neurocognitive function in a follow-up study of patients with schizophrenia. Methods SDs and neurocognition were examined in 35 patients with schizophrenia during their first treatment and 7 years later (mean 7.1, SD 0.42). SDs were examined with the Examination of Anomalous Self-Experience (EASE) instrument. The neurocognitive examination included assessments of psychomotor speed, executive- and memory functions. Results Poorer executive functions at baseline were significantly associated with more SDs 7 years later and smaller reductions in SDs over time. There were no significant associations between other neurocognitive functions and SDs. Discussion Executive functions are important for self-regulation, and impairments in these functions in everyday life may have an impact on the development and/or persistence of SDs.
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Affiliation(s)
- Elisabeth Haug
- Department of Acute Psychiatry and Psychosis Treatment, Innlandet Hospital Trust, Brumunddal, Norway
| | - Merete G Øie
- Department of Research, Innlandet Hospital Trust, Brumunddal, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Ingrid H Svendsen
- Department of Acute Psychiatry and Psychosis Treatment, Innlandet Hospital Trust, Brumunddal, Norway
| | - Paul Møller
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Barnaby Nelson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Ingrid Melle
- Norment Centre, University of Oslo, Oslo, Norway.,Norment Centre, Oslo University Hospital, Oslo, Norway
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Perrottelli A, Giordano GM, Brando F, Giuliani L, Pezzella P, Mucci A, Galderisi S. Unveiling the Associations between EEG Indices and Cognitive Deficits in Schizophrenia-Spectrum Disorders: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12092193. [PMID: 36140594 PMCID: PMC9498272 DOI: 10.3390/diagnostics12092193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Cognitive dysfunctions represent a core feature of schizophrenia-spectrum disorders due to their presence throughout different illness stages and their impact on functioning. Abnormalities in electrophysiology (EEG) measures are highly related to these impairments, but the use of EEG indices in clinical practice is still limited. A systematic review of articles using Pubmed, Scopus and PsychINFO was undertaken in November 2021 to provide an overview of the relationships between EEG indices and cognitive impairment in schizophrenia-spectrum disorders. Out of 2433 screened records, 135 studies were included in a qualitative review. Although the results were heterogeneous, some significant correlations were identified. In particular, abnormalities in alpha, theta and gamma activity, as well as in MMN and P300, were associated with impairments in cognitive domains such as attention, working memory, visual and verbal learning and executive functioning during at-risk mental states, early and chronic stages of schizophrenia-spectrum disorders. The review suggests that machine learning approaches together with a careful selection of validated EEG and cognitive indices and characterization of clinical phenotypes might contribute to increase the use of EEG-based measures in clinical settings.
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Healthcare resource utilization and costs before and after long-acting injectable antipsychotic initiation in commercially insured young adults with schizophrenia. BMC Psychiatry 2022; 22:250. [PMID: 35395757 PMCID: PMC8994268 DOI: 10.1186/s12888-022-03895-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/14/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Long-acting injectable (LAI) antipsychotics use is associated with improved adherence which can reduce the rate of relapse, hospitalization, and associated costs in patients with schizophrenia. Young adults could be at higher risk of poor adherence, hence use of LAI in this population may offer a benefit but the evidence is limited. This study aimed to compare clinical and economic outcomes before and after the initiation of LAI antipsychotics in commercially insured young adults (18-35 years of age) with schizophrenia. METHODS A retrospective claims data study was conducted using the data from the IBM MarketScan® Commercial Claims and Encounters (CCAE) Database. Patients with a continuous enrollment of at least 1-year before and 1-year after the first observed schizophrenia diagnosis (index date) and with the use of ≥1 typical or atypical LAI antipsychotic during the post-index follow-up period were included. A pre-post analysis was conducted to compare relapse rates, healthcare resource utilization, and costs before (from index date to LAI initiation) and after LAI initiation (to end of follow up). RESULTS A total of 2222 patients who initiated LAIs after an index schizophrenia diagnosis were identified. The per patient per month (PPPM) composite relapse event rate (0.109 pre-LAI to 0.073 post-LAI) and hospitalization rate (0.091 to 0.058), all-cause inpatient visits (0.231 to 0.119), and length of stay (2.694 to 1.092 days) significantly decreased from before LAI initiation to after LAI initiation with similar trends seen for mental health and schizophrenia-related measures (all significant; P < 0.0001). All-cause total costs ($4898 to $3078 PPPM) were also decreased after LAI initiation, with similar trends seen for mental health and schizophrenia-related costs (all significant; P < 0.0001). Although medication costs were higher post-LAI period ($311 to $542 PPPM), the cost increase was substantially offset by the decreased costs associated with total healthcare costs. CONCLUSIONS Treatment with LAI antipsychotics was associated with a decrease in relapse event rate, healthcare resource utilization, and costs after LAI initiation compared to before LAI initiation in commercially insured young adults with schizophrenia. Treatment with LAIs in young adults with schizophrenia is potentially associated with significant cost savings to commercial payers.
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Hintze B, Rowicka M, Barczak A. Are Executive Functions Deficits in Early-Onset Chronic Schizophrenia More Severe than in Adult-Onset Chronic Schizophrenia? CLINICAL NEUROPSYCHIATRY 2022; 19:54-63. [PMID: 35360466 PMCID: PMC8951167 DOI: 10.36131/cnfioritieditore20220108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective The research on the age of schizophrenia onset and cognitive impairments leads to contradictory conclusions. It is still unknown whether neurocognitive deficits in early-onset schizophrenia (EOS) are more intense than adulthood-onset schizophrenia (AOS). The study aimed to examine specific aspects of the executive functions of chronic outpatients with different ages of schizophrenia onset. Method Two clinical groups (EOS and AOS) consisted of 60 chronic outpatients with schizophrenia recruited from the community-based support system. The executive functions were measured with the Wisconsin Card Sorting Test (WCST), Trail Making Test A&B (TMT A&B), verbal fluency task (VFT), and the N-back test. Obtained results were compared to control groups consisting of 40 healthy subjects, matched with age, sex, and years of education, respectively. Results There were no differences in various aspects of executive dysfunctions between EOS and AOS outpatients. The outpatients in general, had lower scores than healthy controls regardless of their age of symptom onset. The most important finding suggests that some cognitive domains (visual working memory and processing speed) in presented schizophrenia patients were similar to those in healthy controls. Despite the demographic differences, both clinical groups present the same level of executive functioning. In addition, similar to the healthy participants, the outpatients had no problems in working memory and processing speed. Conclusions These observations suggest that EOS might not be associated with more severe cognitive deterioration. Moreover, the stabilization or improvement of their functioning might be linked with long-term psycho-social rehabilitation and modern pharmacotherapy.
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Affiliation(s)
- Beata Hintze
- Institute of Psychology, The Maria Grzegorzewska University, Warsaw, Poland,Corresponding author Institute of Psychology, The Maria Grzegorzewska University, Szczesliwicka Street 40, 02-353 Warsaw, Poland E-mail:
| | - Magdalena Rowicka
- Institute of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | - Anna Barczak
- Rare Diseases Research Platform, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
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9
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Wu Q, Wang X, Wang Y, Long YJ, Zhao JP, Wu RR. Developments in Biological Mechanisms and Treatments for Negative Symptoms and Cognitive Dysfunction of Schizophrenia. Neurosci Bull 2021; 37:1609-1624. [PMID: 34227057 PMCID: PMC8566616 DOI: 10.1007/s12264-021-00740-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/05/2021] [Indexed: 12/12/2022] Open
Abstract
The causal mechanisms and treatment for the negative symptoms and cognitive dysfunction in schizophrenia are the main issues attracting the attention of psychiatrists over the last decade. The first part of this review summarizes the pathogenesis of schizophrenia, especially the negative symptoms and cognitive dysfunction from the perspectives of genetics and epigenetics. The second part describes the novel medications and several advanced physical therapies (e.g., transcranial magnetic stimulation and transcranial direct current stimulation) for the negative symptoms and cognitive dysfunction that will optimize the therapeutic strategy for patients with schizophrenia in future.
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Affiliation(s)
- Qiongqiong Wu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Xiaoyi Wang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Ying Wang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Yu-Jun Long
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Jing-Ping Zhao
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.
| | - Ren-Rong Wu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.
- Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031, China.
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10
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Øie MG, Sundet K, Haug E, Zeiner P, Klungsøyr O, Rund BR. Cognitive Performance in Early-Onset Schizophrenia and Attention-Deficit/Hyperactivity Disorder: A 25-Year Follow-Up Study. Front Psychol 2021; 11:606365. [PMID: 33519613 PMCID: PMC7841368 DOI: 10.3389/fpsyg.2020.606365] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/21/2020] [Indexed: 11/13/2022] Open
Abstract
Early-Onset Schizophrenia (EOS) and Attention Deficit-Hyperactivity Disorder (ADHD) are early- onset neurodevelopmental disorders associated with cognitive deficits. The current study represents the first attempt to compare these groups on a comprehensive cognitive test battery in a longitudinal design over 25 years in order to enhance our knowledge of particular patterns resulting from the interaction between normal maturational processes and different illness processes of these disorders. In the baseline study, 19 adolescents with schizophrenia were compared to 20 adolescents with ADHD and 30 healthy controls (HC), all between 12 and 18 years of age. After 13 years (T2) and after 25 years (T3) they were re-evaluated with the cognitive test battery. A cognitive Composite Score was used in a linear mixed model. The EOS group had a significant cognitive stagnation or deterioration from T1 to T2 compared to HC. However, the EOS group had the most positive change from T2 to T3, supporting a stable level of cognitive performance over the 25 year span. The ADHD group improved or had similar development as the HC group from T1 to T2. They continued to improve significantly compared to the HC group from T2 to T3. Individuals in the EOS group performed more impaired on the cognitive composite score compared to the HC group and the ADHD group at all three time points. Results might indicate a neurodevelopmental pathway of EOS with subnormal cognitive development specific in adolescence. In comparison, the ADHD group had a more consistent cognitive maturation supporting a maturational delay hypothesis of ADHD.
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Affiliation(s)
- Merete G Øie
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
| | - Kjetil Sundet
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Elisabeth Haug
- Division of Mental Health, Innlandet Hospital Trust, Ottestad, Norway
| | - Pål Zeiner
- Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Bjørn R Rund
- Department of Psychology, University of Oslo, Oslo, Norway.,Vestre Viken Hospital Trust, Drammen, Norway
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11
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Hegelstad WTV, Kreis I, Tjelmeland H, Pfuhl G. Psychosis and Psychotic-Like Symptoms Affect Cognitive Abilities but Not Motivation in a Foraging Task. Front Psychol 2020; 11:1632. [PMID: 32903697 PMCID: PMC7438796 DOI: 10.3389/fpsyg.2020.01632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/16/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Objective Goal-directed behavior is a central feature of human functioning. It requires goal appraisal and implicit cost-benefit analyses, i.e., how much effort to invest in the pursuit of a certain goal, against its value and a confidence judgment regarding the chance of attainment. Persons with severe mental illness such as psychosis often struggle with reaching goals. Cognitive deficits, positive symptoms restricting balanced judgment, and negative symptoms such as anhedonia and avolition may compromise goal attainment. The objective of this study was to investigate to what degree symptom severity is related to cognitive abilities, metacognition, and effort-based decision-making in a visual search task. Methods Two studies were conducted: study 1: N = 52 (healthy controls), and study 2: N = 46 (23 patients with psychosis/23 matched healthy controls). Symptoms were measured by the CAPE-42 (study 1) and the PANSS (study 2). By using a visual search task, we concomitantly measured (a) accuracy in short-term memory, (b) perceived accuracy by participants making a capture area or confidence interval, and (c) effort by measuring how long one searched for the target. Perseverance was assessed in trials in which the target was omitted and search had to be abandoned. Results Higher levels of positive symptoms, and having a diagnosis of psychosis, were associated with larger errors in memory. Participants adjusted both their capture area and their search investment to the error of their memory. Perseverance was associated with negative symptoms in study 1 but not in study 2. Conclusion By simultaneously assessing error and confidence in one's memory, as well as effort in search, we found that memory was affected by positive, not negative, symptoms in healthy controls, and was reduced in patients with psychosis. However, impaired memory did not concur with overconfidence or less effort in search, i.e., goal directed behavior was unrelated to symptoms or diagnosis. Metacognition and motivation were neither affected by cognitive abilities nor by negative symptoms. Clinically, this could indicate that struggles with goal directed behavior in psychosis may not solely be dependent on primary illness factors.
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Affiliation(s)
- Wenche Ten Velden Hegelstad
- TIPS Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
| | - Isabel Kreis
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Håkon Tjelmeland
- Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gerit Pfuhl
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway
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12
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Helldin L, Mohn C, Olsson AK, Hjärthag F. Neurocognitive variability in schizophrenia spectrum disorders: relationship to real-world functioning. Schizophr Res Cogn 2020; 20:100172. [PMID: 32090024 PMCID: PMC7026276 DOI: 10.1016/j.scog.2020.100172] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 12/31/2022]
Abstract
Neurocognitive variability exists within the schizophrenia spectrum disorder (SSD) population, with subgroups performing at the same level as healthy samples Here we study the relationship between different levels of neurocognitive responding and real-world functioning. The participants were 291 SSD patients and 302 healthy controls that were assessed with a comprehensive neurocognitive battery. In addition, the patients were assessed with the Specific Level of Functioning Scale (SLOF). The results showed that the mean neurocognitive test responses of the SSD group were significantly below that of the control group. However, there was considerable overlap between the cognitive scores of the two groups, with as many as 24% of the patients performing above the mean healthy score for some domains. Moreover, the patients with the highest level of neurocognitive functioning reached the highest levels of practical and work-related functioning outcome skills. There was no significant relationship between neurocognitive and social function skills. The large differences in cognitive performance and their associations with functional outcome within the patient group are rarely addressed in clinical practice, but indicate a clear need for individualized treatment of SSD. Early identification of cognitive risk factors for poor real-life functional outcome is necessary in order to alert the clinical and rehabilitation services about patients in need of extra care.
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Affiliation(s)
- Lars Helldin
- Department of Psychiatry, NU Health-Care Hospital, Region Västra Götaland, Sweden
- Department of Psychology, Karlstad University, Sweden
| | - Christine Mohn
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway
| | - Anna-Karin Olsson
- Department of Psychiatry, NU Health-Care Hospital, Region Västra Götaland, Sweden
- Department of Psychology, Karlstad University, Sweden
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13
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The effects of age and sex on cognitive impairment in schizophrenia: Findings from the Consortium on the Genetics of Schizophrenia (COGS) study. PLoS One 2020; 15:e0232855. [PMID: 32401791 PMCID: PMC7219730 DOI: 10.1371/journal.pone.0232855] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023] Open
Abstract
Recently emerging evidence indicates accelerated age-related changes in the structure and function of the brain in schizophrenia, raising a question about its potential consequences on cognitive function. Using a large sample of schizophrenia patients and controls and a battery of tasks across multiple cognitive domains, we examined whether patients show accelerated age-related decline in cognition and whether an age-related effect differ between females and males. We utilized data of 1,415 schizophrenia patients and 1,062 healthy community collected by the second phase of the Consortium on the Genetics of Schizophrenia (COGS-2). A battery of cognitive tasks included the Letter-Number Span Task, two forms of the Continuous Performance Test, the California Verbal Learning Test, Second Edition, the Penn Emotion Identification Test and the Penn Facial Memory Test. The effect of age and gender on cognitive performance was examined with a general linear model. We observed age-related changes on most cognitive measures, which was similar between males and females. Compared to controls, patients showed greater deterioration in performance on attention/vigilance and greater slowness of processing social information with increasing age. However, controls showed greater age-related changes in working memory and verbal memory compared to patients. Age-related changes (η2p of 0.001 to .008) were much smaller than between-group differences (η2p of 0.005 to .037). This study found that patients showed continued decline of cognition on some domains but stable impairment or even less decline on other domains with increasing age. These findings indicate that age-related changes in cognition in schizophrenia are subtle and not uniform across multiple cognitive domains.
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14
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Solís-Vivanco R, Rangel-Hassey F, León-Ortiz P, Mondragón-Maya A, Reyes-Madrigal F, de la Fuente-Sandoval C. Cognitive Impairment in Never-Medicated Individuals on the Schizophrenia Spectrum. JAMA Psychiatry 2020; 77:543-545. [PMID: 32074253 PMCID: PMC7042924 DOI: 10.1001/jamapsychiatry.2020.0001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This cohort study examines cognition in never-medicated individuals at different stages of the illness.
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Affiliation(s)
- Rodolfo Solís-Vivanco
- Neuropsychology Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Felipe Rangel-Hassey
- Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Pablo León-Ortiz
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Alejandra Mondragón-Maya
- Faculty of Higher Studies Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Francisco Reyes-Madrigal
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
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15
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Fett AKJ, Velthorst E, Reichenberg A, Ruggero CJ, Callahan JL, Fochtmann LJ, Carlson GA, Perlman G, Bromet EJ, Kotov R. Long-term Changes in Cognitive Functioning in Individuals With Psychotic Disorders: Findings From the Suffolk County Mental Health Project. JAMA Psychiatry 2020; 77:387-396. [PMID: 31825511 PMCID: PMC6990826 DOI: 10.1001/jamapsychiatry.2019.3993] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE It remains uncertain whether people with psychotic disorders experience progressive cognitive decline or normal cognitive aging after first hospitalization. This information is essential for prognostication in clinical settings, deployment of cognitive remediation, and public health policy. OBJECTIVE To examine long-term cognitive changes in individuals with psychotic disorders and to compare age-related differences in cognitive performance between people with psychotic disorders and matched control individuals (ie, individuals who had never had psychotic disorders). DESIGN, SETTING, AND PARTICIPANTS The Suffolk County Mental Health Project is an inception cohort study of first-admission patients with psychosis. Cognitive functioning was assessed 2 and 20 years later. Patients were recruited from the 12 inpatient facilities of Suffolk County, New York. At year 20, the control group was recruited by random digit dialing and matched to the clinical cohort on zip code and demographics. Data were collected between September 1991 and July 2015. Analysis began January 2016. MAIN OUTCOMES AND MEASURES Change in cognitive functioning in 6 domains: verbal knowledge (Wechsler Adult Intelligence Scale-Revised vocabulary test), verbal declarative memory (Verbal Paired Associates test I and II), visual declarative memory (Visual Reproduction test I and II), attention and processing speed (Symbol Digit Modalities Test-written and oral; Trail Making Test [TMT]-A), abstraction-executive function (Trenerry Stroop Color Word Test; TMT-B), and verbal fluency (Controlled Oral Word Association Test). RESULTS A total of 705 participants were included in the analyses (mean [SD] age at year 20, 49.4 [10.1] years): 445 individuals (63.1%) had psychotic disorders (211 with schizophrenia spectrum [138 (65%) male]; 164 with affective psychoses [76 (46%) male]; 70 with other psychoses [43 (61%) male]); and 260 individuals (36.9%) in the control group (50.5 [9.0] years; 134 [51.5%] male). Cognition in individuals with a psychotic disorder declined on all but 2 tests (average decline: d = 0.31; range, 0.17-0.54; all P < .001). Cognitive declines were associated with worsening vocational functioning (Visual Reproduction test II: r = 0.20; Symbol Digit Modalities Test-written: r = 0.25; Stroop: r = 0.24; P < .009) and worsening negative symptoms (avolition: Symbol Digit Modalities Test-written: r = -0.24; TMT-A: r = -0.21; Stroop: r = -0.21; all P < .009; inexpressivity: Stroop: r = -0.22; P < .009). Compared with control individuals, people with psychotic disrders showed age-dependent deficits in verbal knowledge, fluency, and abstraction-executive function (vocabulary: β = -0.32; Controlled Oral Word Association Test: β = -0.32; TMT-B: β = 0.23; all P < .05), with the largest gap among participants 50 years or older. CONCLUSIONS AND RELEVANCE In individuals with psychotic disorders, most cognitive functions declined over 2 decades after first hospitalization. Observed declines were clinically significant. Some declines were larger than expected due to normal aging, suggesting that cognitive aging in some domains may be accelerated in this population. If confirmed, these findings would highlight cognition as an important target for research and treatment during later phases of psychotic illness.
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Affiliation(s)
- Anne-Kathrin J. Fett
- Department of Psychology, City, University of London, London, United Kingdom,Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Department of Clinical and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York,Seaver Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Abraham Reichenberg
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York,Seaver Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | | - Greg Perlman
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
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16
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Abstract
Psychotic disorders are severe, debilitating, and even fatal. The development of targeted and effective interventions for psychosis depends upon on clear understanding of the timing and nature of disease progression to target processes amenable to intervention. Strong evidence suggests early and ongoing neuroprogressive changes, but timing and inflection points remain unclear and likely differ across cognitive, clinical, and brain measures. Additionally, granular evidence across modalities is particularly sparse in the "bridging years" between first episode and established illness-years that may be especially critical for improving outcomes and during which interventions may be maximally effective. Our objective is the systematic, multimodal characterization of neuroprogression through the early course of illness in a cross-diagnostic sample of patients with psychosis. We aim to (1) interrogate neurocognition, structural brain measures, and network connectivity at multiple assessments over the first eight years of illness to map neuroprogressive trajectories, and (2) examine trajectories as predictors of clinical and functional outcomes. We will recruit 192 patients with psychosis and 36 healthy controls. Assessments will occur at baseline and 8- and 16-month follow ups using clinical, cognitive, and imaging measures. We will employ an accelerated longitudinal design (ALD), which permits ascertainment of data across a longer timeframe and at more frequent intervals than would be possible in a single cohort longitudinal study. Results from this study are expected to hasten identification of actionable treatment targets that are closely associated with clinical outcomes, and identify subgroups who share common neuroprogressive trajectories toward the development of individualized treatments.
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17
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Yang C, Zhong X, Zhou H, Wu Z, Zhang M, Ning Y. Physical Comorbidities are Independently Associated with Higher Rates of Psychiatric Readmission in a Chinese Han Population. Neuropsychiatr Dis Treat 2020; 16:2073-2082. [PMID: 32982246 PMCID: PMC7494391 DOI: 10.2147/ndt.s261223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In people with psychosis, physical comorbidities are highly widespread and leading contributors to the untimely death encountered. Readmission rates in psychiatric patients are very high. Somatic comorbidities could be one of the considerable risk factors for psychiatric rehospitalization. Nevertheless, much less is known about the relation between physical comorbidities and psychiatric readmission. We aimed to investigate the association between physical comorbidities and psychiatric readmission in Han Chinese patients with psychiatric disorders. METHODS We used administrative data for January 1, 2009 to December 31, 2018 from the headquarters of the Affiliated Brain Hospital of Guangzhou Medical University to identify adults with schizophrenia, unipolar depression or bipolar disorder discharged from hospital. Data were extracted on sociodemographic and clinical characteristics. The Charlson comorbidity index (CCI) was used to assess the existence of significant physical comorbidity. Cox proportional hazards regression estimated rehospitalization risk after discharge. RESULTS A total of 15,620 individuals were included in this study, with the mean age of 35.1 years (SD = 12.8), and readmission occurred for 23.6% of participants. Survival analysis showed that physical comorbidities were statistically and significantly associated with psychiatric readmission, even after the adjustment for the number of psychiatric comorbidities, other sociodemographic and clinical variables. CONCLUSION Our results suggest that somatic comorbidities are related with higher rates of psychiatric readmission. Hence, to treat psychosis more effectively and to reduce rehospitalization, it is crucial to treat physical comorbidities promptly and adequately. It is absolutely necessary to bring somatic comorbidities to the forefront of psychiatric treatment and research.
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Affiliation(s)
- Chunyu Yang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.,The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.,The Third People's Hospital of Zhongshan, Zhongshan, Guangdong, People's Republic of China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, Guangdong, People's Republic of China
| | - Xiaomei Zhong
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, Guangdong, People's Republic of China
| | - Huarong Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, Guangdong, People's Republic of China
| | - Zhangying Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, Guangdong, People's Republic of China
| | - Min Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, Guangdong, People's Republic of China
| | - Yuping Ning
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.,The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, Guangdong, People's Republic of China
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18
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Lindgren M, Holm M, Kieseppä T, Suvisaari J. Neurocognition and Social Cognition Predicting 1-Year Outcomes in First-Episode Psychosis. Front Psychiatry 2020; 11:603933. [PMID: 33343430 PMCID: PMC7746550 DOI: 10.3389/fpsyt.2020.603933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/12/2020] [Indexed: 12/22/2022] Open
Abstract
Cognitive performance at illness onset may predict outcomes in first-episode psychosis (FEP), and the change in cognition may associate with clinical changes. Cognitive testing was administered to 54 FEP participants 2 months after entering treatment and to 39 participants after 1 year. We investigated whether baseline cognition predicted 1-year outcomes beyond positive, negative, and affective symptoms and whether the trajectory of cognition associated with clinical change. Baseline overall neurocognitive performance predicted the 1-year social and occupational level, occupational status, and maintaining of life goals. The domain of processing speed associated with the 1-year remission, occupational status, and maintaining of life goals. Baseline social cognition associated with occupational status a year later and the need for hospital treatment during the 1st year after FEP. Most of the associations were retained beyond baseline positive and affective symptom levels, but when accounting for negative symptoms, cognition no longer predicted 1-year outcomes, highlighting how negative symptoms overlap with cognition. The trajectory of neurocognitive performance over the year did not associate with changes in symptoms or functioning. Cognitive testing at the beginning of treatment provided information on the 1-year outcome in FEP beyond positive and affective symptom levels. In particular, the domains of processing speed and social cognition could be targets for interventions that aim to improve the outcome after FEP.
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Affiliation(s)
- Maija Lindgren
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Minna Holm
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuula Kieseppä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Suvisaari
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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19
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Hall MH, Holton KM, Öngür D, Montrose D, Keshavan MS. Longitudinal trajectory of early functional recovery in patients with first episode psychosis. Schizophr Res 2019; 209:234-244. [PMID: 30826261 PMCID: PMC7003957 DOI: 10.1016/j.schres.2019.02.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/11/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is a large variability in the recovery trajectory and outcome of first episode of psychosis [FEP] patients. To date, individuals' outcome trajectories at early stage of illness and potential risk factors associated with a poor outcome trajectory are largely unknown. This study aims to apply three separate predictors (positive symptoms, negative symptoms, and soft neurological signs) to identify homogeneous function outcome trajectories in patients with FEP using objective data-driven methods, and to explore the potential risk /protective factors associated with each trajectory. METHODS A total of 369 first episode patients (93% antipsychotic naive) were included in the baseline assessments and followed-up at 4-8 weeks, 6 months, and 1 year. K means cluster modeling for longitudinal data (kml3d) was used to identify distinct, homogeneous clusters of functional outcome trajectories. Patients with at least 3 assessments were included in the trajectory analyses (N = 129). The Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), and Neurological examination abnormalities (NEA) were used as predictors against Global Assessment of Functioning Scale (GAF). RESULTS In each of the three predictor models, four distinct functional outcome trajectories emerged: "Poor", "Intermediate", High" and "Catch-up". Individuals with male gender; ethnic minority status; low premorbid adjustment; low executive function/IQ, low SES, personality disorder, substance use history may be risk factors for poor recovery. CONCLUSIONS Functioning recovery in individuals with FEP is heterogeneous, although distinct recovery profiles are apparent. Data-driven trajectory analysis can facilitate better characterization of individual longitudinal patterns of functioning recovery.
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Affiliation(s)
- Mei-Hua Hall
- Psychotic Disorders Division, McLean Hospital HMS, Boston, MA, USA.
| | | | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital HMS, Boston, MA
| | - Debra Montrose
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Matcheri S. Keshavan
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA,,Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, HMS, Boston, MA
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20
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Melle I. Cognition in schizophrenia: a marker of underlying neurodevelopmental problems? World Psychiatry 2019; 18:164-165. [PMID: 31059634 PMCID: PMC6502404 DOI: 10.1002/wps.20646] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Ingrid Melle
- NORMENT Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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21
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Green MF, Horan WP, Lee J. Nonsocial and social cognition in schizophrenia: current evidence and future directions. World Psychiatry 2019; 18:146-161. [PMID: 31059632 PMCID: PMC6502429 DOI: 10.1002/wps.20624] [Citation(s) in RCA: 312] [Impact Index Per Article: 62.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cognitive impairment in schizophrenia involves a broad array of nonsocial and social cognitive domains. It is a core feature of the illness, and one with substantial implications for treatment and prognosis. Our understanding of the causes, consequences and interventions for cognitive impairment in schizophrenia has grown substantially in recent years. Here we review a range of topics, including: a) the types of nonsocial cognitive, social cognitive, and perceptual deficits in schizophrenia; b) how deficits in schizophrenia are similar or different from those in other disorders; c) cognitive impairments in the prodromal period and over the lifespan in schizophrenia; d) neuroimaging of the neural substrates of nonsocial and social cognition, and e) relationships of nonsocial and social cognition to functional outcome. The paper also reviews the considerable efforts that have been directed to improve cognitive impairments in schizophrenia through novel psychopharmacology, cognitive remediation, social cognitive training, and alternative approaches. In the final section, we consider areas that are emerging and have the potential to provide future insights, including the interface of motivation and cognition, the influence of childhood adversity, metacognition, the role of neuroinflammation, computational modelling, the application of remote digital technology, and novel methods to evaluate brain network organization. The study of cognitive impairment has provided a way to approach, examine and comprehend a wide range of features of schizophrenia, and it may ultimately affect how we define and diagnose this complex disorder.
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Affiliation(s)
- Michael F. Green
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral SciencesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA,Desert Pacific Mental Illness Research, Education and Clinical CenterVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCAUSA,Veterans Affairs Program for Enhancing Community Integration for Homeless VeteransLos AngelesCAUSA
| | - William P. Horan
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral SciencesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA,Desert Pacific Mental Illness Research, Education and Clinical CenterVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCAUSA,Veterans Affairs Program for Enhancing Community Integration for Homeless VeteransLos AngelesCAUSA
| | - Junghee Lee
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral SciencesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA,Desert Pacific Mental Illness Research, Education and Clinical CenterVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCAUSA,Veterans Affairs Program for Enhancing Community Integration for Homeless VeteransLos AngelesCAUSA
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22
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Menkes MW, Armstrong K, Blackford JU, Heckers S, Woodward ND. Neuropsychological functioning in early and chronic stages of schizophrenia and psychotic bipolar disorder. Schizophr Res 2019; 206:413-419. [PMID: 31104720 PMCID: PMC6530584 DOI: 10.1016/j.schres.2018.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/09/2018] [Accepted: 10/16/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Neuropsychological impairment is common in schizophrenia and psychotic bipolar disorder. It has been hypothesized that the pathways leading to impairment differ between disorders. Cognitive impairment in schizophrenia is believed to result largely from atypical neurodevelopment, whereas bipolar disorder is increasingly conceptualized as a neuroprogressive disorder. The current investigation tested several key predictions of this hypothesis. METHODS Current neuropsychological functioning and estimated premorbid intellectual ability were assessed in healthy individuals (n = 260) and a large, cross-sectional sample of individuals in the early and chronic stages of psychosis (n = 410). We tested the following hypotheses: 1) cognitive impairment is more severe in schizophrenia in the early stage of psychosis; and 2) cognitive decline between early and chronic stages is relatively greater in psychotic bipolar disorder. Additionally, individuals with psychosis were classified as neuropsychologically normal, deteriorated, and compromised (i.e. below average intellectual functioning) to determine if the frequencies of neuropsychologically compromised and deteriorated patients were higher in schizophrenia and psychotic bipolar disorder, respectively. RESULTS Neuropsychological impairment in the early stage of psychosis was more severe in schizophrenia. Psychotic bipolar disorder was not associated with relatively greater cognitive decline between illness stages. The frequency of neuropsychologically compromised patients was higher in schizophrenia; however, substantial portions of both schizophrenia and psychotic bipolar disorder patients were classified as neuropsychologically compromised and deteriorated. CONCLUSIONS While schizophrenia is associated with relatively greater neurodevelopmental involvement, psychotic bipolar disorder and schizophrenia cannot be strictly dichotomized into purely neuroprogressive and neurodevelopmental illness trajectories; there is evidence of both processes in each disorder.
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Affiliation(s)
- Margo W. Menkes
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Kristan Armstrong
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Jennifer Urbano Blackford
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN,Research Service, Tennessee Valley HealthCare System, US Department of Veterans Affairs
| | - Stephan Heckers
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Neil D. Woodward
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
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23
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Clayson PE, Kern RS, Nuechterlein KH, Knowlton BJ, Bearden CE, Cannon TD, Fiske AP, Ghermezi L, Hayata JN, Hellemann GS, Horan WP, Kee K, Lee J, Subotnik KL, Sugar CA, Ventura J, Yee CM, Green MF. Social vs. non-social measures of learning potential for predicting community functioning across phase of illness in schizophrenia. Schizophr Res 2019; 204:104-110. [PMID: 30121183 PMCID: PMC6377348 DOI: 10.1016/j.schres.2018.07.046] [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] [Received: 05/01/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022]
Abstract
Studies demonstrate that dynamic assessment (i.e., learning potential) improves the prediction of response to rehabilitation over static measures in individuals with schizophrenia. Learning potential is most commonly assessed using neuropsychological tests under a test-train-test paradigm to examine change in performance. Novel learning potential approaches using social cognitive tasks may have added value, particularly for the prediction of social functioning, but this area is unexplored. The present study is the first to investigate whether patients with schizophrenia demonstrate social cognitive learning potential across phase of illness. This study included 43 participants at clinical high risk (CHR), 63 first-episode, and 36 chronic schizophrenia patients. Assessment of learning potential involved test-train-test versions of the Wisconsin Card Sorting Test (non-social cognitive learning potential) and the Facial Emotion Identification Test (social cognitive learning potential). Non-social and social cognition pre-training scores (static scores) uniquely predicted concurrent community functioning in patients with schizophrenia, but not in CHR participants. Learning potential showed no incremental explanation of variance beyond static scores. First-episode patients showed larger non-social cognitive learning potential than CHR participants and were similar to chronic patients; chronic patients and CHR participants were similar. Group differences across phase of illness were not observed for social cognitive learning potential. Subsequent research could explore whether non-social and social cognitive learning potential relate differentially to non-social versus social types of training and rehabilitation.
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Affiliation(s)
- Peter E. Clayson
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA;,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA;,Corresponding author at: VA Greater Los Angeles Healthcare System, MIRECC 210A, Bldg. 210, 11301 Wilshire Blvd., Los Angeles, CA 90073, United States.
| | - Robert S. Kern
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA;,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA;,Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | - Barbara J. Knowlton
- Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA;,Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | | | - Alan P. Fiske
- Department of Anthropology, University of California Los Angeles, Los Angeles, CA
| | - Livon Ghermezi
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jacqueline N. Hayata
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Gerhard S. Hellemann
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - William P. Horan
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA;,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Kimmy Kee
- Department of Psychology, California State University Channel Islands, Los Angeles, CA
| | - Junghee Lee
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA;,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Kenneth L. Subotnik
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Catherine A. Sugar
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Cindy M. Yee
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA;,Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | - Michael. F. Green
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA;,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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24
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Cotter J, Barnett JH, Granger K. The Use of Cognitive Screening in Pharmacotherapy Trials for Cognitive Impairment Associated With Schizophrenia. Front Psychiatry 2019; 10:648. [PMID: 31551837 PMCID: PMC6743013 DOI: 10.3389/fpsyt.2019.00648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/12/2019] [Indexed: 11/13/2022] Open
Abstract
There are currently no regulatory approved pharmacological treatments for cognitive impairment associated with schizophrenia (CIAS). One possibility is that trial methodology itself is hindering their development. Emerging evidence suggests that patients with schizophrenia may show limited benefit from pro-cognitive interventions if they already exhibit intact cognitive performance, relative to normative thresholds. The aim of this report was to examine the extent to which objectively assessed cognitive performance has been used as an eligibility and/or stratification criterion in CIAS pharmacotherapy trials. On 16th January 2019, we conducted a systematic search of studies listed on ClinicalTrials.gov to identify randomized, double-blind, placebo-controlled, add-on pharmacotherapy trials conducted in patients with a diagnosis of schizophrenia, in which a paper-and-pencil or computerized cognitive task (or battery) was specified as a primary outcome measure. Of the 87 trials that met our inclusion criteria, 10 (11.5%) required the presence of an objectively assessed cognitive deficit as part of their patient eligibility criteria. No studies reported stratifying patients according to the presence or degree of cognitive impairment they exhibited. These results suggest that the vast majority of CIAS trials may have been underpowered due to the inclusion of cognitively "normal" patients. Purposive screening for cognitive impairment could increase CIAS trial success.
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Affiliation(s)
- Jack Cotter
- Cambridge Cognition, Cambridge, United Kingdom
| | - Jennifer H Barnett
- Cambridge Cognition, Cambridge, United Kingdom.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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25
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Polese D, Fornaro M, Palermo M, De Luca V, de Bartolomeis A. Treatment-Resistant to Antipsychotics: A Resistance to Everything? Psychotherapy in Treatment-Resistant Schizophrenia and Nonaffective Psychosis: A 25-Year Systematic Review and Exploratory Meta-Analysis. Front Psychiatry 2019; 10:210. [PMID: 31057434 PMCID: PMC6478792 DOI: 10.3389/fpsyt.2019.00210] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/22/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Roughly 30% of schizophrenia patients fail to respond to at least two antipsychotic trials. Psychosis has been traditionally considered to be poorly sensitive to psychotherapy. Nevertheless, there is increasing evidence that psychological interventions could be considered in treatment-resistant psychosis (TRP). Despite the relevance of the issue and the emerging neurobiological underpinnings, no systematic reviews have been published. Here, we show a systematic review of psychotherapy interventions in TRP patients of the last 25 years. Methods: The MEDLINE/PubMed, ISI WEB of Knowledge, and Scopus databases were inquired from January 1, 1993, to August 1, 2018, for reports documenting augmentation or substitution with psychotherapy for treatment-resistant schizophrenia (TRS) and TRP patients. Quantitative data fetched by Randomized Controlled Trials (RCTs) were pooled for explorative meta-analysis. Results: Forty-two articles have been found. Cognitive behavioral therapy (CBT) was the most frequently recommended psychotherapy intervention for TRS (studies, n = 32, 76.2%), showing efficacy for general psychopathology and positive symptoms as documented by most of the studies, but with uncertain efficacy on negative symptoms. Other interventions showed similar results. The usefulness of group therapy was supported by the obtained evidence. Few studies focused on negative symptoms. Promising results were also reported for resistant early psychosis. Limitations: Measurement and publication bias due to the intrinsic limitations of the appraised original studies. Conclusions: CBT, psychosocial intervention, supportive counseling, psychodynamic psychotherapy, and other psychological interventions can be recommended for clinical practice. More studies are needed, especially for non-CBT interventions and for all psychotherapies on negative symptoms.
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Affiliation(s)
- Daniela Polese
- Treatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples "Federico II", Naples, Italy.,Department of Neuroscience, Psychiatric Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Michele Fornaro
- Treatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples "Federico II", Naples, Italy
| | - Mario Palermo
- Treatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples "Federico II", Naples, Italy
| | - Vincenzo De Luca
- Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andrea de Bartolomeis
- Treatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples "Federico II", Naples, Italy
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26
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Weibell MA, Johannessen JO, Auestad B, Bramness J, Brønnick K, Haahr U, Joa I, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Røssberg JI, Simonsen E, Vaglum P, Stain H, Friis S, Hegelstad WTV. Early Substance Use Cessation Improves Cognition-10 Years Outcome in First-Episode Psychosis Patients. Front Psychiatry 2019; 10:495. [PMID: 31354551 PMCID: PMC6640174 DOI: 10.3389/fpsyt.2019.00495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/24/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Cognitive impairment may be a risk factor for, as well as a consequence of, psychosis. Non-remitting symptoms, premorbid functioning, level of education, and socioeconomic background are known correlates. A possible confounder of these associations is substance use, which is common among patients with psychosis and linked to worse clinical outcomes. Studies however show mixed results for the effect of substance use on cognitive outcomes. In this study, the long-term associations of substance use with cognition in a representative sample of first-episode psychosis patients were examined. Methods: The sample consisted of 195 patients. They were assessed for symptom levels, function, and neurocognition at 1, 2, 5, and 10 years after first treatment. Test scores were grouped into factor analysis-based indices: motor speed, verbal learning, visuomotor processing, verbal fluency, and executive functioning. A standardized composite score of all tests was also used. Patients were divided into four groups based on substance-use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users, and nonusers. Data were analyzed using linear mixed effects modeling. Results: Gender, premorbid academic functioning, and previous education were the strongest predictors of cognitive trajectories. However, on motor speed and verbal learning indices, patients who stopped using substances within the first 2 years of follow-up improved over time, whereas the other groups did not. For verbal fluency, the longitudinal course was parallel for all four groups, while patients who stopped using substances demonstrated superior performances compared with nonusers. Persistent users demonstrated impaired visuomotor processing speed compared with nonusers. Within the stop- and episodic use groups, patients with narrow schizophrenia diagnoses performed worse compared with patients with other diagnoses on verbal learning and on the overall composite neurocognitive index. Discussion: This study is one of very few long-term studies on cognitive impairments in first-episode psychosis focusing explicitly on substance use. Early cessation of substance use was associated with less cognitive impairment and some improvement over time on some cognitive measures, indicating a milder illness course and superior cognitive reserves to draw from in recovering from psychosis.
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Affiliation(s)
- Melissa A Weibell
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Bjørn Auestad
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway.,Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Jørgen Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorder, Innland Hospital Trust, Hamar, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kolbjørn Brønnick
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Ulrik Haahr
- Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Tor Ketil Larsen
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Stein Opjordsmoen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway.,Vestre Viken Hospital Trust, Drammen, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Helen Stain
- School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom
| | - Svein Friis
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Wenche Ten Velden Hegelstad
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
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27
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Studying and modulating schizophrenia-associated dysfunctions of oligodendrocytes with patient-specific cell systems. NPJ SCHIZOPHRENIA 2018; 4:23. [PMID: 30451850 PMCID: PMC6242875 DOI: 10.1038/s41537-018-0066-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/30/2018] [Indexed: 02/07/2023]
Abstract
Postmortem studies in patients with schizophrenia (SCZ) have revealed deficits in myelination, abnormalities in myelin gene expression and altered numbers of oligodendrocytes in the brain. However, gaining mechanistic insight into oligodendrocyte (OL) dysfunction and its contribution to SCZ has been challenging because of technical hurdles. The advent of individual patient-derived human-induced pluripotent stem cells (hiPSCs), combined with the generation of in principle any neuronal and glial cell type, including OLs and oligodendrocyte precursor cells (OPCs), holds great potential for understanding the molecular basis of the aetiopathogenesis of genetically complex psychiatric diseases such as SCZ and could pave the way towards personalized medicine. The development of neuronal and glial co-culture systems now appears to enable the in vitro study of SCZ-relevant neurobiological endophenotypes, including OL dysfunction and myelination, with unprecedented construct validity. Nonetheless, the meaningful stratification of patients before the subsequent functional analyses of patient-derived cell systems still represents an important bottleneck. Here, to improve the predictive power of ex vivo disease modelling we propose using hiPSC technology to focus on representatives of patient subgroups stratified for genomic and/or phenomic features and neurobiological cell systems. Therefore, this review will outline the evidence for the involvement of OPCs/OLs in SCZ in the context of their proposed functions, including myelination and axon support, the implications for hiPSC-based cellular disease modelling and potential strategies for patient selection.
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28
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Sheffield JM, Karcher NR, Barch DM. Cognitive Deficits in Psychotic Disorders: A Lifespan Perspective. Neuropsychol Rev 2018; 28:509-533. [PMID: 30343458 DOI: 10.1007/s11065-018-9388-2] [Citation(s) in RCA: 237] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/15/2018] [Indexed: 12/15/2022]
Abstract
Individuals with disorders that include psychotic symptoms (i.e. psychotic disorders) experience broad cognitive impairments in the chronic state, indicating a dimension of abnormality associated with the experience of psychosis. These impairments negatively impact functional outcome, contributing to the disabling nature of schizophrenia, bipolar disorder, and psychotic depression. The robust and reliable nature of cognitive deficits has led researchers to explore the timing and profile of impairments, as this may elucidate different neurodevelopmental patterns in individuals who experience psychosis. Here, we review the literature on cognitive deficits across the life span of individuals with psychotic disorder and psychotic-like experiences, highlighting the dimensional nature of both psychosis and cognitive ability. We identify premorbid generalized cognitive impairment in schizophrenia that worsens throughout development, and stabilizes by the first-episode of psychosis, suggesting a neurodevelopmental course. Research in affective psychosis is less clear, with mixed evidence regarding premorbid deficits, but a fairly reliable generalized deficit at first-episode, which appears to worsen into the chronic state. In general, cognitive impairments are most severe in schizophrenia, intermediate in bipolar disorder, and the least severe in psychotic depression. In all groups, cognitive deficits are associated with poorer functional outcome. Finally, while the generalized deficit is the clearest and most reliable signal, data suggests specific deficits in verbal memory across all groups, specific processing speed impairments in schizophrenia and executive functioning impairments in bipolar disorder. Cognitive deficits are a core feature of psychotic disorders that provide a window into understanding developmental course and risk for psychosis.
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Affiliation(s)
- Julia M Sheffield
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave S, Nashville, TN, 37212, USA.
| | - Nicole R Karcher
- Department of Psychological & Brain Sciences, Washington University St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA.,Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA.,Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
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29
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Untreated illness and recovery in clients of an early psychosis intervention program: a 10-year prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2018; 53:171-182. [PMID: 29188310 DOI: 10.1007/s00127-017-1464-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate whether duration of untreated psychosis (DUP) and duration of untreated illness (DUI) are associated with measures of both subjective and objective recovery 10 years after a first episode of psychosis. METHODS A cohort of 65 clients from an early psychosis intervention program completed a battery of outcome measures 10 years following initial treatment for first-episode psychosis (FEP). The outcomes of interest were self-perceived recovery scores (Maryland Assessment of Recovery in People with Serious Mental Illness Scale) and occupational activity, defined as engagement in work and/or school on a full/part-time basis. Multiple linear and logistic regression analyses were used to estimate the associations between DUP and DUI with each measure of recovery, adjusting for potential confounding factors. RESULTS We did not find a statistically significant association between DUP and either occupational activity (OR = 1.26, 95% CI 0.81-1.95) or self-perceived recovery score (β = - 0.73, 95% CI - 2.42 to 0.97). However, we found a significant negative association between DUI and self-perceived recovery score (β = - 0.52, 95% CI - 0.87 to - 0.16). CONCLUSIONS Our findings suggest that DUI may have a stronger influence than DUP on recovery from FEP at 10-year follow-up. This suggests the potential value in targeted interventions for people with a long DUI to increase the likelihood of achieving recovery after the first episode of psychosis.
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30
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Suvisaari J, Mantere O, Keinänen J, Mäntylä T, Rikandi E, Lindgren M, Kieseppä T, Raij TT. Is It Possible to Predict the Future in First-Episode Psychosis? Front Psychiatry 2018; 9:580. [PMID: 30483163 PMCID: PMC6243124 DOI: 10.3389/fpsyt.2018.00580] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/23/2018] [Indexed: 12/26/2022] Open
Abstract
The outcome of first-episode psychosis (FEP) is highly variable, ranging from early sustained recovery to antipsychotic treatment resistance from the onset of illness. For clinicians, a possibility to predict patient outcomes would be highly valuable for the selection of antipsychotic treatment and in tailoring psychosocial treatments and psychoeducation. This selective review summarizes current knowledge of prognostic markers in FEP. We sought potential outcome predictors from clinical and sociodemographic factors, cognition, brain imaging, genetics, and blood-based biomarkers, and we considered different outcomes, like remission, recovery, physical comorbidities, and suicide risk. Based on the review, it is currently possible to predict the future for FEP patients to some extent. Some clinical features-like the longer duration of untreated psychosis (DUP), poor premorbid adjustment, the insidious mode of onset, the greater severity of negative symptoms, comorbid substance use disorders (SUDs), a history of suicide attempts and suicidal ideation and having non-affective psychosis-are associated with a worse outcome. Of the social and demographic factors, male gender, social disadvantage, neighborhood deprivation, dysfunctional family environment, and ethnicity may be relevant. Treatment non-adherence is a substantial risk factor for relapse, but a small minority of patients with acute onset of FEP and early remission may benefit from antipsychotic discontinuation. Cognitive functioning is associated with functional outcomes. Brain imaging currently has limited utility as an outcome predictor, but this may change with methodological advancements. Polygenic risk scores (PRSs) might be useful as one component of a predictive tool, and pharmacogenetic testing is already available and valuable for patients who have problems in treatment response or with side effects. Most blood-based biomarkers need further validation. None of the currently available predictive markers has adequate sensitivity or specificity used alone. However, personalized treatment of FEP will need predictive tools. We discuss some methodologies, such as machine learning (ML), and tools that could lead to the improved prediction and clinical utility of different prognostic markers in FEP. Combination of different markers in ML models with a user friendly interface, or novel findings from e.g., molecular genetics or neuroimaging, may result in computer-assisted clinical applications in the near future.
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Affiliation(s)
- Jaana Suvisaari
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Outi Mantere
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jaakko Keinänen
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Teemu Mäntylä
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Eva Rikandi
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Maija Lindgren
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Tuula Kieseppä
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tuukka T Raij
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland
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31
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Anda L, Brønnick KS, Johnsen E, Kroken RA, Jørgensen H, Løberg EM. The Course of Neurocognitive Changes in Acute Psychosis: Relation to Symptomatic Improvement. PLoS One 2016; 11:e0167390. [PMID: 27977720 PMCID: PMC5157988 DOI: 10.1371/journal.pone.0167390] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 11/14/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Cognitive impairment is a core aspect of psychosis, but the course of cognitive functioning during acute psychosis remains poorly understood, as does the association between symptom change and neurocognitive change. Some studies have found cognitive improvement to be related to improvement in negative symptoms, but few have examined cognitive changes in the early acute phase, when clinical improvement mainly happens. This study's aim was to investigate the relation between cognitive and symptomatic change in clinically heterogeneous patients during the early acute phase of psychosis. METHOD Participants (n = 84), including both first-episode and previously ill patients, were recruited from consecutive admissions to the acute psychiatric emergency ward of Haukeland University Hospital, Bergen, Norway, as part of the Bergen Psychosis Project (BPP). The RBANS neurocognitive test battery was administered on admission and again at discharge from the acute ward (mean time 4.1 weeks, SD 1.86 weeks). Symptomatic change was measured by PANSS. RESULTS The proportion of subjects with cognitive impairment (t < 35) was 28.6% in the acute phase and 13.1% at follow-up. A sequential multiple linear regression model with RBANS change as the dependent variable found PANSS negative symptoms change to significantly predict total RBANS performance improvement (beta = -.307, p = .016). There was no significant difference between subjects with schizophrenia and those with other psychotic disorders in terms of cognitive change. CONCLUSION The proportion of subjects with mild to moderate impairment in cognitive test performance is reduced across the acute phase of psychosis, with improvement related to amelioration of negative symptoms.
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Affiliation(s)
- Liss Anda
- TIPS, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Kolbjørn S. Brønnick
- TIPS, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Institute of Health, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rune A. Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hugo Jørgensen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
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32
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Teigset CM, Mohn C, Rund BR. Gestational length affects neurocognition in early-onset schizophrenia. Psychiatry Res 2016; 244:78-85. [PMID: 27474856 DOI: 10.1016/j.psychres.2016.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 06/16/2016] [Accepted: 07/09/2016] [Indexed: 12/17/2022]
Abstract
Obstetric complications (OC) have been linked to an increased risk for schizophrenia in offspring, especially in early-onset schizophrenia (EOS). Extensive cognitive deficits occur in EOS, although no study has yet to investigate the relationship between OC and cognition in EOS. This study aims to examine the frequency of OC in EOS compared to controls, and also investigates the relationship between OC and neurocognitive dysfunction in the two groups. Nineteen EOS patients and 53 healthy controls were tested with the MATRICS Consensus Cognitive Battery (MCCB), and the cognitive measures were combined with OC data from the Norwegian Birth Registry. The results indicated no group differences in OC in EOS and healthy controls, but a shorter gestational length in the EOS group led to significant decreases in the overall neurocognitive composite score, and in processing speed. This suggests that the poorer neuropsychological performances commonly found in EOS may be partly attributable to the length of gestation. The worsened neurocognitive functioning did not appear among controls, so gestational length had a different impact on the two groups. Our findings indicated that a shorter gestational length did not increase the risk for developing EOS, but did significantly affect the cognitive difficulties in this group.
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Affiliation(s)
- Charlotte M Teigset
- Vestre Viken Hospital Trust, Research Department, Wergelandsgate 10, 3004 Drammen, Norway.
| | - Christine Mohn
- Vestre Viken Hospital Trust, Research Department, Wergelandsgate 10, 3004 Drammen, Norway.
| | - Bjørn Rishovd Rund
- Vestre Viken Hospital Trust, Research Department, Wergelandsgate 10, 3004 Drammen, Norway; Department of Psychology, University of Oslo, Postboks 1094 Blindern, 0317 Oslo, Norway.
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McCleery A, Lee J, Fiske AP, Ghermezi L, Hayata JN, Hellemann GS, Horan WP, Kee KS, Kern RS, Knowlton BJ, Subotnik KL, Ventura J, Sugar CA, Nuechterlein KH, Green MF. Longitudinal stability of social cognition in schizophrenia: A 5-year follow-up of social perception and emotion processing. Schizophr Res 2016; 176:467-472. [PMID: 27443808 PMCID: PMC5026923 DOI: 10.1016/j.schres.2016.07.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Individuals with schizophrenia exhibit marked and disproportional impairment in social cognition, which is associated with their level of community functioning. However, it is unclear whether social cognitive impairment is stable over time, or if impairment worsens as a function of illness chronicity. Moreover, little is known about the longitudinal associations between social cognition and community functioning. METHOD Forty-one outpatients with schizophrenia completed tests of emotion processing (Mayer-Salovey-Caruso Emotional Intelligence Test, MSCEIT) and social perception (Relationships Across Domains, RAD) at baseline and approximately five years later. Stability of performance was assessed using paired t-tests and correlations. Longitudinal associations between social cognition and community functioning (Role Functioning Scale, RFS) were assessed using cross-lagged panel correlation analysis. RESULTS Performance on the two social cognition tasks were stable over follow-up. There were no significant mean differences between assessment points [p's≥0.20, Cohen'sd's≤|0.20|], and baseline performance was highly correlated with performance at follow-up [ρ's≥0.70, ICC≥0.83, p's<0.001]. The contemporaneous association between social cognition and community functioning was moderately large at follow-up [ρ=0.49, p=0.002]. However, baseline social cognition did not show a significant longitudinal influence on follow-up community functioning [z=0.31, p=0.76]. CONCLUSIONS These data support trait-like stability of selected areas of social cognition in schizophrenia. Cross-lagged correlations did not reveal a significant unidirectional influence of baseline social cognition on community functioning five years later. However, consistent with the larger literature, a moderately large cross-sectional association between social cognition and community functioning was observed. Based on stability and cross-sectional associations, these results suggest that social cognition might have short-term implications for functional outcome rather than long-term consequences.
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Affiliation(s)
- Amanda McCleery
- UCLA, Semel Institute for Neuroscience and Human Behavior, United States; UCLA, Department of Psychology, United States; VISN 22 Mental Illness Research, Education, and Clinical Center (MIRECC) Greater Los Angeles VA Healthcare System, United States.
| | - Junghee Lee
- UCLA, Semel Institute for Neuroscience and Human Behavior, United States; VISN 22 Mental Illness Research, Education, and Clinical Center (MIRECC) Greater Los Angeles VA Healthcare System, United States
| | | | - Livon Ghermezi
- UCLA, Semel Institute for Neuroscience and Human Behavior, United States
| | | | | | - William P Horan
- UCLA, Semel Institute for Neuroscience and Human Behavior, United States; VISN 22 Mental Illness Research, Education, and Clinical Center (MIRECC) Greater Los Angeles VA Healthcare System, United States
| | - Kimmy S Kee
- California State University Channel Islands, Department of Psychology, United States
| | - Robert S Kern
- UCLA, Semel Institute for Neuroscience and Human Behavior, United States; VISN 22 Mental Illness Research, Education, and Clinical Center (MIRECC) Greater Los Angeles VA Healthcare System, United States
| | | | - Kenneth L Subotnik
- UCLA, Semel Institute for Neuroscience and Human Behavior, United States
| | - Joseph Ventura
- UCLA, Semel Institute for Neuroscience and Human Behavior, United States
| | - Catherine A Sugar
- UCLA, Semel Institute for Neuroscience and Human Behavior, United States; VISN 22 Mental Illness Research, Education, and Clinical Center (MIRECC) Greater Los Angeles VA Healthcare System, United States; UCLA, Department of Biostatistics, United States
| | - Keith H Nuechterlein
- UCLA, Semel Institute for Neuroscience and Human Behavior, United States; UCLA, Department of Psychology, United States
| | - Michael F Green
- UCLA, Semel Institute for Neuroscience and Human Behavior, United States; VISN 22 Mental Illness Research, Education, and Clinical Center (MIRECC) Greater Los Angeles VA Healthcare System, United States
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34
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Cognitive intermediate phenotype and genetic risk for psychosis. Curr Opin Neurobiol 2016; 36:23-30. [DOI: 10.1016/j.conb.2015.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/11/2015] [Accepted: 08/26/2015] [Indexed: 12/26/2022]
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Chi MH, Hsiao CY, Chen KC, Lee LT, Tsai HC, Hui Lee I, Chen PS, Yang YK. The readmission rate and medical cost of patients with schizophrenia after first hospitalization - A 10-year follow-up population-based study. Schizophr Res 2016; 170:184-90. [PMID: 26678982 DOI: 10.1016/j.schres.2015.11.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/19/2015] [Accepted: 11/27/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hospital readmissions caused by relapse in patients with schizophrenia are associated with prognosis. Identifying individuals at high risk of readmission and providing interventions to lower the readmission rate are important. METHODS Patients with schizophrenia who were hospitalized for the first time were recruited from the National Health Insurance Research Database from 2001 to 2010 (n=808, mean age 28.9years) and compared with matched controls. Data on the demographics, cost, and utilization of medical resources of patients who were readmitted were compared with non-readmitted patients. The readmission time curve was analyzed by the Kaplan-Meier method. RESULT 570 (70.5%) patients were readmitted within 10years; the median time between admissions was 1.9years, and 25% of subjects were readmitted within 4months of the first hospitalization. There were no significant differences in age, gender, or length of hospitalization between the readmission and non-readmission groups. Taking into account all psychiatric medical services, the readmission group had a significantly higher mean frequency of care and a greater medical cost than the non-readmission group and matched controls. However, there were no significant differences with regard to non-psychiatric medical services. CONCLUSION Schizophrenia has a high rate of readmission and high medical cost in naturalistic settings. In addition to the traditional hospital-based treatment model for patients with schizophrenia, the development of an effective intervention program is important, especially in the early years of the disease.
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Affiliation(s)
- Mei Hung Chi
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih Yin Hsiao
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kao Chin Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Lan-Ting Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin Chun Tsai
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
| | - I Hui Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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36
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Chou PH, Lin WH, Lin CC, Hou PH, Li WR, Hung CC, Lin CP, Lan TH, Chan CH. Duration of Untreated Psychosis and Brain Function during Verbal Fluency Testing in First-Episode Schizophrenia: A Near-Infrared Spectroscopy Study. Sci Rep 2015; 5:18069. [PMID: 26656662 PMCID: PMC4674798 DOI: 10.1038/srep18069] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/09/2015] [Indexed: 01/17/2023] Open
Abstract
A longer duration of untreated psychosis (DUP) has been associated with poor clinical outcomes in patients with schizophrenia (SZ); however, it remains unclear whether this is due to neurotoxic effects of psychosis. The purpose of this study was to use near-infrared spectroscopy (NIRS) to investigate the influence of DUP on brain function using two verbal fluency tests (VFTs) in patients with first-episode SZ (FES). A total of 28 FES patients and 29 healthy controls (HC) underwent NIRS during VFTs. Group comparisons of cortical activity were made using two-tailed t-tests and the false discovery rate method. We then examined the associations between DUP and hemodynamic changes in each channel to identify any effects of DUP on brain cortical activity. During the letter VFT, the HC group exhibited significantly greater cortical activations over bilateral frontotemporal regions compared to FES patients. However, this distinction was not observed while performing a category version of the VFT. In addition, no associations between DUP and brain cortical activity were observed in the FES group during either VFT. In conclusion, we did not find an association between DUP and frontotemporal cortical activities. This might be because neurodevelopmental disturbances result in neurocognitive deficits long before psychotic symptoms onset.
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Affiliation(s)
- Po-Han Chou
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Hao Lin
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Chien Lin
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Hsun Hou
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Social Work and Child Welfare, Providence University, Taichung, Taiwan
| | - Wan-Rung Li
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Chun Hung
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan.,Brain Connectivity Lab, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Po Lin
- Department of Social Work and Child Welfare, Providence University, Taichung, Taiwan.,Brain Connectivity Lab, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Tsuo-Hung Lan
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Hong Chan
- Department of Psychiatry, Conde S. Januário General Hospital, Macau, China
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Rodriguez-Jimenez R, Dompablo M, Bagney A, Santabárbara J, Aparicio AI, Torio I, Moreno-Ortega M, Lopez-Anton R, Lobo A, Kern RS, Green MF, Jimenez-Arriero MA, Santos JL, Nuechterlein KH, Palomo T. The MCCB impairment profile in a Spanish sample of patients with schizophrenia: Effects of diagnosis, age, and gender on cognitive functioning. Schizophr Res 2015; 169:116-120. [PMID: 26416441 DOI: 10.1016/j.schres.2015.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 09/06/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
The MATRICS Consensus Cognitive Battery (MCCB) was administered to 293 schizophrenia outpatients and 210 community residents in Spain. Our first objective was to identify the age- and gender-corrected MCCB cognitive profile of patients with schizophrenia. The profile of schizophrenia patients showed deficits when compared to controls across the seven MCCB domains. Reasoning and Problem Solving and Social Cognition were the least impaired, while Visual Learning and Verbal Learning showed the greatest deficits. Our second objective was to study the effects on cognitive functioning of age and gender, in addition to diagnosis. Diagnosis was found to have the greatest effect on cognition (Cohen's d>0.8 for all MCCB domains); age and gender also had effects on cognitive functioning, although to a lesser degree (with age usually having slightly larger effects than gender). The effects of age were apparent in all domains (with better performance in younger subjects), except for Social Cognition. Gender had effects on Attention/Vigilance, Working Memory, Reasoning and Problem Solving (better performance in males), and Social Cognition (better performance in females). No interaction effects were found between diagnosis and age, or between diagnosis and gender. This lack of interactions suggests that age and gender effects are not different in patients and controls.
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Affiliation(s)
- R Rodriguez-Jimenez
- Department of Psychiatry, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry,Universidad Complutense de Madrid, Spain.
| | - M Dompablo
- Department of Psychiatry, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - A Bagney
- Department of Psychiatry, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - J Santabárbara
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Preventive Medicine and Public Health, Universidad de Zaragoza,Spain
| | - A I Aparicio
- Department of Psychiatry, Hospital Virgen de La Luz, Cuenca,Spain
| | - I Torio
- Department of Psychiatry, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - M Moreno-Ortega
- Department of Psychiatry, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - R Lopez-Anton
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychology and Sociology, Universidad de Zaragoza, Spain
| | - A Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, Universidad de Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Spain
| | - R S Kern
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, USA; VA Greater Los Angeles Healthcare System, Los Angeles, USA
| | - M F Green
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, USA; VA Greater Los Angeles Healthcare System, Los Angeles, USA
| | - M A Jimenez-Arriero
- Department of Psychiatry, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry,Universidad Complutense de Madrid, Spain
| | - J L Santos
- Department of Psychiatry, Hospital Virgen de La Luz, Cuenca,Spain
| | - K H Nuechterlein
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, USA; Department of Psychology, UCLA, Los Angeles, USA
| | - T Palomo
- Department of Psychiatry, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry,Universidad Complutense de Madrid, Spain
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Balda M, Calvó M, Padilla E, Guerrero G, Molina J, Florenzano NV, Kamis D, Escobar JI, Cloninger CR, de Erausquin G. Detection, Assessment, and Management of Schizophrenia in an Andean Population of South America: Parkinsonism Testing and Transcranial Ultrasound as Preventive Tools. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2015; 13:432-440. [PMID: 26516317 DOI: 10.1176/appi.focus.20150018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Schizophrenia is a debilitating psychiatric illness that is among the world's top 10 causes of long-term disability, affecting people who are just entering the peak of social, economic, and intellectual productivity. Such functional loss is particularly relevant in indigenous communities, which rely on change in functional status (rather than on the presence of symptoms) to identify mental illness. Particularly among the indigenous communities of Latin America, the gap between mental health need and availability of resources to reduce the burden has been judged "a case of outrageous exclusion." For more than a decade, as part of the Investigation of Movement Abnormalities and Genetic of Schizophrenia study, the authors have been studying vulnerability markers (genetic, motor, imaging, and neuropsychological differences) for schizophrenia in a remote, indigenous population in rural northern Argentina. In this article, the authors discuss the implementation of a task-shifting paradigm resulting in more proficient identification and referral of individuals with untreated psychosis and a severalfold reduction in the duration of untreated psychosis, with very high retention rates (70%) and treatment adherence during a decade in a rural environment. The authors also propose to use transcranial ultrasound screening and testing for parkinsonism at illness onset before introduction of neuroleptics as potentially useful markers in determining illness severity, negative symptomatology, and tolerance to antipsychotic treatment/refractoriness.
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Affiliation(s)
- Mara Balda
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, and Roskamp Laboratory for Brain Development, Modulation and Repair, Morsani College of Medicine, University of South Florida, Tampa
| | - Maria Calvó
- Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA), Buenos Aires, Argentina
| | - Eduardo Padilla
- Ministerio de Salud, Hospital Neuropsiquiátrico Néstor Sequeiros, Provinicia de Jujuy, Argentina
| | - Gonzalo Guerrero
- FULTRA, Buenos Aires, Argentina; and Hospital Neuropsiquiátrico Néstor Sequeiros, Provinicia de Jujuy, Argentina
| | - Juan Molina
- Roskamp Laboratory for Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa
| | | | - Danielle Kamis
- Roskamp Laboratory for Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa
| | - Javier I Escobar
- Department of Global Health and Department of Psychiatry and Family Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - C Robert Cloninger
- Sansone Family Center for Well-Being and Center for Psychobiology of Personality, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Gabriel de Erausquin
- Roskamp Laboratory for Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa
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