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Chekroud AM, Hawrilenko M, Loho H, Bondar J, Gueorguieva R, Hasan A, Kambeitz J, Corlett PR, Koutsouleris N, Krumholz HM, Krystal JH, Paulus M. Illusory generalizability of clinical prediction models. Science 2024; 383:164-167. [PMID: 38207039 DOI: 10.1126/science.adg8538] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 11/10/2023] [Indexed: 01/13/2024]
Abstract
It is widely hoped that statistical models can improve decision-making related to medical treatments. Because of the cost and scarcity of medical outcomes data, this hope is typically based on investigators observing a model's success in one or two datasets or clinical contexts. We scrutinized this optimism by examining how well a machine learning model performed across several independent clinical trials of antipsychotic medication for schizophrenia. Models predicted patient outcomes with high accuracy within the trial in which the model was developed but performed no better than chance when applied out-of-sample. Pooling data across trials to predict outcomes in the trial left out did not improve predictions. These results suggest that models predicting treatment outcomes in schizophrenia are highly context-dependent and may have limited generalizability.
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Affiliation(s)
- Adam M Chekroud
- Spring Health, New York City, NY 10010, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA
| | | | - Hieronimus Loho
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA
| | | | | | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Augsburg, 86159 Augsburg, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Philip R Corlett
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT 06520, USA
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Martin Paulus
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
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2
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Singh D, Guest PC, Dobrowolny H, Fischbach T, Meyer-Lotz G, Breitling-Ziegler C, Haghikia A, Vielhaber S, Steiner J. Cytokine alterations in CSF and serum samples of patients with a first episode of schizophrenia: results and methodological considerations. Eur Arch Psychiatry Clin Neurosci 2023; 273:1387-1393. [PMID: 36773080 PMCID: PMC10449694 DOI: 10.1007/s00406-023-01569-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023]
Abstract
We determined cytokine levels in paired serum/CSF samples from first-episode schizophrenia (FES) participants (n = 20) and controls (n = 21) using a 13-plex immunoassay. Applying strictly-determined detection limits, 12 cytokines were found in serum and two in CSF. Higher serum MCP-1 levels (p = 0.007) were present in FES versus controls, which correlated with serum IgG (R = - 0.750; p = 0.013). Finally, IL-18 levels correlated with body weight in FES (R = 0.691; p = 0.041). This study demonstrates potential limitations in the sensitivity of multiplex cytokine assays for CSF studies in mental disorders and suggests that some published studies in this area should be re-evaluated.
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Affiliation(s)
- Deepti Singh
- Department of Psychiatry, Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany
- Laboratory of Translational Psychiatry, Otto-von-Guericke-University, Magdeburg, Germany
| | - Paul C Guest
- Department of Psychiatry, Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany
- Laboratory of Translational Psychiatry, Otto-von-Guericke-University, Magdeburg, Germany
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Henrik Dobrowolny
- Department of Psychiatry, Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany
- Laboratory of Translational Psychiatry, Otto-von-Guericke-University, Magdeburg, Germany
| | - Tino Fischbach
- Department of Psychiatry, Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany
- Laboratory of Translational Psychiatry, Otto-von-Guericke-University, Magdeburg, Germany
| | - Gabriela Meyer-Lotz
- Department of Psychiatry, Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany
- Laboratory of Translational Psychiatry, Otto-von-Guericke-University, Magdeburg, Germany
| | - Carolin Breitling-Ziegler
- Department of Psychiatry, Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany
- Laboratory of Translational Psychiatry, Otto-von-Guericke-University, Magdeburg, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto-von-Guericke-University, Magdeburg, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke-University, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- German Center for Mental Health (DZP), Center for Intervention and Research On Adaptive and Maladaptive Brain Circuits Underlying, Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke-University, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Johann Steiner
- Department of Psychiatry, Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.
- Laboratory of Translational Psychiatry, Otto-von-Guericke-University, Magdeburg, Germany.
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany.
- Center for Health and Medical Prevention (CHaMP), Magdeburg, Germany.
- German Center for Mental Health (DZP), Center for Intervention and Research On Adaptive and Maladaptive Brain Circuits Underlying, Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany.
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3
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Ponce-Correa F, Caqueo-Urízar A, Berrios R, Escobar-Soler C. Defining recovery in schizophrenia: A review of outcome studies. Psychiatry Res 2023; 322:115134. [PMID: 36871410 DOI: 10.1016/j.psychres.2023.115134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Abstract
Schizophrenia is a chronic disorder with a heterogenous course and different ways in which recovery is measured or perceived. Recovery in schizophrenia is a complex process that it can be defined either from a clinical perspective focused on sustained symptom and functional remission, or from a patient-focused one, as a self-broadening process aimed at living a meaningful life beyond mental illness. Until now, studies analysed these domains separately, without examining their mutual relations and changes over time. Therefore, this meta-analysis aimed to examine the relationship of global measures of subjective recovery with each of the components of clinical recovery such as symptom severity and functioning, in patients with schizophrenia spectrum disorders. The results showed that the association between different indicators of personal recovery and remission are weak and inverse (dIG+ = -0.18, z = -2.71, p < 0.01), however, this finding is not substantial according to the sensitivity indicators. With respect to functionality and personal recovery, there was a moderate relationship (dIG+ = 0.26, z = 7.894, p < 0.01) with adequate sensitivity indices. In addition, a low consensus exists between subjective measures that are more related to the patient's perspective and clinical measures based on experts and clinician's viewpoint.
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Affiliation(s)
- Felipe Ponce-Correa
- Programa Doctorado en Psicología, Escuela de Psicología y Filosofía, Facultad de Ciencias Sociales y Jurídicas, Universidad de Tarapacá, Avenida 18 de Septiembre N 2222, Casilla 7-D, Arica, Chile
| | | | - Raúl Berrios
- Departamento de administración, Facultad de administración y economía, Universidad de Santiago de Chile, Chile
| | - Carolang Escobar-Soler
- Programa Doctorado en Psicología, Escuela de Psicología y Filosofía, Facultad de Ciencias Sociales y Jurídicas, Universidad de Tarapacá, Avenida 18 de Septiembre N 2222, Casilla 7-D, Arica, Chile
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Iasevoli F, D’Ambrosio L, Ciccarelli M, Barone A, Gaudieri V, Cocozza S, Pontillo G, Brunetti A, Cuocolo A, de Bartolomeis A, Pappatà S. Altered Patterns of Brain Glucose Metabolism Involve More Extensive and Discrete Cortical Areas in Treatment-resistant Schizophrenia Patients Compared to Responder Patients and Controls: Results From a Head-to-Head 2-[18F]-FDG-PET Study. Schizophr Bull 2023; 49:474-485. [PMID: 36268829 PMCID: PMC10016407 DOI: 10.1093/schbul/sbac147] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND HYPOTHESIS Treatment resistant schizophrenia (TRS) affects almost 30% of patients with schizophrenia and has been considered a different phenotype of the disease. In vivo characterization of brain metabolic patterns associated with treatment response could contribute to elucidate the neurobiological underpinnings of TRS. Here, we used 2-[18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) to provide the first head-to-head comparative analysis of cerebral glucose metabolism in TRS patients compared to schizophrenia responder patients (nTRS), and controls. Additionally, we investigated, for the first time, the differences between clozapine responders (Clz-R) and non-responders (Clz-nR). STUDY DESIGN 53 participants underwent FDG-PET studies (41 patients and 12 controls). Response to conventional antipsychotics and to clozapine was evaluated using a standardized prospective procedure based on PANSS score changes. Maps of relative brain glucose metabolism were processed for voxel-based analysis using Statistical Parametric Mapping software. STUDY RESULTS Restricted areas of significant bilateral relative hypometabolism in the superior frontal gyrus characterized TRS compared to nTRS. Moreover, reduced parietal and frontal metabolism was associated with high PANSS disorganization factor scores in TRS (P < .001 voxel level uncorrected, P < .05 cluster level FWE-corrected). Only TRS compared to controls showed significant bilateral prefrontal relative hypometabolism, more extensive in CLZ-nR than in CLZ-R (P < .05 voxel level FWE-corrected). Relative significant hypermetabolism was observed in the temporo-occipital regions in TRS compared to nTRS and controls. CONCLUSIONS These data indicate that, in TRS patients, altered metabolism involved discrete brain regions not found affected in nTRS, possibly indicating a more severe disrupted functional brain network associated with disorganization symptoms.
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Affiliation(s)
- Felice Iasevoli
- Section of Psychiatry, Unit of Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Luigi D’Ambrosio
- Section of Psychiatry, Unit of Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Mariateresa Ciccarelli
- Section of Psychiatry, Unit of Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Annarita Barone
- Section of Psychiatry, Unit of Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Andrea de Bartolomeis
- Section of Psychiatry, Unit of Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
- UNESCO Chair on Health Education and Sustainable Development - University of Naples Federico II, Naples, Italy
| | - Sabina Pappatà
- Institute of Biostructure and Bioimaging, National Research Council, Via T. De Amicis 95, 80145, Naples, Italy
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Kho SH, Yee JY, Puang SJ, Han L, Chiang C, Rapisarda A, Goh WWB, Lee J, Sng JCG. DNA methylation levels of RELN promoter region in ultra-high risk, first episode and chronic schizophrenia cohorts of schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:81. [PMID: 36216926 PMCID: PMC9550813 DOI: 10.1038/s41537-022-00278-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/18/2022] [Indexed: 06/16/2023]
Abstract
The essential role of the Reelin gene (RELN) during brain development makes it a prominent candidate in human epigenetic studies of Schizophrenia. Previous literature has reported differing levels of DNA methylation (DNAm) in patients with psychosis. Therefore, this study aimed to (1) examine and compare RELN DNAm levels in subjects at different stages of psychosis cross-sectionally, (2) analyse the effect of antipsychotics (AP) on DNAm, and (3) evaluate the effectiveness and applicability of RELN promoter DNAm as a possible biological-based marker for symptom severity in psychosis.. The study cohort consisted of 56 healthy controls, 87 ultra-high risk (UHR) individuals, 26 first-episode (FE) psychosis individuals and 30 chronic schizophrenia (CS) individuals. The Positive and Negative Syndrome Scale (PANSS) was used to assess Schizophrenia severity. After pyrosequencing selected CpG sites of peripheral blood, the Average mean DNAm levels were compared amongst the 4 subgroups. Our results showed differing levels of DNAm, with UHR having the lowest (7.72 ± 0.19) while the CS had the highest levels (HC: 8.78 ± 0.35; FE: 7.75 ± 0.37; CS: 8.82 ± 0.48). Significantly higher Average mean DNAm levels were found in CS subjects on AP (9.12 ± 0.61) compared to UHR without medication (UHR(-)) (7.39 ± 0.18). A significant association was also observed between the Average mean DNAm of FE and PANSS Negative symptom factor (R2 = 0.237, ß = -0.401, *p = 0.033). In conclusion, our findings suggested different levels of DNAm for subjects at different stages of psychosis. Those subjects that took AP have different DNAm levels. There were significant associations between FE DNAm and Negative PANSS scores. With more future experiments and on larger cohorts, there may be potential use of DNAm of the RELN gene as one of the genes for the biological-based marker for symptom severity in psychosis.
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Affiliation(s)
- Sok-Hong Kho
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Jie Yin Yee
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Shu Juan Puang
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Luke Han
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Christine Chiang
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Attilio Rapisarda
- Research Division, Institute of Mental Health, Singapore, Singapore
- Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Wilson Wen Bin Goh
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Jimmy Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Research Division, Institute of Mental Health, Singapore, Singapore
- Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Judy Chia Ghee Sng
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Poonia S, Sharaf M, Procyshyn RM, White R, Rafizadeh R. Amisulpride Augmentation of Clozapine in Clozapine-Resistant Schizophrenia: A Case Series. Can J Hosp Pharm 2022; 75:234-238. [PMID: 35847467 PMCID: PMC9245404 DOI: 10.4212/cjhp.3178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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7
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Myken AN, Ebdrup BH, Sørensen ME, Broberg BV, Skjerbæk MW, Glenthøj BY, Lykkesfeldt J, Nielsen MØ. Lower Vitamin C Levels Are Associated With Less Improvement in Negative Symptoms in Initially Antipsychotic-Naïve Patients With First-Episode Psychosis. Int J Neuropsychopharmacol 2022; 25:613-618. [PMID: 35532335 PMCID: PMC9380709 DOI: 10.1093/ijnp/pyac029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 11/21/2022] Open
Abstract
Low levels of vitamin C have been observed in patients with schizophrenia and psychosis, and vitamin C may affect the dopaminergic system. Likewise, antipsychotic medication modulates striatal dopamine D2 receptors. We measured vitamin C levels in 52 patients with first-episode psychoses (24 females, age 23.1 ± 5.2 years) and 57 matched HCs (20 females, age 22.7 ± 4.3 years) before and after 6 weeks where patients received aripiprazole monotherapy (mean dose 10.4 mg ± 4.8 mg). At baseline, patients displayed lower levels of vitamin C (57.4 ± 25.9 µM) than controls (72.7 ± 21.4 µM) (t = 3.4, P = .001). Baseline symptoms and vitamin C levels were not correlated. Higher baseline vitamin C levels were associated with more improvement in negative symptoms (n = 39, R2 = 0.20, F = 8.2, P = .007), but not with age, sex, or p-aripiprazole. Because negative symptoms are generally considered challenging to alleviate, a potential adjunctive effect of vitamin C on treatment response should be tested in future randomized clinical trials.
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Affiliation(s)
- Anders N Myken
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark,Faculty of health and Medical Science, Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Bjørn H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark,Faculty of health and Medical Science, Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Mikkel E Sørensen
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Brian V Broberg
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Martin W Skjerbæk
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Birte Y Glenthøj
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark,Faculty of health and Medical Science, Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Jens Lykkesfeldt
- Faculty of Health and Medical Sciences, Department of Veterinary and Animal Sciences, University of Copenhagen, Denmark (Dr Lykkesfeldt)
| | - Mette Ø Nielsen
- Correspondence: Mette Ødegaard Nielsen, PhD, Nordstjernevej 41, DK-2600 Glostrup, Denmark ()
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Iasevoli F, Razzino E, Altavilla B, Avagliano C, Barone A, Ciccarelli M, D'Ambrosio L, Matrone M, Milandri F, Notar Francesco D, Fornaro M, de Bartolomeis A. Relationships between early age at onset of psychotic symptoms and treatment resistant schizophrenia. Early Interv Psychiatry 2022; 16:352-362. [PMID: 33998142 PMCID: PMC9291026 DOI: 10.1111/eip.13174] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 04/21/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
AIM Early age at schizophrenia onset (EOS) has been associated with a worse clinical course, although previous studies reported substantial heterogeneity. Despite the relevance of the subject, the relationship between the age of onset and treatment resistant schizophrenia (TRS) is less clear. METHODS We screened 197 non-affective psychotic patients. Of these, 99 suffered from schizophrenia and were putative TRS and were included in a prospective 4-to-8-week trial to assess their response to antipsychotics. According to status (TRS/nonTRS) and age-at-onset (early: ≤18 years, EOS; adult: >18 years, adult onset schizophrenia [AOS]) patients were subdivided in EOS-TRS, EOS-nonTRS, AOS-TRS, AOS-nonTRS. Multiple clinical variables were measured and compared by analysis of covariance (ANCOVA), using age as a covariate. Two-way analysis of variance (ANOVA) was used to assess whether significant differences were attributable to TRS status or age-at-onset. RESULTS The rate of TRS patients was significantly higher in EOS compared to AOS. At the ANCOVA, EOS-TRS had significantly worse clinical, cognitive, and psychosocial outcomes compared to the other groups. Overall, EOS-TRS were more impaired than EOS-nonTRS, while significant differences with AOS-TRS were less consistent, albeit appreciable. Two-way ANOVA demonstrated that, in the majority of the investigated variables, the significant differences among groups were attributable to the TRS status effect rather than to age-at-onset or combined effects. CONCLUSIONS These results suggest that refractoriness to antipsychotics may be strongly linked to the early onset of psychotic symptoms, possibly as a result of common neurobiology.
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Affiliation(s)
- Felice Iasevoli
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Eugenio Razzino
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Benedetta Altavilla
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Camilla Avagliano
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Annarita Barone
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Mariateresa Ciccarelli
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Luigi D'Ambrosio
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Marta Matrone
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Federica Milandri
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Danilo Notar Francesco
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Michele Fornaro
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Andrea de Bartolomeis
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
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9
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Resting-state functional connectivity predictors of treatment response in schizophrenia - A systematic review and meta-analysis. Schizophr Res 2021; 237:153-165. [PMID: 34534947 DOI: 10.1016/j.schres.2021.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/18/2021] [Accepted: 09/06/2021] [Indexed: 11/21/2022]
Abstract
We aimed to systematically synthesize and quantify the utility of pre-treatment resting-state functional magnetic resonance imaging (rs-fMRI) in predicting antipsychotic response in schizophrenia. We searched the PubMed/MEDLINE database for studies that examined the magnitude of association between baseline rs-fMRI assessment and subsequent response to antipsychotic treatment in persons with schizophrenia. We also performed meta-analyses for quantifying the magnitude and accuracy of predicting response defined continuously and categorically. Data from 22 datasets examining 1280 individuals identified striatal and default mode network functional segregation and integration metrics as consistent determinants of treatment response. The pooled correlation coefficient for predicting improvement in total symptoms measured continuously was ~0.47 (12 datasets; 95% CI: 0.35 to 0.59). The pooled odds ratio of predicting categorically defined treatment response was 12.66 (nine datasets; 95% CI: 7.91-20.29), with 81% sensitivity and 76% specificity. rs-fMRI holds promise as a predictive biomarker of antipsychotic treatment response in schizophrenia. Future efforts need to focus on refining feature characterization to improve prediction accuracy, validate prediction models, and evaluate their implementation in clinical practice.
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Khonsari NM, Badrfam R, Mohammdi MR, Rastad H, Etemadi F, Vafaei Z, Zandifar A. Effect of Aerobic Exercise as Adjunct Therapy on the Improvement of Negative Symptoms and Cognitive Impairment in Patients With Schizophrenia: A Randomized, Case-Control Clinical Trial. J Psychosoc Nurs Ment Health Serv 2021; 60:38-43. [PMID: 34677118 DOI: 10.3928/02793695-20211014-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study aimed to evaluate the effects of exercise on negative and cognitive symptoms and simultaneous evaluation of brain and hippocampus volume in patients with schizophrenia. Forty patients with schizophrenia were randomly divided into two groups. The intervention group, in addition to pharmacological treatment, underwent a multi-session exercise program for 8 weeks. At the beginning and end of the study, patients were assessed for cognitive status and negative symptoms using the Mini-Mental State Examination (MMSE) and Positive and Negative Syndrome Scale (PANSS), respectively. Total brain volume and hippocampus volume were also measured using magnetic resonance imaging. Overall, mean MMSE score significantly improved over time, but this improvement was greater in the intervention group (29%) compared to the control group (11%). The same was true for the PANSS negative score (21.5% vs. 53.5%). Absolute hippocampus volume during these 8 weeks, in exercise and control groups, increased from 6.24 to 7.11 and 6.44 to 6.59, respectively. The greater increase in volume obtained in the intervention group was statistically significant (p = 0.003). Exercise may be associated with improved cognitive function and negative symptoms in patients with schizophrenia; however, additional studies are warranted. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
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Long-term safety and durability of effect with a combination of olanzapine and samidorphan in patients with schizophrenia: results from a 1-year open-label extension study. CNS Spectr 2021; 26:383-392. [PMID: 32393412 DOI: 10.1017/s1092852920001376] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Combination olanzapine and samidorphan (OLZ/SAM), in development for schizophrenia and bipolar I disorder, is intended to provide the efficacy of olanzapine while mitigating olanzapine-associated weight gain. OLZ/SAM safety, tolerability, and efficacy from a 52-week open-label extension study in patients with schizophrenia are reported. METHODS Patients previously completing the 4-week, double-blind ENLIGHTEN-1 study switched from OLZ/SAM, olanzapine, or placebo to OLZ/SAM. Assessments included adverse events (AEs), weight, vital signs, Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression-Severity (CGI-S) scores. Baseline was prior to first dose of OLZ/SAM in the extension study. RESULTS In total, 281 patients enrolled, 277 received ≥1 OLZ/SAM dose, and 183 (66.1%) completed 52 weeks. Reasons for discontinuation included patient withdrawal (15.5%), loss to follow-up (6.9%), AEs (5.8%), and lack of efficacy (1.8%). AEs were reported in 136 (49.1%) patients; increased weight (13%) and somnolence (8%) were most common. Ten serious AEs were reported in eight patients (2.9%); none were considered treatment related. There were no deaths. Mean (SD) baseline weight was 79.1 (17.8) kg. Mean weight change from baseline to week 52 was 1.86 kg (2.79% increase). PANSS total and CGI-S scores continued to decline over 52 weeks (mean [95% CI] changes from baseline to week 52: -16.2 [-18.5, -14.0] and -0.9 [-1.0, -0.8], respectively). CONCLUSION OLZ/SAM was generally well tolerated in this extension study; most patients completed the 52-week treatment period with sustained improvement in schizophrenia symptoms. Mean increases in weight stabilized by week 6 with limited subsequent change through end of treatment.
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12
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Galderisi S, Mucci A, Dollfus S, Nordentoft M, Falkai P, Kaiser S, Giordano GM, Vandevelde A, Nielsen MØ, Glenthøj LB, Sabé M, Pezzella P, Bitter I, Gaebel W. EPA guidance on assessment of negative symptoms in schizophrenia. Eur Psychiatry 2021; 64:e23. [PMID: 33597064 PMCID: PMC8080207 DOI: 10.1192/j.eurpsy.2021.11] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background During the last decades, a renewed interest for negative symptoms (NS) was brought about by the increased awareness that they interfere severely with real-life functioning, particularly when they are primary and persistent. Methods In this guidance paper, we provide a systematic review of the evidence and elaborate several recommendations for the conceptualization and assessment of NS in clinical trials and practice. Results Expert consensus and systematic reviews have provided guidance for the optimal assessment of primary and persistent negative symptoms; second-generation rating scales, which provide a better assessment of the experiential domains, are available; however, NS are still poorly assessed both in research and clinical settings. This European Psychiatric Association (EPA) guidance recommends the use of persistent negative symptoms (PNS) construct in the context of clinical trials and highlights the need for further efforts to make the definition of PNS consistent across studies in order to exclude as much as possible secondary negative symptoms. We also encourage clinicians to use second-generation scales, at least to complement first-generation ones. The EPA guidance further recommends the evidence-based exclusion of several items included in first-generation scales from any NS summary or factor score to improve NS measurement in research and clinical settings. Self-rated instruments are suggested to further complement observer-rated scales in NS assessment. Several recommendations are provided for the identification of secondary negative symptoms in clinical settings. Conclusions The dissemination of this guidance paper may promote the development of national guidelines on negative symptom assessment and ultimately improve the care of people with schizophrenia.
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Affiliation(s)
- S Galderisi
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - A Mucci
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - S Dollfus
- CHU de Caen, Service de Psychiatrie, 14000Caen, France.,Normandie Univ, UNICAEN, ISTS EA 7466, GIP Cyceron, 14000Caen, France.,Normandie Univ, UNICAEN, UFR de Médecine, 14000Caen, France
| | - M Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - P Falkai
- Department of Psychiatry, University of Munich, Munich, Germany
| | - S Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - G M Giordano
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - A Vandevelde
- CHU de Caen, Service de Psychiatrie, 14000Caen, France.,Normandie Univ, UNICAEN, ISTS EA 7466, GIP Cyceron, 14000Caen, France.,Normandie Univ, UNICAEN, UFR de Médecine, 14000Caen, France
| | - M Ø Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark.,Center for Neuropsychiatric Schizophrenia Research, CNSR, Glostrup, Denmark
| | - L B Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - M Sabé
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - P Pezzella
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - I Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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13
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Afshari B, Shiri N, Ghoreishi FS, Valianpour M. Examination and Comparison of Cognitive and Executive Functions in Clinically Stable Schizophrenia Disorder, Bipolar Disorder, and Major Depressive Disorder. DEPRESSION RESEARCH AND TREATMENT 2020; 2020:2543541. [PMID: 33414961 PMCID: PMC7752301 DOI: 10.1155/2020/2543541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 11/29/2020] [Accepted: 12/10/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Schizophrenia (SC), bipolar disorder (BD), and major depressive disorder (MDD) are associated with various cognitive and executive dysfunctions. The aim of the present study was to evaluate and compare cognitive and executive dysfunctions in schizophrenia, bipolar disorder, and major depressive disorder. MATERIALS AND METHODS Sixty-four schizophrenia patients, 68 bipolar patients, 62 patients with major depressive disorder, and 75 healthy individuals participated in the present study. All participants were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Young Mania Rating Scale (YMRS), Positive and Negative Syndrome Scale (PANSS), Beck Depression Inventory (BDI-II), Trial Making Test (TMT), Four-Choice Reaction Time Task, Ruler Drop Method (RDM), Tower of London (TOL) task, and the Wisconsin Card Sorting Task (WCST). Data were analyzed by chi-square, Kolmogorov-Smirnov, and independent t-tests; ANOVA; and MANOVA. RESULTS In the cognitive function, the scores of SC, BD, and MDD patients were lower than those of healthy individuals. Also, the scores of MDD patients were lower than those of other patients, and the scores of BD patients were lower than those of SC patients. In the executive function, the scores of SC, BD, and MDD patients were lower than those of healthy individuals. Moreover, the scores of the MDD group were higher than those of the BD and SC groups, and the scores of the SC group were higher than those of the BD group. CONCLUSION Patients with SC, BD, and MDD have poorer cognitive and executive functions than healthy individuals, even when these patients are in a stable state. Assessment of cognitive and executive functions in SC, BD, and MDD patients can help in understanding the pathology of these disorders.
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Affiliation(s)
| | - Nasrin Shiri
- Kashan University of Medical Science, Kashan, Iran
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14
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França G, Laranjeira E, Silva F, Monteiro L, Moreira AM, Carvalho S. Attachment Style and Insight in Schizophrenia: a Cross-Sectional Study. Psychiatr Q 2020; 91:31-43. [PMID: 31768908 DOI: 10.1007/s11126-019-09675-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Attachment theory provides a model for understanding impairments in social and interpersonal functioning. Schizophrenia is a neuropsychiatry disorder frequently associated with compromised social functioning and limited social support networks. However, the relationship between attachment style and psychopathology dimensions, including insight, isn't fully understood To determine whether there is a relationship between the attachment style and markers for severity of schizophrenia and insight. We conducted a cross-sectional study of 41 patients with schizophrenia and 34 patients with non-psychotic disorders used as a control group. Patients were assessed using semi-structured diagnostic interviews and self-reporting questionnaires, including Adult Attachment Scale-Revised. The schizophrenia group was also given the Positive and Negative Syndrome Scale and the Markova and Berrios Insight Scale. Insecure attachment was overrepresented in the schizophrenic group, and this difference was mainly accounted for lower levels of dependence, representing a moderate effect size (Cohen's d = 0.32). In the schizophrenia group, the closeness and the dependence subscale were negatively correlated with psychopathology severity. Using a multiple regression analysis, the insight was predicted by attachment anxiety, accounting for 20% of the total variance (R2 = 0.199, p <0.05). Our data confirm previous evidence that insecure attachment is associated with schizophrenia and suggest that the less comfortable the patient is with closeness and intimacy the greater the severity of symptoms. Furthermore, our findings indicate that higher separation anxiety might predict a better insight.
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Affiliation(s)
- Gustavo França
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal.
| | - Erika Laranjeira
- Center for Economics and Finance, Oporto University, Porto, Portugal
| | - Fabio Silva
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| | - Lília Monteiro
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| | - Ana Maria Moreira
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| | - Serafim Carvalho
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
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15
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Lee BJ, Kim SW, Kim JJ, Yu JC, Lee KY, Won SH, Lee SH, Kim SH, Kang SH, Kim E, Kim K, Piao YH, Chung YC. Defining Treatment Response, Remission, Relapse, and Recovery in First-Episode Psychosis: A Survey among Korean Experts. Psychiatry Investig 2020; 17:163-174. [PMID: 32093460 PMCID: PMC7046996 DOI: 10.30773/pi.2019.0240] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/17/2019] [Accepted: 12/02/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE For the proper treatment of first-episode psychosis, assessment of treatment response, remission, relapse, and recovery is important. Therefore, the present study aimed to develop operational definitions of clinical outcomes in first-episode psychosis. METHODS A questionnaire was developed by a panel of experts and underwent three revisions. The final survey was presented to 150 psychiatrists who were members of the Korean Society for Schizophrenia Research. Respondents selected factors that they believed were important to consider while defining treatment response, remission, relapse, and recovery using a 6-point Likert scale. Selected factors that constituted each definition were statistically extracted, and operational definitions were developed. RESULTS A total of 91 experts responded to the survey. The extent of reduction in psychopathology, socio-occupational functioning, and duration of each state were the core factors of each definition. Outcomes obtained from discussions and consultations by experts have been summarized and proposed. CONCLUSION The criteria developed in this survey tended to be somewhat stricter than those used by other studies. The fundamental reason for this is that this survey focused on first-episode psychosis. A better understanding of each definition in first-episode psychosis is necessary to improve effective treatment outcomes.
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Affiliation(s)
- Bong Ju Lee
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jung Jin Kim
- Department of Psychiatry, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Republic of Korea
| | - Je-Chun Yu
- Department of Psychiatry, Eulji University School of Medicine, Eulji University Hospital, Daejeon, Republic of Korea
| | - Kyu Young Lee
- Department of Psychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul, Republic of Korea
| | - Seung-Hee Won
- Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Inje University College of Medicine, Goyang, Republic of Korea
| | - Seung-Hyun Kim
- Department of Psychiatry, Korea University College of Medicine, Guro Hospital, Seoul, Republic of Korea
| | - Shi Hyun Kang
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - Euitae Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kunhyung Kim
- Department of Occupational and Environmental Medicine, Institute of Environmental and Occupational Medicine, Busan Paik Hospital, Inje University, Busan, Republic of Korea
| | - Yang Hong Piao
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
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Leucht S, Barabássy Á, Laszlovszky I, Szatmári B, Acsai K, Szalai E, Harsányi J, Earley W, Németh G. Linking PANSS negative symptom scores with the Clinical Global Impressions Scale: understanding negative symptom scores in schizophrenia. Neuropsychopharmacology 2019; 44:1589-1596. [PMID: 30836381 PMCID: PMC6785000 DOI: 10.1038/s41386-019-0363-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/29/2019] [Accepted: 02/25/2019] [Indexed: 12/29/2022]
Abstract
Understanding how rating scale improvement corresponds to a clinical impression in patients with negative symptoms of schizophrenia may help define the clinical relevance of change in this patient population. We conducted post hoc equipercentile linking analyses of Positive and Negative Syndrome Scale (PANSS) outcomes (e.g., PANSS-Factor Score for Negative Symptoms [FSNS]) with Clinical Global Impressions-Improvement (CGI-I) and -Severity (CGI-S) ratings on data from patients treated with cariprazine (n = 227) or risperidone (n = 229) in a clinical study evaluating negative symptoms in schizophrenia. Patients were prospectively selected for persistent, predominant negative symptoms of schizophrenia (PNS), and minimal positive/depressive/extrapyramidal symptoms. Linking results demonstrated that greater improvement on PANSS-derived measures corresponded to clinical impressions of greater improvement, as measured by the CGI-I, and less severe disease states, as measured by the CGI-S. For example, CGI-S scores of 1 (normal), 2, 3, 4, 5, and 6 (severely ill) corresponded to PANSS-FSNS scores of 7, 13, 19, 24, 29, and 35, respectively. Likewise, CGI-I scores of minimally improved, much improved, and very much improved corresponded to a change from baseline in PANSS-FSNS scores of -27%, -49%, and -100%, respectively. These are important findings for the interpretation of the results of trials in patients with persistent negative symptoms.
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Affiliation(s)
- Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany.
| | - Ágota Barabássy
- 0000 0004 0621 5862grid.418137.8Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | - István Laszlovszky
- 0000 0004 0621 5862grid.418137.8Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | - Balázs Szatmári
- 0000 0004 0621 5862grid.418137.8Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | - Károly Acsai
- 0000 0004 0621 5862grid.418137.8Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | - Erzsébet Szalai
- 0000 0004 0621 5862grid.418137.8Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | - Judit Harsányi
- 0000 0004 0621 5862grid.418137.8Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | | | - György Németh
- 0000 0004 0621 5862grid.418137.8Medical Division, Gedeon Richter Plc, Budapest, Hungary
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17
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Nielsen LD, Bech P, Hounsgaard L, Gildberg FA. Construct validity of the Mechanical Restraint - Confounders, Risk, Alliance Score (MR-CRAS): a new risk assessment instrument. Nord J Psychiatry 2019; 73:331-339. [PMID: 31264926 DOI: 10.1080/08039488.2019.1634757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: A new short-term risk assessment instrument, the Mechanical Restraint - Confounders, Risk, Alliance Score (MR - CRAS) checklist, including three subscales with altogether 18 items, has been developed in close collaboration with forensic mental health nurses, psychiatrists' etc., and shows evidence of being comprehensible, relevant, comprehensive and easy to use for assessing the patient's readiness to be released from mechanical restraint. Aim: The aim of this study was to investigate whether the subscales: confounders, risk and parameters of alliance constituted separate subscales and needed further revisions. Materials and methods: MR - CRAS was field-study tested among nurses, nurse assistants and social and health care assistants in 13 Danish closed forensic mental health inpatient units, and a Mokken analysis of scalability and a Spearman correlation analysis were performed. Results: MR - CRAS was completed by clinicians in 143 episodes of mechanical restraint, representing 88 patients, with a mean duration of 63.25 hours. Most patients were younger men, diagnosed within the schizophrenia spectrum. One-third of the patients had repeated mechanical restraint episodes ranging between 2 and 8 episodes. MR - CRAS and especially the parameters of alliance were perceived as usable for assessment of the patient's readiness to be released from mechanical restraint. The psychometric analyses showed that the three subscales were unidimensional. Conclusions: The study shows evidence of the construct validity of MR - CRAS among clinicians at closed forensic mental health inpatient units. MR - CRAS contributes with a common language and structured, systematic and transparent observations and assessments on an hour by hour basis during mechanical restraint.
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Affiliation(s)
- Lea Deichmann Nielsen
- a Department of Psychiatry , Middelfart , Denmark.,b Nursing Education, University College South , Esbjerg , Denmark.,c Open, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark , Odense , Denmark.,d Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark , Odense , Denmark
| | - Per Bech
- e Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen , Hilleroed , Denmark
| | - Lise Hounsgaard
- c Open, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark , Odense , Denmark.,d Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark , Odense , Denmark.,f Institute of Nursing and Health Science, University of Greenland , Nuuk , Greenland.,g University College Lillebaelt , Vejle , Denmark
| | - Frederik Alkier Gildberg
- a Department of Psychiatry , Middelfart , Denmark.,d Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark , Odense , Denmark
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Comparison of original and revised reinforcement sensitivity theory in clinically-stable schizophrenia and bipolar disorder patients. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2018.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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19
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Association between COMT gene polymorphisms, clinical symptoms, and cognitive functions in Han Chinese patients with schizophrenia. Psychiatr Genet 2018; 28:47-54. [PMID: 29634613 DOI: 10.1097/ypg.0000000000000194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Catechol-O-methyltransferase (COMT) gene variants may be involved in the pathogenesis of psychotic symptoms, and associated especially with negative symptom in schizophrenia, but their roles in cognitive function and treatment response remain unclear. The aim of this study was to explore the association between COMT gene polymorphisms, clinical symptoms (including cognitive function), and treatment response to antipsychotic medications in patients with schizophrenia. PATIENTS AND METHODS A total of 200 Han Chinese inpatients with schizophrenia were recruited in accordance with Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV). In total, 96 of them completed assessments at baseline and after 8 weeks of antipsychotic treatment. Clinical symptoms were assessed using the Positive And Negative Syndrome Scale (PANSS), and cognitive function was evaluated using the Verbal Fluency Test, Trail Making Test A-B, Stroop Color-Word Test, and Wisconsin Card Sorting Test. Two single nucleotide polymorphisms, rs4680 and rs165599, on the COMT gene were genotyped. RESULTS At baseline, we found no significant genotypic association between rs4680 and clinical symptoms or cognitive function. After 8 weeks of antipsychotic treatment, compared with patients with GG genotype, patients with AA/AG genotypes at rs4680 showed significantly higher scores on PANSS total, both at baseline and at the end of 8 weeks, especially in negative and general psychopathology symptoms. Patients with GG at rs165599 scored significantly higher on the Stroop test, suggesting better cognitive performance after 8 weeks of treatment. No significant association was found between rs165599 genotype and psychiatric symptoms as assessed by the PANSS and cognitive function tests at baseline. CONCLUSION Our findings suggest that the COMT gene polymorphisms may influence the response to antipsychotic treatment in Han Chinese patients with schizophrenia.
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Iasevoli F, D'Ambrosio L, Notar Francesco D, Razzino E, Buonaguro EF, Giordano S, Patterson TL, de Bartolomeis A. Clinical evaluation of functional capacity in treatment resistant schizophrenia patients: Comparison and differences with non-resistant schizophrenia patients. Schizophr Res 2018; 202:217-225. [PMID: 29934250 DOI: 10.1016/j.schres.2018.06.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 04/05/2018] [Accepted: 06/11/2018] [Indexed: 01/03/2023]
Abstract
Treatment resistant schizophrenia (TRS) is defined by poor or non-response to conventional antipsychotic agents. Functional capacity is defined as the baseline potential of a patient to function in the community, irrespective of actual achievements gained, and has never been studied in TRS. Here, we screened 182 patients with psychotic symptoms and separated them in TRS (n = 28) and non-TRS (n = 32) ones, to evaluate whether they exhibited differential extents and predictive clinical variables of functional capacity. Functional capacity was measured by the UCSD Performance-Based Skills Assessment (UPSA). Psychotic symptoms by PANSS, social functioning by PSP and SLOF, clinical severity of the illness, cognitive functioning, and neurological soft signs (NSS) were assessed. TRS patients had non-significant lower UPSA scores compared to non-TRS (t-test: p > 0.05). In TRS, UPSA score correlated with multiple clinical variables. The highest effect sizes were observed for PANSS negative score (r = -0.67, p < 0.005); SLOF Area1 score (r = 0.66, p < 0.005); NSS severity (r = -0.61, p < 0.005). Multivariate analysis showed that main predictors of UPSA score in TRS patients were PANSS negative score, education years, NSS, Problem Solving performances, and PSP score (F = 11.12, R2 = 0.75, p < 0.0005). These variables were not predictive of UPSA score in non-TRS patients. Hierarchical analysis found that variance in UPSA score mainly depended on negative symptoms, NSS, and problem solving (F = 15.21, R2 = 0.65, p < 0.0005). Path analysis individuated two separate paths to UPSA score. These results delineate a limited and independent group of candidate predictors to be putatively accounted for therapeutic interventions to improve functional capacity, and possibly social functioning, in TRS patients.
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Affiliation(s)
- Felice Iasevoli
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Luigi D'Ambrosio
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Danilo Notar Francesco
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Eugenio Razzino
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Elisabetta Filomena Buonaguro
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Sara Giordano
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Andrea de Bartolomeis
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy.
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Evaluation of a few discrete clinical markers may predict categorization of actively symptomatic non-acute schizophrenia patients as treatment resistant or responders: A study by ROC curve analysis and multivariate analyses. Psychiatry Res 2018; 269:481-493. [PMID: 30195742 DOI: 10.1016/j.psychres.2018.08.109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 07/04/2018] [Accepted: 08/24/2018] [Indexed: 02/07/2023]
Abstract
Here, we used Receiver Operating Characteristic (ROC) curve analysis to determine whether clinical factors may aid predicting the categorization of schizophrenia patients as Treatment Resistant (TRS) or antipsychotic responsive schizophrenia (ARS). Patients with an established condition of TRS or ARS were assessed for: clinical presentation and course; neurological soft signs (NES); psychopathology by PANSS; cognitive performances; quality of life scale (QLS); functional capacity; social functioning (PSP and SLOF scales). In ROC curve analysis, significance indicated that the Area under curve (AUC) allowed distinguishing between TRS and ARS. Multivariate analyses were additionally used to provide independent predictive analysis. Multiple clinical variables showed significant AUCs. The largest significant AUCs were found for: NES total score; SLOF Area2; QLS subscale; antipsychotic doses. The highest sensitivity was found for NES total score, the highest specificity for previous hospitalizations. The highest Odds Ratio of being included within the TRS category were found for: NES total score (7.5); QLS total score (5.49); and previous hospitalizations (4.76). This same circumscribed group of variables was also found to be predictive of TRS when adopting stepwise logistic regression or discriminant analysis. We concluded that the evaluation of few clinical factors may provide reliable and accurate predictions on whether one schizophrenia patient may be categorized as a TRS.
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Anderson AE, Marder S, Reise SP, Savitz A, Salvadore G, Fu DJ, Li Q, Turkoz I, Han C, Bilder RM. Bifactor Modeling of the Positive and Negative Syndrome Scale: Generalized Psychosis Spans Schizoaffective, Bipolar, and Schizophrenia Diagnoses. Schizophr Bull 2018; 44:1204-1216. [PMID: 29420822 PMCID: PMC6192503 DOI: 10.1093/schbul/sbx163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Common genetic variation spans schizophrenia, schizoaffective and bipolar disorders, but historically, these syndromes have been distinguished categorically. A symptom dimension shared across these syndromes, if such a general factor exists, might provide a clearer target for understanding and treating mental illnesses that share core biological bases. METHOD We tested the hypothesis that a bifactor model of the Positive and Negative Syndrome Scale (PANSS), containing 1 general factor and 5 specific factors (positive, negative, disorganized, excited, anxiety), explains the cross-diagnostic structure of symptoms better than the traditional 5-factor model, and examined the extent to which a general factor reflects the overall severity of symptoms spanning diagnoses in 5094 total patients with a diagnosis of schizophrenia, schizoaffective, and bipolar disorder. RESULTS The bifactor model provided superior fit across diagnoses, and was closer to the "true" model, compared to the traditional 5-factor model (Vuong test; P < .001). The general factor included high loadings on 28 of the 30 PANSS items, omitting symptoms associated with the excitement and anxiety/depression domains. The general factor had highest total loadings on symptoms that are often associated with the positive and disorganization syndromes, but there were also substantial loadings on the negative syndrome thus leading to the interpretation of this factor as reflecting generalized psychosis. CONCLUSIONS A bifactor model derived from the PANSS can provide a stronger framework for measuring cross-diagnostic psychopathology than a 5-factor model, and includes a generalized psychosis dimension shared at least across schizophrenia, schizoaffective, and bipolar disorder.
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Affiliation(s)
- Ariana E Anderson
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA,Department of Statistics, University of California, Los Angeles, Los Angeles, CA,To whom correspondence should be addressed; Semel Institute at UCLA, 760 Westwood Plaza, Suite 28–224, Los Angeles, CA 90095; tel: (310)-254-5680, fax: (310)-825-0733, e-mail:
| | - Stephen Marder
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Steven P Reise
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA
| | - Adam Savitz
- Janssen Research and Development, Titusville, NJ
| | | | - Dong Jing Fu
- Janssen Research and Development, Titusville, NJ
| | - Qingqin Li
- Janssen Research and Development, Titusville, NJ
| | | | - Carol Han
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Robert M Bilder
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA,Department of Psychology, University of California, Los Angeles, Los Angeles, CA
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PARANOID SCHIZOPHRENIA NEGATIVE SYMPTOMS FEATURES IN CASE OF PRESENCE OF MUSICAL EAR. EUREKA: HEALTH SCIENCES 2018. [DOI: 10.21303/2504-5679.2018.00650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In our work, we propose one of the options for a prognostic criterion, which at the beginning of the disease can provide sufficient evidence to predict the form and severity of negative symptoms in schizophrenia.
Aim. To investigate the influence of the presence of ear on music on the degree of severity of deficiency symptoms in paranoid schizophrenia.
The study was conducted on the basis of the third clinical department of the Lviv Regional Clinical Psychiatric Hospital for the period of 2015. 40 patients with paranoid form of schizophrenia, aged 18 to 35, were examined, of which: group I – 20 patients with advanced ear on music (average age 28.60±1.01 years) and group II – 20 patients with no ear on music (average age 27.30±1.15 years). The main methods of studying the observation groups were: clinical-psychopathological, pathopsychological, and statistical. The pathopsychological study of the evaluation of negative symptoms was conducted using the "Qualitative Assessment Scale for Positivity, Negative and General Psychopathological Syndromes" (PANSS – Positive and Negative Syndrome Scale), namely, its PANSS-NS subscale. Comparison of the probability of the difference between the average indices of unrelated groups was carried out using the Mann-Whitney method, comparing the relative parameters of the distribution structure by the xi-square criterion.
Analysis of the results of the study shows that in patients with developed ear on music, the level of deficiency symptoms of negative symptoms under the PANSS-NS subclass is 2.2 times lower (p <0.01) than in patients with no developed ear on music: 2.04±0.14 against 4.46±0.17 points, respectively. Comparing the key indicators of the PANSS-NS subscale in patients with paranoid schizophrenia with advanced ear on music, it was found that the manifestations of "Violations of abstract thinking" (N5 – 2.35±0.15 points), "Violation of spontaneity and smoothness in the conversation" (N6 – 2.30±0.15 points) and "Stereotyped thinking" (N7 – 2.20±0.16 points). All these negative symptoms were in patients with muscular earache with significantly lower scores: from lack of severity (1 point) to weakness (3 points). The lack of expressiveness (1 point) was most common in N4 "Passive-apathy social strangeness " - 35.00±10.67 % of patients, very weak severity (2 points) - for N1 "Blurred passion" - 75.00±9.68 % of patients (p <0.05 with the proportion of negative symptoms 1 and 3 points), weakness (3 points) - for N5 – 45.00±11.12 % of patients (p <0.05 with the proportion of negative symptoms 1 point ) The highest proportion (70.00±10.25 %, p <0.05 with a share of negative symptoms of 6 points) of patients with paranoid schizophrenia without ear on music had a high severity (5 points) of rigidity and stereotyping of thinking (N7).
The obtained data prove the influence of the factor of the presence of ear on music on deficit syndrome, as well as on the forms and degree of severity of negative symptoms in paranoid schizophrenia.
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Allostatic load is associated with psychotic symptoms and decreases with antipsychotic treatment in patients with schizophrenia and first-episode psychosis. Psychoneuroendocrinology 2018; 90:35-42. [PMID: 29427955 DOI: 10.1016/j.psyneuen.2018.02.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/28/2018] [Accepted: 02/01/2018] [Indexed: 01/19/2023]
Abstract
Current pathophysiological models of schizophrenia suggest that stress contributes to the etiology and trajectory of the disorder. We investigated if allostatic load (AL), an integrative index of neuroendocrine, immune and metabolic dysregulation in response to chronic stress, is elevated in patients with schizophrenia (SCZ) and first-episode psychosis (FEP) and related to psychotic symptoms and social and occupational functioning. Additionally, we assessed the temporal dynamics of AL in response to treatment with second-generation antipsychotics. AL, psychotic symptoms and psychosocial functioning were assessed in a longitudinal design in patients with SCZ (n = 28), FEP (n = 28), and healthy controls (n = 53) at baseline and 6 and 12 weeks after commencement of antipsychotic therapy. AL at baseline was higher in patients with SCZ and FEP relative to controls, but not different between patients with SCZ and FEP. Adjusting for age and smoking, we found that positive symptoms were positively correlated with AL and psychosocial functioning was negatively correlated with AL at trend level. Linear mixed model analysis demonstrated that AL decreased after treatment was commenced in patients with SCZ and FEP between the baseline assessment and the 6 and 12-week follow-up. AL was not predictive of treatment response or symptomatic remission. Our data provide evidence for cumulative physiological dysregulation in patients with SCZ and FEP that is linked to the experience of current positive psychotic symptoms. AL could be a useful tool to monitor biological signatures related to chronic stress and unhealthy behaviors in schizophrenia.
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de Bartolomeis A, Prinzivalli E, Callovini G, D'Ambrosio L, Altavilla B, Avagliano C, Iasevoli F. Treatment resistant schizophrenia and neurological soft signs may converge on the same pathology: Evidence from explanatory analysis on clinical, psychopathological, and cognitive variables. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:356-366. [PMID: 28887181 DOI: 10.1016/j.pnpbp.2017.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/17/2017] [Accepted: 09/03/2017] [Indexed: 12/31/2022]
Abstract
Here, we investigated neurological soft signs (NSSs) in treatment resistant schizophrenia (TRS) vs treatment responder schizophrenia (SZ) patients. TRS is a severe condition, affecting approximately one-third of schizophrenia patients and representing a relevant clinical challenge. NSSs are neurological abnormalities reportedly described in schizophrenia patients and linked to dysregulated network connections. We explored the possibility that NSSs may be: i) more severe in TRS patients; ii) differentially associated to clinical/cognitive variables in TRS vs SZ; iii) predictive of having TRS. In addition, we evaluated whether diagnosis may mediate NSSs associations with the above-mentioned variables. Consecutive patients with schizophrenia diagnosis underwent stringent assessment for TRS diagnosis. Demographics and clinical variables were recorded. Psychopathology (by Positive and Negative Syndrome Scale, PANSS), cognitive performances, and NSSs (by Neurological Evaluation Scale, NES) were tested. TRS had higher scores than SZ patients in total NES score and in almost all NES subscales, even after correction for duration of illness and antipsychotic dose (ANCOVA, p<0.05). NSSs significantly correlated with multiple clinical, psychopathological, and cognitive variables (above all: duration of disease and negative symptoms) in TRS but not in SZ patients. Two-way ANOVA showed NSS-x-diagnosis interaction in determining outcomes on multiple cognitive performances, but not in other clinical variables. However, simple main effect analysis detected a significant relationship between high severity NSSs and TRS diagnosis on multiple clinical and cognitive outcomes. Hierarchical regression analysis showed that diagnosis was among a discrete number of predictors yielding significant increases in variance explained on NES total, Sensory Integration and Other Signs subscales' scores. NSSs, together with antipsychotic dose and disease severity, were found to be significantly predictive of TRS diagnosis in a binary logistic regression model. These results suggest a stringent association between NSSs and TRS diagnosis, and may imply that NSSs association with clinical, psychopathological, and cognitive variables may be in part mediated by TRS diagnosis.
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Affiliation(s)
- Andrea de Bartolomeis
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy.
| | - Emiliano Prinzivalli
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Gemma Callovini
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Luigi D'Ambrosio
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Benedetta Altavilla
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Camilla Avagliano
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Felice Iasevoli
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
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Nielsen MØ, Rostrup E, Broberg BV, Wulff S, Glenthøj B. Negative Symptoms and Reward Disturbances in Schizophrenia Before and After Antipsychotic Monotherapy. Clin EEG Neurosci 2018; 49:36-45. [PMID: 29145751 DOI: 10.1177/1550059417744120] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Negative symptoms (NS) are a central part of the symptomatology of schizophrenia, which is highly correlated to the functional outcome. Disturbances of the brain reward system are suggested to be central in the pathogenesis of NS by decreasing motivation and hedonic experiences. In this study, we compared reward-related brain activity in patients improving and not improving in NS after treatment with amisulpride. METHODS Thirty-nine antipsychotic-naive patients and 49 healthy controls completed functional magnetic resonance imaging with a modified monetary incentive delay task. Psychopathology of the patients was characterised with Positive and Negative Syndrome Scale (PANSS), and they were treated with individual doses of amisulpride (mean 271 mg) for 6 weeks, after which the examinations were repeated. RESULTS Patients improved on positive, general, and total PANSS score after treatment ( P < .001). Fourteen patients had ≥20% improvement of NS, whereas 25 patients improved <20%. At baseline, one-way analysis of variance showed group difference bilaterally in the caudate nucleus and in the right nucleus accumbens (all P < .002), which was caused by decreased reward anticipation activity in the nonimproving patients compared to healthy controls. There was a significant group × time interaction, with the healthy controls and the improvers decreasing and the nonimprovers increasing in reward anticipation activity after treatment, most pronounced in the left caudate nucleus ( P = .001). DISCUSSION Patients improving in NS score had a less aberrant reward system at baseline, but reward related activity was reduced over time. Patients not improving in NS showed decreased striatal reward-activity at baseline, which improved over time. Whether this is associated with alteration in working memory and reward learning or with pronounced symptoms within specific domains of NS may be addressed in future studies.
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Affiliation(s)
- Mette Ødegaard Nielsen
- 1 Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital, Mental Health Centre Glostrup, Denmark
| | - Egill Rostrup
- 1 Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital, Mental Health Centre Glostrup, Denmark.,2 Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine Rigshospitalet, Glostrup, Denmark
| | - Brian Villumsen Broberg
- 1 Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital, Mental Health Centre Glostrup, Denmark
| | - Sanne Wulff
- 1 Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital, Mental Health Centre Glostrup, Denmark
| | - Birte Glenthøj
- 1 Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital, Mental Health Centre Glostrup, Denmark
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Calabrò M, Porcelli S, Crisafulli C, Wang SM, Lee SJ, Han C, Patkar AA, Masand PS, Albani D, Raimondi I, Forloni G, Bin S, Cristalli C, Mantovani V, Pae CU, Serretti A. Genetic Variants Within Molecular Targets of Antipsychotic Treatment: Effects on Treatment Response, Schizophrenia Risk, and Psychopathological Features. J Mol Neurosci 2018; 64:62-74. [PMID: 29164477 DOI: 10.1007/s12031-017-1002-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/14/2017] [Indexed: 12/14/2022]
Abstract
Schizophrenia (SCZ) is a common and severe mental disorder. Genetic factors likely play a role in its pathophysiology as well as in treatment response. In the present study, we investigated the effects of several single nucleotide polymorphisms (SNPs) within 9 genes involved with antipsychotic (AP) mechanisms of action. Two independent samples were recruited. The Korean sample included 176 subjects diagnosed with SCZ and 326 healthy controls, while the Italian sample included 83 subjects and 194 controls. AP response as measured by the positive and negative syndrome scale (PANSS) was the primary outcome, while the secondary outcome was the SCZ risk. Exploratory analyses were performed on (1) symptom clusters response (as measured by PANSS subscales); (2) age of onset; (3) family history; and (4) suicide history. Associations evidenced in the primary analyses did not survive to the FDR correction. Concerning SCZ risk, we partially confirmed the associations among COMT and MAPK1 genetic variants and SCZ. Finally, our exploratory analysis suggested that CHRNA7 and HTR2A genes may modulate both positive and negative symptoms responses, while PLA2G4A and SIGMAR1 may modulate respectively positive and negative symptoms responses. Moreover, GSK3B, HTR2A, PLA2G4A, and S100B variants may determine an anticipation of SCZ age of onset. Our results did not support a primary role for the genes investigated in AP response as a whole. However, our exploratory findings suggested that these genes may be involved in symptom clusters response.
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Affiliation(s)
- Marco Calabrò
- Department of Biomedical and Dental Sciences and Morphofunctional Images, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, Messina, Italy
| | - Stefano Porcelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Concetta Crisafulli
- Department of Biomedical and Dental Sciences and Morphofunctional Images, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, Messina, Italy
| | - Sheng-Min Wang
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Soo-Jung Lee
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Ashwin A Patkar
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Prakash S Masand
- Global Medical Education, New York, NY, USA
- Academic Medicine Education Institute, Duke-NUS Medical School, Singapore, Singapore
| | - Diego Albani
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Ilaria Raimondi
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Gianluigi Forloni
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Sofia Bin
- Center for Applied Biomedical Research (CRBA, St. Orsola University Hospital, Bologna, Italy
| | - Carlotta Cristalli
- Center for Applied Biomedical Research (CRBA, St. Orsola University Hospital, Bologna, Italy
| | - Vilma Mantovani
- Center for Applied Biomedical Research (CRBA, St. Orsola University Hospital, Bologna, Italy
| | - Chi-Un Pae
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea.
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
- Department of Psychiatry, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, 2 Sosa-Dong, Wonmi-Gu, Bucheon, Kyeonggi-Do, 420-717, Republic of Korea.
- Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
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Papazisis G, Goulas A, Sarrigiannidis A, Bargiota S, Antoniadis D, Raikos N, Basgiouraki E, Bozikas VP, Garyfallos G. ABCB1 and CYP2D6 polymorphisms and treatment response of psychotic patients in a naturalistic setting. Hum Psychopharmacol 2018; 33. [PMID: 29250824 DOI: 10.1002/hup.2644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/28/2017] [Accepted: 11/10/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of our study was to examine the association between ABCB1 polymorphisms G2677T/A (rs2032582) and C3435T (rs1045642) and common CYP2D6 variants, with the response to antipsychotic treatment of psychotic patients, in a naturalistic setting, in Greece. METHODS One hundred patients suffering from schizophrenia and other psychotic disorders were included in the study. Dosages were normalized to chlorpromazine equivalents. Response following 1 month of treatment was assessed as either a continuous variable, using the distribution of the corrected Positive and Negative Syndrome Scale percent change, or as a dichotomous variable defined as the number of patients scoring ≥30% from the corrected baseline Positive and Negative Syndrome Scale score. Genotyping was achieved with established polymerase chain reaction-restriction fragment length polymorphism methods. RESULTS With response treated as a continuous variable, the homozygous recessive rs2032582 genotypes (TT) who were simultaneously carriers of a loss-of-function CYP2D6 allele (*4 or *5) responded significantly worse than the rest of the patients. Comparison of genotype frequencies revealed a statistically significant association of the above combination. No significant association between chlorpromazine equivalents and the tested genotypes was detected. CONCLUSION We have detected a possible interaction between ABCB1 and CYP2D6 in affecting response of psychotic patients to drug treatment, in a naturalistic setting.
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Affiliation(s)
- Georgios Papazisis
- Department of Clinical Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Goulas
- 1st Department of Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexios Sarrigiannidis
- 2nd University Department of Psychiatry, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavroula Bargiota
- 2nd University Department of Psychiatry, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Diomidis Antoniadis
- 2nd University Department of Psychiatry, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Raikos
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouela Basgiouraki
- 1st Department of Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios P Bozikas
- 1st University Department of Psychiatry, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Garyfallos
- 2nd University Department of Psychiatry, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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How well do patients with a first episode of schizophrenia respond to antipsychotics: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2017; 27:835-844. [PMID: 28669774 DOI: 10.1016/j.euroneuro.2017.06.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/21/2017] [Accepted: 06/20/2017] [Indexed: 11/21/2022]
Abstract
It is often stated that first-episode patients tend to respond better to antipsychotics than chronic patients, but the exact numbers and moderators of response in this population are unclear. We, therefore, present the first systematic review on response rates of first episode patients with schizophrenia in randomized trials. We searched multiple databases for randomized-controlled trials of antipsychotics in acutely ill patients with a first episode of schizophrenia (last search: November 17, 2016). The outcomes were response rate based on two criteria, at least 50% PANSS or BPRS total score reduction from baseline and at least 20% reduction. Data were pooled in a single-group summary meta-analysis using Comprehensive Meta-Analysis software. Moreover, several potential moderators of response to antipsychotics were examined by meta-regression. We included 17 studies with a total of 3156 participants. On the average, 81.3%/51.9% of the first-episode patients reached an at least 20%/50% PANSS or BPRS reduction from baseline, respectively. Meta-regressions revealed a better treatment response in female patients, in more severely ill patients at baseline, in antipsychotic naïve patients, in patients with a shorter illness duration and in open studies. Study duration and dosage were no significant moderators of response. Our finding suggest that more than 80% of first-episode patients achieved 20% PANSS/BPRS reduction from baseline and around 50% achieved a 50% PANSS/BPRS reduction. Several patient characteristics moderated response rates.
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Calabrò M, Porcelli S, Crisafulli C, Wang SM, Lee SJ, Han C, Patkar AA, Masand PS, Albani D, Raimondi I, Forloni G, Bin S, Mattiaccio A, Mantovani V, Jun TY, Pae CU, Serretti A. Genetic Variants Within Key Nodes of the Cascade of Antipsychotic Mechanisms: Effects on Antipsychotic Response and Schizophrenia Psychopathology in a Naturalistic Treatment Setting in Two Independent Korean and Italian Samples. Adv Ther 2017; 34:1482-1497. [PMID: 28508933 DOI: 10.1007/s12325-017-0555-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Schizophrenia (SCZ) is one of the most disabling psychiatric disorders. Genetic factors play an important role in both SCZ liability and its treatment outcome. In the present paper, we investigated the effects of several single nucleotide polymorphisms (SNPs) within ten strong candidate genes involved with antipsychotics (APs) mechanisms of action. METHODS Two independent samples were investigated in the present study. Totals of 176 SCZ subjects and 326 controls of Korean ancestry, and 83 SCZ subjects and 194 controls of Italian ancestry were recruited and genotyped. SCZ risk and other parameters were also investigated. RESULTS Concerning APs response, only a nominal association with HOMER1 rs3822568 in the Korean sample was found. In the haplotype analysis, rs9801117 C-rs12668837 C-rs4621754 A haplotype within ESYT2 and NCAPG2 genes was associated with APs response in the same sample. As for secondary outcomes, rs7439 within PKDCC and rs12668837 within NCAPG2 were associated with SCZ risk in the Italian sample. In the haplotype analysis, rs2788478 G-rs2657375 T-rs1039621 A within the region between WDR60 and ESYT genes and rs2013 C (ESYT2)-rs6459896 A (NCAPG2) haplotypes were associated with SCZ in the same sample. No association was found in the Korean sample. Finally, our exploratory data suggest a possible modulation of HOMER1, ARC, BDNF, TXNRD2, WDR60, and ESYT2 genes in the APs response to specific symptom clusters. CONCLUSION Our results did not support a primary role for the genes investigated in the APs response. On the other hand, our secondary results suggest a possible involvement of NACPG2 and PKDCC in SCZ liability. Finally, our exploratory findings may deserve further investigations in specific studies.
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Kumari S, Malik M, Florival C, Manalai P, Sonje S. An Assessment of Five (PANSS, SAPS, SANS, NSA-16, CGI-SCH) commonly used Symptoms Rating Scales in Schizophrenia and Comparison to Newer Scales (CAINS, BNSS). ACTA ACUST UNITED AC 2017; 8. [PMID: 29430333 PMCID: PMC5805140 DOI: 10.4172/2155-6105.1000324] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Scales measuring positive and negative symptoms in schizophrenia remain the primary mo Scales measuring positive and negative symptoms in schizophrenia remain the primary mode of assessing and diagnosing schizophrenia by clinicians and researchers. The scales are mainly used to monitor the severity of positive and negative symptoms and track treatment response in schizophrenics. Although these scales are widely used, quality as well as general utility of each scale varies. The quality is determined by the validity and reliability of the scales. The utility of the scale is determined by the time of administration and the settings for which the scales can be administered in research or clinical settings. There are relatively fewer articles on the utility of newer scales like CAINS (Clinical Assessment Interview for Negative Symptoms) and the BNSS (Brief Negative Symptom Scale) that compare them to the older scales PANSS (Positive and Negative Symptoms Scale), SAPS (Scale for the Assessment of Positive Symptoms) SANS (the Scale for the Assessment of Negative Symptoms), NSA-16 (Negative Symptom Assessment-16) and CGI-SCH (Clinical Global Impression Schizophrenia. The older scales were developed more than 30 years ago. Since then, our understanding of negative symptoms has evolved and currently there are newer rating scales evaluating the validity of negative symptoms. The older scales do not incorporate the latest research on negative symptoms. CAINS and BNSS are attractive for both their reliability and their concise accessible format, however, a scale that is simpler, accessible, user-friendly, that incorporates a multidimensional model of schizophrenia, addresses the psychosocial and cognitive component has yet to be developed.
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Affiliation(s)
- Suneeta Kumari
- Department of Psychiatry and Behavioral Sciences, Howard University Hospital, Washington DC, USA
| | - Mansoor Malik
- Department of Psychiatry and Behavioral Sciences, Howard University Hospital, Washington DC, USA
| | - Christina Florival
- Department of Psychiatry and Behavioral Sciences, Howard University Hospital, Washington DC, USA
| | - Partam Manalai
- Department of Psychiatry and Behavioral Sciences, Howard University Hospital, Washington DC, USA
| | - Snezana Sonje
- Department of Psychiatry and Behavioral Sciences, Howard University Hospital, Washington DC, USA
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Ryan A, Baker A, Dark F, Foley S, Gordon A, Hatherill S, Stathis S, Saha S, Bruxner G, Beckman M, Richardson D, Berk M, Dean O, McGrath J, Group CW, Scott J. The efficacy of sodium benzoate as an adjunctive treatment in early psychosis - CADENCE-BZ: study protocol for a randomized controlled trial. Trials 2017; 18:165. [PMID: 28388932 PMCID: PMC5383965 DOI: 10.1186/s13063-017-1908-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/16/2017] [Indexed: 11/18/2022] Open
Abstract
Background Psychotic disorders affect up to 3% of the population and are often chronic and disabling. Innovation in the pharmacological treatment of psychosis has remained stagnant in recent decades. In order to improve outcomes for those with psychotic disorders, we present a protocol for the trial of a common food preservative, sodium benzoate, as an adjunctive treatment in early psychosis. Methods Persons experiencing early psychosis (n = 160) will be recruited through hospitals and community mental health services in Queensland, Australia. Patients will be randomized to receive either 12-week treatment with 1000 mg (500 mg twice daily (BD)) sodium benzoate or placebo. Patients will undergo fortnightly outcome assessments, in addition to weekly ongoing capacity to consent, drug compliance and safety assessments. The primary outcome measure is the Positive and Negative Syndrome Scale (PANSS) total score. Secondary outcomes are Global Assessment of Function (GAF), Assessment of Quality of Life Scale (AQOL), the Activity and Participation Questionnaire (APQ6), International Physical Activity Questionnaires (IPAQ), Simple Physical Activity Questionnaire (SIMPAQ), Physical Activity Questionnaire, Clinical Global Impression (CGI), Hamilton Depression rating Scale-17 items (HDRS), Opiate Treatment Index (OTI) and the Patients’ Global Impression of Improvement (PGI-I). As a tertiary objective, changes from baseline to endpoint in to serum markers related to D-alanine, L-alanine, D-serine, L-serine, glycine and glutamate will be investigated. Discussion Consumers and clinicians are keen to help develop better treatments for those with psychosis. This study, part of the wider Cadence clinical trials platform will examine if a safe and accessible food preservative can help optimize outcomes in those with psychosis. Trial Registration Australian New Zealand Clinical Trials registry (ANZCTR), ACTRN12615000187549. Registered on 26 February 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1908-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alex Ryan
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,University of Queensland Centre for Clinical Research, University of Queensland, Herston, QLD, Australia
| | - Andrea Baker
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Frances Dark
- Metro South Mental Health, 519 Kessels Road, MacGregor, QLD, 4109, Australia
| | - Sharon Foley
- Metro South Mental Health, 519 Kessels Road, MacGregor, QLD, 4109, Australia
| | - Anne Gordon
- Metro North Mental Health, Royal Brisbane and Women's Hospital, Level 3 UQCCR, RBWH, Herston, QLD, 4029, Australia
| | - Sean Hatherill
- Logan Hospital, Armstrong Rd and Loganlea Rd, Meadowbrook, QLD, 4131, Australia
| | - Stephen Stathis
- Lady Cilento Children's Hospital, Raymond Terrace, South Brisbane, QLD, 4101, Australia
| | - Sukanta Saha
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - George Bruxner
- Metro North Mental Health, Caboolture and Redcliffe Hospitals, Caboolture, QLD, Australia
| | - Martin Beckman
- Specialist Child and Adolescent Psychiatrist, Evolve Therapeutic Services Logan, Child and Youth Mental Health Services Logan, Academic Clinical Unit Logan, Metro South Hospital and Health Services, Logan, QLD, Australia
| | - Drew Richardson
- Prince Charles Hospital, Chermside, Rode Rd, Chermside, QLD, 4032, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, Deakin University, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia.,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North, Main Block, Parkville, 3052, Australia
| | - Olivia Dean
- IMPACT Strategic Research Centre, Deakin University, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia.,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North, Main Block, Parkville, 3052, Australia
| | - John McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - Cadence Working Group
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - James Scott
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia. .,University of Queensland Centre for Clinical Research, University of Queensland, Herston, QLD, Australia. .,Metro North Mental Health, Royal Brisbane and Women's Hospital, Level 3 UQCCR, RBWH, Herston, QLD, 4029, Australia.
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33
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Howes OD, McCutcheon R, Agid O, de Bartolomeis A, van Beveren NJ, Birnbaum ML, Bloomfield MA, Bressan RA, Buchanan RW, Carpenter WT, Castle DJ, Citrome L, Daskalakis ZJ, Davidson M, Drake RJ, Dursun S, Ebdrup BH, Elkis H, Falkai P, Fleischacker WW, Gadelha A, Gaughran F, Glenthøj BY, Graff-Guerrero A, Hallak JE, Honer WG, Kennedy J, Kinon BJ, Lawrie SM, Lee J, Leweke FM, MacCabe JH, McNabb CB, Meltzer H, Möller HJ, Nakajima S, Pantelis C, Reis Marques T, Remington G, Rossell SL, Russell BR, Siu CO, Suzuki T, Sommer IE, Taylor D, Thomas N, Üçok A, Umbricht D, Walters JT, Kane J, Correll CU. Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology. Am J Psychiatry 2017; 174:216-229. [PMID: 27919182 PMCID: PMC6231547 DOI: 10.1176/appi.ajp.2016.16050503] [Citation(s) in RCA: 588] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines. METHOD A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus. RESULTS Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50%) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds; only two studies (5%) utilized the same criteria. The consensus group identified minimum and optimal criteria, employing the following principles: 1) current symptoms of a minimum duration and severity determined by a standardized rating scale; 2) moderate or worse functional impairment; 3) prior treatment consisting of at least two different antipsychotic trials, each for a minimum duration and dosage; 4) systematic monitoring of adherence and meeting of minimum adherence criteria; 5) ideally at least one prospective treatment trial; and 6) criteria that clearly separate responsive from treatment-resistant patients. CONCLUSIONS There is considerable variation in current approaches to defining treatment resistance in schizophrenia. The authors present consensus guidelines that operationalize criteria for determining and reporting treatment resistance, adequate treatment, and treatment response, providing a benchmark for research and clinical translation.
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Affiliation(s)
- Oliver D. Howes
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Rob McCutcheon
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Ofer Agid
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Andrea de Bartolomeis
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Nico J.M. van Beveren
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Michael L. Birnbaum
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Michael A.P. Bloomfield
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Rodrigo A. Bressan
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Robert W. Buchanan
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - William T. Carpenter
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - David J. Castle
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Leslie Citrome
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Zafiris J. Daskalakis
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Michael Davidson
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Richard J. Drake
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Serdar Dursun
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Bjørn H. Ebdrup
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Helio Elkis
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Peter Falkai
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - W. Wolfgang Fleischacker
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Ary Gadelha
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Fiona Gaughran
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Birte Y. Glenthøj
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Ariel Graff-Guerrero
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Jaime E.C. Hallak
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - William G. Honer
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - James Kennedy
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Bruce J. Kinon
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Stephen M. Lawrie
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Jimmy Lee
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - F. Markus Leweke
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - James H. MacCabe
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Carolyn B. McNabb
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Herbert Meltzer
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Hans-Jürgen Möller
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Shinchiro Nakajima
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Christos Pantelis
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Tiago Reis Marques
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Gary Remington
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Susan L. Rossell
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Bruce R. Russell
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Cynthia O. Siu
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Takefumi Suzuki
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Iris E. Sommer
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - David Taylor
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Neil Thomas
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Alp Üçok
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Daniel Umbricht
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - James T.R. Walters
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - John Kane
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
| | - Christoph U. Correll
- From King's College London, Institute of Psychiatry, Psychology, and Neuroscience; MRC Clinical Sciences Centre; Institute of Clinical Sciences, Imperial College, and Hammersmith Hospital London; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Section of Psychiatry and Treatment Resistant Psychosis and the Laboratory of Translational Psychiatry, School of Medicine of Naples Federico II, Naples; the Departments of Psychiatry and
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Iasevoli F, Fagiolini A, Formato MV, Prinzivalli E, Giordano S, Balletta R, De Luca V, de Bartolomeis A. Assessing patient-rated vs. clinician-rated adherence to the therapy in treatment resistant schizophrenia, schizophrenia responders, and non-schizophrenia patients. Psychiatry Res 2017; 249:159-166. [PMID: 28104562 DOI: 10.1016/j.psychres.2017.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/27/2016] [Accepted: 01/03/2017] [Indexed: 01/23/2023]
Abstract
The present study evaluated consistency, reliability, and determinants of two real-world measures of adherence to prescription in 57 schizophrenia and 61 non-schizophrenia patients. Treatment resistant schizophrenia (TRS) was additionally diagnosed in 28 of the schizophrenia patients. Patients were screened for clinical severity, cognitive functioning, and adherence by 10-item Drug Attitude Inventory (DAI-10) or Adherence-to-Therapy (AtT), a clinician-rated tool developed by our group. DAI-10 and AtT scores showed a significant correlation (p=0.039; ρ=0.21; df=103). Compared to the DAI-10 scale, a higher number of variables were associated with AtT. In schizophrenia and TRS patients, substance abuse was the only significant predictor of lower DAI-10 score (p=0.027, F=5.2, R2=0.07, and p=0.06, F=8.9, R2=0.23, respectively). Lower AtT score was significantly associated with first-generation antipsychotic use (p=0.001, RR: 2.00 [1.40-2.87]), positive symptoms (p=0.02, RR: 1.63 [1.05-2.53]), impaired verbal fluency (p=0.01, RR: 1.88 [0.81-4.32]) or problem solving (p=0.01, RR: 2.14 [0.92-4.98]). AtT, but not DAI-10, score correlated with the score on the Personal and Social Performance scale (p=0.02, F=5.86, R2=0.08). Overall, AtT score was predicted by pharmacological, psychopathological, and cognitive factors, and predictive of psychosocial functioning. Therefore, AtT measure may represent a convenient and practical tool to evaluate schizophrenia patients' adherence.
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Affiliation(s)
- Felice Iasevoli
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | | | - Maria Vittoria Formato
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Emiliano Prinzivalli
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Sara Giordano
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Raffaele Balletta
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Vincenzo De Luca
- Centre for Addiction and Mental Health; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Andrea de Bartolomeis
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy.
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35
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Egger ST, Vetter S, Weniger G, Vandeleur C, Seifritz E, Müller M. The Use of the Health of the Nation Outcome Scales for Assessing Functional Change in Treatment Outcome Monitoring of Patients with Chronic Schizophrenia. Front Public Health 2016; 4:220. [PMID: 27790607 PMCID: PMC5062760 DOI: 10.3389/fpubh.2016.00220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/23/2016] [Indexed: 11/13/2022] Open
Abstract
Background Schizophrenia is a severe mental disorder that is characterized not only by symptomatic severity but also by high levels of functional impairment. An evaluation of clinical outcome in treatment of schizophrenia should therefore target not only assessing symptom change but also alterations in functioning. This study aimed to investigate whether there is an agreement between functional- and symptom-based outcomes in a clinical sample of admissions with chronic forms of schizophrenia. Methods A full 3-year cohort of consecutive inpatient admissions for schizophrenia (N = 205) was clinically rated with the Positive and Negative Symptom Scale (PANSS) and the Health of the Nation Outcome Scales (HoNOS) as measures of functioning at the time of admission and discharge. The sample was stratified twofold: first, according to the degree of PANSS symptom improvement during treatment with the sample being divided into three treatment response groups: non-response, low response, and high response. Second, achievement of remission was defined using the Remission in Schizophrenia Working Group criteria based on selected PANSS symptoms. Repeated measures analyses were used to compare the change of HoNOS scores over time across groups. Results More than a half of all admissions achieved a symptom reduction of at least 20% during treatment and around one quarter achieved remission at discharge. Similarly, HoNOS scores improved significantly between admission and discharge. Interaction analyses indicated higher functional improvements to be associated with increasing levels of treatment response. Conclusion Functional improvement in individuals treated for schizophrenia was linked to a better clinical outcome, which implies a functional association. Thus, improvement of functioning represents an important therapeutic target in the treatment of schizophrenia.
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Affiliation(s)
- Stephan T Egger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry , Zurich , Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry , Zurich , Switzerland
| | - Godehard Weniger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry , Zurich , Switzerland
| | - Caroline Vandeleur
- Department of Psychiatry, University Hospital of Lausanne , Lausanne , Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry , Zurich , Switzerland
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry , Zurich , Switzerland
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Crippa A, Orsini N. Dose-response meta-analysis of differences in means. BMC Med Res Methodol 2016; 16:91. [PMID: 27485429 PMCID: PMC4971698 DOI: 10.1186/s12874-016-0189-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 07/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background Meta-analytical methods are frequently used to combine dose-response findings expressed in terms of relative risks. However, no methodology has been established when results are summarized in terms of differences in means of quantitative outcomes. Methods We proposed a two-stage approach. A flexible dose-response model is estimated within each study (first stage) taking into account the covariance of the data points (mean differences, standardized mean differences). Parameters describing the study-specific curves are then combined using a multivariate random-effects model (second stage) to address heterogeneity across studies. Results The method is fairly general and can accommodate a variety of parametric functions. Compared to traditional non-linear models (e.g. Emax, logistic), spline models do not assume any pre-specified dose-response curve. Spline models allow inclusion of studies with a small number of dose levels, and almost any shape, even non monotonic ones, can be estimated using only two parameters. We illustrated the method using dose-response data arising from five clinical trials on an antipsychotic drug, aripiprazole, and improvement in symptoms in shizoaffective patients. Using the Positive and Negative Syndrome Scale (PANSS), pooled results indicated a non-linear association with the maximum change in mean PANSS score equal to 10.40 (95 % confidence interval 7.48, 13.30) observed for 19.32 mg/day of aripiprazole. No substantial change in PANSS score was observed above this value. An estimated dose of 10.43 mg/day was found to produce 80 % of the maximum predicted response. Conclusion The described approach should be adopted to combine correlated differences in means of quantitative outcomes arising from multiple studies. Sensitivity analysis can be a useful tool to assess the robustness of the overall dose-response curve to different modelling strategies. A user-friendly R package has been developed to facilitate applications by practitioners.
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Affiliation(s)
- Alessio Crippa
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Nicola Orsini
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Iasevoli F, Giordano S, Balletta R, Latte G, Formato MV, Prinzivalli E, De Berardis D, Tomasetti C, de Bartolomeis A. Treatment resistant schizophrenia is associated with the worst community functioning among severely-ill highly-disabling psychiatric conditions and is the most relevant predictor of poorer achievements in functional milestones. Prog Neuropsychopharmacol Biol Psychiatry 2016; 65:34-48. [PMID: 26320028 DOI: 10.1016/j.pnpbp.2015.08.010] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 12/12/2022]
Abstract
The aim of this work was to compare achievements in milestones of community functioning in highly disabling psychiatric conditions, including treatment resistant schizophrenia (TRS), schizophrenia (responsive to antipsychotics), bipolar disorder, and anxiety/depressive diseases. Also, we investigated the predictors of community functioning outcomes across several domains. Among consecutive patients screened, 188 met inclusion criteria and 118 ultimately entered the study. Diagnosis of TRS was made by stringent criteria, including historic and perspective evaluations and excluding potential confounding factors. Achievements in functional milestones of everyday living were recorded. Performances in discrete cognitive tasks were assessed. The Positive and Negative Syndrome Scale, the Personal and Social Performance Scale, the Drug Attitude Inventory-10, and the Quality of Life Enjoyment and Satisfaction Questionnaire were administered. TRS patients showed the highest impairment in community functioning among diagnostic groups. TRS was found to have more severe psychopathology, more impaired cognitive functioning, and poorer psychosocial adjustment compared to all the other groups. In the whole sample, the main predictors of community functioning were the diagnostic group (with TRS diagnosis associated with worst functioning) and achievements in the other functional milestones. In psychotic patients, however, the main predictors of community functioning were clinical and psychopathological variables. These results may support the hypothesis that TRS represents a separate schizophrenia subtype, with its own neurobiology, psychopathology and clinical course. Our results identify a group of modifiable predictors to be addressed to prevent community disability.
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Affiliation(s)
- Felice Iasevoli
- Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Sara Giordano
- Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Raffaele Balletta
- Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Gianmarco Latte
- Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Maria Vittoria Formato
- Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Emiliano Prinzivalli
- Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Domenico De Berardis
- National Health Service, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", Teramo, Italy; Department of Neurosciences and Imaging, University G. D'Annunzio, Chieti, Italy
| | - Carmine Tomasetti
- Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy; National Health Service, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment, Hospital "Maria SS dello Splendore", Giulianova, TE, Italy
| | - Andrea de Bartolomeis
- Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy.
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Chiliza B, Ojagbemi A, Esan O, Asmal L, Oosthuizen P, Kidd M, Gureje O, Emsley R. Combining depot antipsychotic with an assertive monitoring programme for treating first-episode schizophrenia in a resource-constrained setting. Early Interv Psychiatry 2016; 10:54-62. [PMID: 24690088 DOI: 10.1111/eip.12141] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 02/28/2014] [Indexed: 11/27/2022]
Abstract
AIM To assess the feasibility and effectiveness of depot antipsychotic (flupenthixol decanoate) combined with an assertive monitoring programme (AMP) in first-episode schizophrenia. METHODS This was a prospective, non-comparative, longitudinal study conducted over 12 months assessing patient acceptance, adherence, outcome in domains of psychopathology, functionality and quality of life, and tolerability. RESULTS Of 207 participants, 149 (72%) completed 12 months of treatment. Acceptance of and adherence to depot was good. Treatment response was achieved by 170 (82%) participants and remission by 124 (60%). Thirty-three (19%) responders relapsed and 10 (5%) participants met a priori criteria for treatment resistance. Treatment was generally well tolerated. CONCLUSIONS Combination of depot antipsychotic with an AMP may be an effective and safe intervention in early phases of schizophrenia, and may be particularly suitable for resource-constrained settings.
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Affiliation(s)
- Bonginkosi Chiliza
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Akin Ojagbemi
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oluyomi Esan
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Laila Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Piet Oosthuizen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Stellenbosch University, Stellenbosch, South Africa
| | - Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Robin Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Garcia-Portilla MP, Garcia-Alvarez L, Saiz PA, Al-Halabi S, Bobes-Bascaran MT, Bascaran MT, Muñiz J, Bobes J. Psychometric evaluation of the negative syndrome of schizophrenia. Eur Arch Psychiatry Clin Neurosci 2015; 265:559-66. [PMID: 25802109 DOI: 10.1007/s00406-015-0595-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 03/15/2015] [Indexed: 11/25/2022]
Abstract
In this paper, we reviewed the available instruments for assessing the negative syndrome of schizophrenia, describing their strengths and weaknesses. Current instruments were classified into two categories according to their content validity and assessment approach as first- or second-generation instruments. The BPRS, SANS, the SENS and the PANSS belong to the first generation, while the BNSS, the CAINS and the MAP-SR belong to the second generation. The NSA can be considered a transitional instrument between the two. First-generation instruments have more content validity problems than second-generation instruments do, as they do not accurately reflect the currently accepted negative syndrome (they do not include all negative symptoms and signs or they include symptoms from other dimensions). They also have more problems relative to the use of behavioural referents instead of internal experiences of deficits when assessing symptoms, which may lead to measuring functioning instead of negative symptoms. Further research needs to be done in this area in order to ensure the evaluation of primary negative symptoms and internal experiences involved in negative symptoms rather than external behaviours.
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Affiliation(s)
- Maria Paz Garcia-Portilla
- Department of Psychiatry, University of Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain.,Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain
| | - Leticia Garcia-Alvarez
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain
| | - Pilar A Saiz
- Department of Psychiatry, University of Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain.,Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain
| | - Susana Al-Halabi
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain
| | - Maria Teresa Bobes-Bascaran
- Hospital Clínico, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Maria Teresa Bascaran
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain
| | - José Muñiz
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain.,Department of Psychology, University of Oviedo, Plaza de Feijóo, 33003, Oviedo, Spain
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain. .,Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain.
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Harshe DG, Vadlamani N, Tharayil HM, Andrade C. Suicide lethality scale: Concerns regarding validity and scoring. Indian J Psychiatry 2015; 57:429. [PMID: 26813783 PMCID: PMC4711250 DOI: 10.4103/0019-5545.171839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Devavrat G Harshe
- Department of Psychiatry, Dr D Y Patil Medical College, Kolhapur, Maharashtra, India. E-mail: E-mail:
| | - Naresh Vadlamani
- Columbus Hospital, Institute of Psychiatry and Deaddiction, Hyderabad, Telangana, India
| | - Harish M Tharayil
- Department of Psychiatry, Government Medical College, Kozhikode, Kerala, India
| | - Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Wulff S, Pinborg LH, Svarer C, Jensen LT, Nielsen MØ, Allerup P, Bak N, Rasmussen H, Frandsen E, Rostrup E, Glenthøj BY. Striatal D(2/3) Binding Potential Values in Drug-Naïve First-Episode Schizophrenia Patients Correlate With Treatment Outcome. Schizophr Bull 2015; 41:1143-52. [PMID: 25698711 PMCID: PMC4535636 DOI: 10.1093/schbul/sbu220] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
One of best validated findings in schizophrenia research is the association between blockade of dopamine D2 receptors and the effects of antipsychotics on positive psychotic symptoms. The aim of the present study was to examine correlations between baseline striatal D(2/3) receptor binding potential (BP(p)) values and treatment outcome in a cohort of antipsychotic-naïve first-episode schizophrenia patients. Additionally, we wished to investigate associations between striatal dopamine D(2/3) receptor blockade and alterations of negative symptoms as well as functioning and subjective well-being. Twenty-eight antipsychotic-naïve schizophrenia patients and 26 controls were included in the study. Single-photon emission computed tomography (SPECT) with [(123)I]iodobenzamide ([(123)I]-IBZM) was used to examine striatal D(2/3) receptor BP(p). Patients were examined before and after 6 weeks of treatment with the D(2/3) receptor antagonist amisulpride. There was a significant negative correlation between striatal D(2/3) receptor BP(p) at baseline and improvement of positive symptoms in the total group of patients. Comparing patients responding to treatment to nonresponders further showed significantly lower baseline BP(p) in the responders. At follow-up, the patients demonstrated a negative correlation between the blockade and functioning, whereas no associations between blockade and negative symptoms or subjective well-being were observed. The results show an association between striatal BP(p) of dopamine D(2/3) receptors in antipsychotic-naïve first-episode patients with schizophrenia and treatment response. Patients with a low BP(p) have a better treatment response than patients with a high BP(p). The results further suggest that functioning may decline at high levels of dopamine receptor blockade.
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Affiliation(s)
- Sanne Wulff
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Psychiatric Center Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen, Denmark;
| | - Lars Hageman Pinborg
- Neurobiology Research Unit (NRU), Rigshospitalet, University of Copenhagen, Denmark
| | - Claus Svarer
- Neurobiology Research Unit (NRU), Rigshospitalet, University of Copenhagen, Denmark
| | - Lars Thorbjørn Jensen
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark
| | - Mette Ødegaard Nielsen
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Psychiatric Center Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Peter Allerup
- Department of Education, Centre for Research in Compulsory Schooling, Aarhus University, Denmark
| | - Nikolaj Bak
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Psychiatric Center Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Hans Rasmussen
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Psychiatric Center Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Erik Frandsen
- Department of Diagnostics, Functional Imaging Unit and Section of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, University of Copenhagen, Denmark
| | - Egill Rostrup
- Department of Diagnostics, Functional Imaging Unit and Section of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, University of Copenhagen, Denmark
| | - Birte Yding Glenthøj
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Psychiatric Center Glostrup, University of Copenhagen, Copenhagen, Denmark;,Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen, Denmark
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Duhig M, Patterson S, Connell M, Foley S, Capra C, Dark F, Gordon A, Singh S, Hides L, McGrath JJ, Scott J. The prevalence and correlates of childhood trauma in patients with early psychosis. Aust N Z J Psychiatry 2015; 49:651-9. [PMID: 25722463 DOI: 10.1177/0004867415575379] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To describe the prevalence and demographic, clinical and functional correlates of childhood trauma in patients attending early psychosis clinics. METHOD Participants were recruited from outpatients attending four early psychosis services. Exposure to childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). Psychopathology was measured using the Positive and Negative Syndrome Scale and the Depression, Anxiety and Stress Scale. Social and vocational functioning and substance use were also assessed. RESULTS Over three-quarters of the 100 patients reported exposure to any childhood trauma. Emotional, physical and sexual abuse were reported by 54%, 23% and 28% of patients, respectively, while 49% and 42% of patients reported emotional and physical neglect, respectively. Female participants were significantly more likely to be exposed to emotional and sexual abuse. Exposure to childhood trauma was correlated with positive psychotic symptoms and higher levels of depressive, anxiety and stress symptoms; however, it had no impact on social or vocational functioning or recent substance use. CONCLUSION Exposure to childhood trauma was common in patients with early psychosis, and associated with increased symptomatology. Existing recommendations that standard clinical assessment of patients with early psychosis should include inquiry into exposure to childhood trauma are supported.
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Affiliation(s)
- Michael Duhig
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia The University of Queensland Centre for Clinical Research, Herston, QLD, Australia School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Sue Patterson
- Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Melissa Connell
- The University of Queensland Centre for Clinical Research, Herston, QLD, Australia
| | - Sharon Foley
- Metro South Mental Health, Princess Alexandra Hospital, Wooloongabba, QLD, Australia
| | - Carina Capra
- Metro South Mental Health, Princess Alexandra Hospital, Wooloongabba, QLD, Australia
| | - Frances Dark
- Metro South Mental Health, Princess Alexandra Hospital, Wooloongabba, QLD, Australia
| | - Anne Gordon
- Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Saveena Singh
- Early Psychosis Service, Gold Coast Health Service District, Burleigh Heads, Gold Coast, QLD, Australia
| | - Leanne Hides
- School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, QLD, Australia Institute of Health and Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - John J McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - James Scott
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia The University of Queensland Centre for Clinical Research, Herston, QLD, Australia Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia Discipline of Psychiatry, University of Queensland, St Lucia, QLD, Australia
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Kheirabadi GR, Rafizadeh M, Omranifard V, Yari A, Maracy MR, Mehrabi T, Sadri S. Effects of needs-assessment-based psycho-education of schizophrenic patients' families on the severity of symptoms and relapse rate of patients. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2014; 19:558-63. [PMID: 25558250 PMCID: PMC4280717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 04/22/2014] [Indexed: 10/27/2022]
Abstract
BACKGROUND Family psycho-education is one of the most effective interventions for preventing relapse in patients with schizophrenia. We evaluated the efficacy of a needs-assessment-based educational program in comparison with a current program (textbook based) in the treatment of schizophrenia. MATERIALS AND METHODS Patients with schizophrenia and their families (N = 60) were allocated to needs-assessment-based education (treatment) and textbook-based (control) programs; both included 10 sessions of education within about 6 months. Symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS) prior to intervention and every 3 months for a total of 18 months. A 25% decrease or increase in total PANSS score was considered as response or relapse, respectively. RESULTS Forty-two cases completed the study. The total PANSS score was significantly decreased in both groups with more reduction in the treatment group. Positive and negative scale scores were reduced in the treatment group, but not significantly in the control group. Response rate was higher in the treatment group and relapse rate was lower (15% vs. 27.2%, P = 0.279). In logistic regression analysis, needs-assessment-based psycho-education was associated with more treatment response. CONCLUSIONS Needs-assessment-based psycho-education is more effective than textbook-based education for treating schizophrenia. We recommend psychiatric care centers to conduct needs-assessment and develop their own program for family psycho-education.
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Affiliation(s)
- Gholam Reza Kheirabadi
- Department of Psychiatry, Behavioral Sciences Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Rafizadeh
- Department of Psychiatry, Behavioral Sciences Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Victoria Omranifard
- Department of Psychiatry, Behavioral Sciences Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Yari
- Department of Psychiatry, Behavioral Sciences Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tayebe Mehrabi
- Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sima Sadri
- Psychologist, Payamenour University of Tehran, Tehran, Iran
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Association between the brain-derived neurotrophic factor Val66Met polymorphism and therapeutic response to olanzapine in schizophrenia patients. Psychopharmacology (Berl) 2014; 231:3757-64. [PMID: 24595507 DOI: 10.1007/s00213-014-3515-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 02/15/2014] [Indexed: 12/22/2022]
Abstract
RATIONALE Brain-derived neurotrophic factor (BDNF) is a neurotrophin that plays a major role in neurogenesis and neuroplasticity, and in the modulation of several neurotransmitter systems including the dopaminergic system. There are mixed reports about the association between the BDNF Val66Met polymorphism, schizophrenia, and treatment response to antipsychotic drugs. OBJECTIVES The present study evaluated the association of the BDNF Val66Met polymorphism with treatment response to atypical antipsychotic olanzapine in schizophrenia and the possible predictive value of the BDNF Val66Met genotype status in treatment response to antipsychotic medication. METHODS The study included 590 ethnically homogenous Caucasian patients with schizophrenia (diagnosed using the SCID), 40.2 ± 12.0 years old, treated with olanzapine monotherapy (10-20 mg/day), or with other antipsychotics such as risperidone (3-6 mg/day), clozapine (100-500 mg/day), haloperidol (3-115 mg/day), fluphenazine (4-25 mg/day), and quetiapine (50-800 mg/day). Patients were subdivided into responders and non-responders according to a 50 % reduction in the Positive and Negative Syndrome Scale (PANSS) total and subscale scores after 8 weeks of treatment. RESULTS The results, corrected for possible effects of gender and age, showed a significant association between the BDNF Val66Met polymorphism and treatment response to olanzapine in patients. The Val/Val genotype was observed more frequently in treatment responders to olanzapine, and this genotype was associated with an improvement in clinical symptoms. CONCLUSIONS Our results suggest that BDNF Val66Met variants might influence the response to 8 weeks of monotherapy with olanzapine, in a relatively large sample of patients with schizophrenia.
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van Erp TGM, Preda A, Nguyen D, Faziola L, Turner J, Bustillo J, Belger A, Lim KO, McEwen S, Voyvodic J, Mathalon DH, Ford J, Potkin SG. Converting positive and negative symptom scores between PANSS and SAPS/SANS. Schizophr Res 2014; 152:289-94. [PMID: 24332632 PMCID: PMC3966195 DOI: 10.1016/j.schres.2013.11.013] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 11/02/2013] [Accepted: 11/10/2013] [Indexed: 11/19/2022]
Abstract
The Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), and the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) are the most widely used schizophrenia symptom rating scales, but despite their co-existence for 25 years no easily usable between-scale conversion mechanism exists. The aim of this study was to provide equations for between-scale symptom rating conversions. Two-hundred-and-five schizophrenia patients [mean age±SD=39.5±11.6, 156 males] were assessed with the SANS, SAPS, and PANSS. Pearson's correlations between symptom scores from each of the scales were computed. Linear regression analyses, on data from 176 randomly selected patients, were performed to derive equations for converting ratings between the scales. Intraclass correlations, on data from the remaining 29 patients, not part of the regression analyses, were performed to determine rating conversion accuracy. Between-scale positive and negative symptom ratings were highly correlated. Intraclass correlations between the original positive and negative symptom ratings and those obtained via conversion of alternative ratings using the conversion equations were moderate to high (ICCs=0.65 to 0.91). Regression-based equations may be useful for conversion between schizophrenia symptom severity as measured by the SANS/SAPS and PANSS, though additional validation is warranted. This study's conversion equations, implemented at http:/converteasy.org, may aid in the comparison of medication efficacy studies, in meta- and mega-analyses examining symptoms as moderator variables, and in retrospective combination of symptom data in multi-center data sharing projects that need to pool symptom rating data when such data are obtained using different scales.
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Affiliation(s)
- Theo G M van Erp
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA 92617, United States
| | - Adrian Preda
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA 92617, United States
| | - Dana Nguyen
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA 92617, United States
| | - Lawrence Faziola
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA 92617, United States
| | - Jessica Turner
- Mind Research Network, Albuquerque, NM 87106, United States; Departments of Psychiatry & Neuroscience, University of New Mexico, Albuquerque, NM 87131, United States
| | - Juan Bustillo
- Departments of Psychiatry & Neuroscience, University of New Mexico, Albuquerque, NM 87131, United States
| | - Aysenil Belger
- Departments of Psychiatry and Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, United States
| | - Sarah McEwen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - James Voyvodic
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710, United States
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA 94143, United States; Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, United States
| | - Judith Ford
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA 94143, United States; Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, United States
| | - Steven G Potkin
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA 92617, United States
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Samara MT, Spineli LM, Furukawa TA, Engel RR, Davis JM, Salanti G, Leucht S. Imputation of response rates from means and standard deviations in schizophrenia. Schizophr Res 2013; 151:209-14. [PMID: 24262679 DOI: 10.1016/j.schres.2013.10.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 09/26/2013] [Accepted: 10/28/2013] [Indexed: 11/19/2022]
Abstract
Missing outcome data is a major threat in meta-analytical studies of schizophrenia. Most clinical trials in psychiatry report only continuous outcome measures and express the effect of an intervention as a difference of means. However, these results are difficult to interpret for clinicians. Converting continuous data to binary response rates is one possible solution to the problem. Based on means and standard deviations for a continuous outcome, we examined the performance of an imputation method to define a dichotomous outcome using original individual patients' data from 16 randomized trials (6276 participants) comparing antipsychotic drugs in schizophrenia. We concluded that the imputed values re-captured in a reasonable degree the observed values providing a simple and practical alternative methodological choice for imputation of missing binary data in schizophrenia trials; nevertheless, the imputation method tended to introduce biases, especially for extreme risks and large treatment differences.
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Affiliation(s)
- Myrto T Samara
- Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany
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Anghelescu IG, Janssens L, Kent J, de Boer P, Tritsmans L, Daly EJ, van Nueten L, Schmidt ME. Does early improvement predict response to the fast-dissociating D₂ receptor antagonist JNJ-37822681 in patients with acute schizophrenia? Eur Neuropsychopharmacol 2013; 23:1043-50. [PMID: 22995972 DOI: 10.1016/j.euroneuro.2012.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 08/24/2012] [Accepted: 08/25/2012] [Indexed: 10/27/2022]
Abstract
Early predictability of sustained response to atypical antipsychotics in patients with schizophrenia has important implications for clinical decision making. In order to investigate whether early onset of efficacy correlates with week-6 response for the selective fast-dissociating D2 receptor antagonist JNJ-37822681, we analysed data from a 12-week placebo- and active-controlled (olanzapine) study designed to evaluate efficacy and safety of JNJ-37822681. Factors, including baseline Positive and Negative Syndrome Scale (PANSS) total score, waist circumference, weight, body mass index group, number of previous hospitalisations, age at diagnosis, race, sex and age at study entry, and relative (%) change from baseline on day 3 (early improvement) in PANSS total score, were analysed using logistic regression models and receiver operator characteristic (ROC) curve analysis, to predict the week-6 efficacy response (≥ 30% improvement in PANSS total score). Results showed that week-6 response with JNJ-37822681 30 mg bid treatment could be reliably predicted by improvement in PANSS total score on day 3, the number of previous hospitalisations, and race (80% accuracy [ROC area under curve]). Early improvement (day 3) in PANSS score had the highest predictive value as a single factor across all JNJ-37822681 doses. At a specificity of 70%, sensitivity for predicting week-6 response was: 0.60, 0.64, and 0.74 in the 10-, 20-, and 30 mg bid JNJ-37822681 groups, respectively; 0.40 in olanzapine group. Early improvement in PANSS may be a simple and reliable way to predict sustained response with JNJ-37822681 in patients with acute schizophrenia.
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Affiliation(s)
- Ion-George Anghelescu
- Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Turnhoutseweg 30, 2340 Beerse, QJ;Belgium, Germany.
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Neural markers of negative symptom outcomes in distributed working memory brain activity of antipsychotic-naive schizophrenia patients. Int J Neuropsychopharmacol 2013; 16:1195-204. [PMID: 23164479 DOI: 10.1017/s1461145712001253] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Since working memory deficits in schizophrenia have been linked to negative symptoms, we tested whether features of the one could predict the treatment outcome in the other. Specifically, we hypothesized that working memory-related functional connectivity at pre-treatment can predict improvement of negative symptoms in antipsychotic-treated patients. Fourteen antipsychotic-naive patients with first-episode schizophrenia were clinically assessed before and after 7 months of quetiapine monotherapy. At baseline, patients underwent functional magnetic resonance imaging while performing a verbal n-back task. Spatial independent component analysis identified task-modulated brain networks. A linear support vector machine was trained with these components to discriminate six patients who showed improvement in negative symptoms from eight non-improvers. Classification accuracy and significance was estimated by leave-one-out cross-validation and permutation tests, respectively. Two frontoparietal and one default mode network components predicted negative symptom improvement with a classification accuracy of 79% (p = 0.003). Discriminating features were found in the frontoparietal networks but not the default mode network. These preliminary data suggest that functional patterns at baseline can predict negative symptom treatment-response in schizophrenia. This information may be used to stratify patients into subgroups thereby facilitating personalized treatment.
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Pharmacokinetic-pharmacodynamic modeling of antipsychotic drugs in patients with schizophrenia Part I: the use of PANSS total score and clinical utility. Schizophr Res 2013; 146:144-52. [PMID: 23473810 DOI: 10.1016/j.schres.2013.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 01/22/2013] [Accepted: 02/06/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND To develop a pharmacokinetic-pharmacodynamic (PK-PD) model using individual-level data of Positive and Negative Syndrome Scale (PANSS) total score to characterize the antipsychotic drug effect taking into account the placebo effect and dropout rate. In addition, a clinical utility (CU) criterion that describes the usefulness of a drug therapy was calculated using the efficacy of the drug and dropout rates. METHODS Data from 12 clinical trials in schizophrenia patients was used to quantify the effects of the antipsychotic drugs (APs), namely, haloperidol, risperidone, olanzapine, ziprasidone and paliperidone. Compartmental PK models were used to describe the time course of plasma drug concentrations. The combination of an Emax and the Weibull model was used to describe the drug and placebo effects. The steady-state drug concentrations were assumed to be the drivers of the exposure-response relationship. An exponential model was utilized to identify the predictors of probability of dropout. Simulations were performed to check the predictability of the model, and to calculate the CU of the drugs based on PANSS scores and dropout rates. RESULTS The maximal drug effect (E(max)) was highest for olanzapine whilst it was lowest for ziprasidone. Higher observed PANSS scores resulted in a greater likelihood of dropout. Taking into account the efficacy and the drop-out rate, all APs possessed a comparable CU at the therapeutic doses. The resulting PK-PD model parameters were used to compute the effective concentration and dose required to produce a clinically meaningful 30% drop in PANSS score from the baseline. CONCLUSIONS The developed PK-PD model and the associated CU score allow the evaluation of the time course of the PANSS scores of the different APs and a proper comparison of their clinically relevant treatments effects.
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