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Pöthe B, Conus P, Golay P. Impact of a family history of mental disorders on the characteristics of patients with early psychosis. Early Interv Psychiatry 2024. [PMID: 38572759 DOI: 10.1111/eip.13525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/15/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
AIM Children of parents with psychiatric illness have a higher risk of developing psychiatric disorders. This is particularly the case for psychoses and the evolution of these disorders could likely differ. The aim of this study was to study the impact of a first-degree and second-degree family history of psychiatric disorders (FHPD) on the characteristics of patients with early psychosis in a specialized programme. METHOD This research is a prospective study based on 408 patients aged 18-35 years enrolled in the Treatment and Early Intervention in Psychosis Program (TIPP) with a three-years follow-up. Various characteristics were compared between patients with first-degree-FHPD and those without, then between patients with 2nd degree-FHPD and those without. The influence of the number of parents with first or second degree FHPD on clinical characteristics was also studied. RESULTS Our results showed an influence of FHPD on the characteristics of patients presenting a first episode of psychosis. Over the 3 years of follow-up, patients with at least one second-degree relative showed more negative and depressive symptoms and poorer general functioning than patient who did not. The number of parents with first or second degree FHPD was also negatively associated with several clinical variables. CONCLUSION The results of this study confirm the existence of a distinct premorbid profile and a different evolution in patients with FHPD, which is not limited to first-degree relatives. This suggests the importance of specific needs that should be addressed during treatment.
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Affiliation(s)
- Barbara Pöthe
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Philippe Conus
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Philippe Golay
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland
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2
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Shishido R, Kunii Y, Hino M, Izumi R, Nagaoka A, Hayashi H, Kakita A, Tomita H, Yabe H. Evidence for increased DNA damage repair in the postmortem brain of the high stress-response group of schizophrenia. Front Psychiatry 2023; 14:1183696. [PMID: 37674553 PMCID: PMC10478254 DOI: 10.3389/fpsyt.2023.1183696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/12/2023] [Indexed: 09/08/2023] Open
Abstract
Background Schizophrenia (SZ) is a disorder diagnosed by specific symptoms and duration and is highly heterogeneous, clinically and pathologically. Although there are an increasing number of studies on the association between genetic and environmental factors in the development of SZ, the actual distribution of the population with different levels of influence of these factors has not yet been fully elucidated. In this study, we focused on stress as an environmental factor and stratified SZ based on the expression levels of stress-responsive molecules in the postmortem prefrontal cortex. Methods We selected the following stress-responsive molecules: interleukin (IL) -1β, IL-6, IL-10, tumor necrosis factor-α, interferon-γ, glucocorticoid receptor, brain-derived neurotrophic factor, synaptophysin, S100 calcium-binding protein B, superoxide dismutase, postsynaptic density protein 95, synuclein, apolipoprotein A1 (ApoA1), ApoA2, and solute carrier family 6 member 4. We performed RNA sequencing in the prefrontal gray matter of 25 SZ cases and 21 healthy controls and conducted a hierarchical cluster analysis of SZ based on the gene expression levels of stress-responsive molecules, which yielded two clusters. After assessing the validity of the clusters, they were designated as the high stress-response SZ group and the low stress-response SZ group, respectively. Ingenuity Pathway Analysis of differentially expressed genes (DEGs) between clusters was performed, and Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining was conducted on four cases each in the high and low stress-response SZ groups to validate DNA damage. Results We found higher prevalence of family history of SZ in the low stress-response SZ group (0/3 vs. 5/4, p = 0.04). Pathway analysis of DEGs between clusters showed the highest enrichment for DNA double-strand break repair. TUNEL staining showed a trend toward a lower percentage of TUNEL-positive cells in the high stress-response SZ group. Conclusion Our results suggest that there are subgroups of SZ with different degrees of stress impact. Furthermore, the pathophysiology of these subgroups may be associated with DNA damage repair. These results provide new insights into the interactions and heterogeneity between genetic and environmental factors.
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Affiliation(s)
- Risa Shishido
- Department of Neuropsychiatry, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuto Kunii
- Department of Neuropsychiatry, School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Disaster Psychiatry, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| | - Mizuki Hino
- Department of Neuropsychiatry, School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Disaster Psychiatry, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| | - Ryuta Izumi
- Department of Neuropsychiatry, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Atsuko Nagaoka
- Department of Neuropsychiatry, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hideki Hayashi
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Hiroaki Tomita
- Department of Disaster Psychiatry, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| | - Hirooki Yabe
- Department of Neuropsychiatry, School of Medicine, Fukushima Medical University, Fukushima, Japan
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Selvendra A, Toh WL, Neill E, Tan EJ, Rossell SL, Morgan VA, Castle DJ. Age of onset by sex in schizophrenia: Proximal and distal characteristics. J Psychiatr Res 2022; 151:454-460. [PMID: 35605342 DOI: 10.1016/j.jpsychires.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/14/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Earlier schizophrenia onset in men relative to women has been a consistent finding in the literature, but a nuanced understanding of underlying reasons remains elusive. Further consideration should be given to factors associated with sex differences in age of onset. METHOD Participants with schizophrenia were derived from the 2010 Australian Survey of High Impact Psychosis (n = 857). The SHIP survey constituted a representative, population-based study of almost 1.5 million Australian adults seen at various mental health services, and assessed personal health information, psychiatric comorbidities as well as psychosis illness and treatment. Hierarchical clustering was employed to identify age of onset by sex. Within-sex comparisons on distal and proximal factors affecting age of onset were conducted. RESULTS Using modal age, two and three clusters were respectively found in men (early versus late onset) and women (early versus mid versus late onset). Early onset groups in both sexes had an increased family history of psychosis compared to older onset, but other risk factors were not consistent across the sexes. Less premorbid impairment was noted in females with middle to later onset schizophrenia. CONCLUSION These findings further inform our understanding of the pathogenesis of schizophrenia. Added explorations of trends in older onset schizophrenia cohorts is especially important.
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Affiliation(s)
- Ajit Selvendra
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.
| | - Wei Lin Toh
- Centre for Mental Health (CMH), Swinburne University of Technology, Melbourne, VIC, Australia
| | - Erica Neill
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; Centre for Mental Health (CMH), Swinburne University of Technology, Melbourne, VIC, Australia
| | - Eric J Tan
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Centre for Mental Health (CMH), Swinburne University of Technology, Melbourne, VIC, Australia
| | - Susan L Rossell
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Centre for Mental Health (CMH), Swinburne University of Technology, Melbourne, VIC, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, University of Western Australia, Perth, WA, Australia; Centre for Clinical Research in Neuropsychiatry, Medical School, University of Western Australia, Perth, WA, Australia
| | - David J Castle
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
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Neurodevelopment regulators miR-137 and miR-34 family as biomarkers for early and adult onset schizophrenia. NPJ SCHIZOPHRENIA 2021; 7:35. [PMID: 34226568 PMCID: PMC8257739 DOI: 10.1038/s41537-021-00164-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/09/2021] [Indexed: 02/06/2023]
Abstract
Early-onset schizophrenia (EOS) may have stronger familial aggregation and a more severe outcome than adult-onset schizophrenia (AOS). MicroRNA (miRNA) takes on dual roles as a genetic and epigenetic modulator, which may mediate the influence of genetic risk. Neurological soft signs (NSS) are neurological abnormalities that may be intermediate phenotypes or endophenotypes for schizophrenia. Our previous study found poorer performance on NSS tests from patients with EOS and their unaffected first-degree relatives. Thus, we aimed to identify a set of aberrant neurodevelopmental-related miRNAs that could serve as potential biomarkers for EOS or schizophrenia with NSS. This study included 215 schizophrenia patients (104 EOS and 111 AOS), 72 unaffected first-degree relatives, 31 patients with bipolar disorder, and 100 healthy controls. Differential expression analysis revealed that miR-137, miR-34b, and miR-34c were significantly up-regulated in patients with schizophrenia and their unaffected first-degree relatives compared to healthy controls. Receiver operating characteristic (ROC) analysis showed that the miR-137 expression signature could be used to discriminate between patients with EOS and healthy controls (AUC = 0.911). Additionally, miR-34b had the highest ability to discriminate between EOS and AOS (AUC = 0.810), which may indicate different aetiological pathways to disease onset. Moreover, miR-137 dysregulation was correlated with almost all NSS subscales (i.e., sensory integration, motor sequencing, etc.) and, when EOS patients with NSS, miR-137 expression discriminated these patients from healthy controls to a greater extent (AUC = 0.957). These findings support the potential for neurodevelopmental-related miRNAs to be used as indicators of vulnerability to EOS.
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Cuesta MJ, Sánchez-Torres AM, Lorente-Omeñaca R, Zandio M, Moreno-Izco L, Peralta V. Validity and utility of a set of clinical criteria for cognitive impairment associated with psychosis (CIAPs). Psychiatry Res 2020; 293:113404. [PMID: 32911349 DOI: 10.1016/j.psychres.2020.113404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 01/12/2023]
Abstract
Schizophrenia and other psychoses display a common profile of mild to moderate cognitive deficits that are associated with poor functional outcomes. Cognitive impairment is usually evaluated by neuropsychological assessment, and interview-based measures with good psychometric properties and high utility for clinical practice are now available. However, the extent to which a set of clinical criteria can be used as proxy measures of cognitive deficits in this population has not been tested. This study aimed to examine the empirical validity of a set of clinical criteria for cognitive impairment associated with psychosis (CIAPs). Ninety-eight patients with non-pure affective psychosis and 50 healthy-matched controls were included. The CIAPs criteria were empirically tested against antecedent, concurrent and outcome validators and by means of a neuropsychological evaluation based on MATRICS Consensus Cognitive Battery (MCCB). The CIAPs criteria showed strong associations with outcomes and certain antecedent validators and moderate associations with concurrent validators. The CIAPs criteria achieved superior neuropsychological validity compared to current DSM 5 criteria for schizophrenia, the B-criterion of DSM 5 schizophrenia or a combination of both criteria. Cognitive impairment associated with psychosis can be clinically assessed and is a useful tool for clinical practice and predicting outcomes of schizophrenia and related psychosis.
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Affiliation(s)
- Manuel J Cuesta
- Psychiatry Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| | | | | | - María Zandio
- Psychiatry Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Lucía Moreno-Izco
- Psychiatry Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Victor Peralta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
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Hatzimanolis A, Stefanatou P, Kattoulas E, Ralli I, Dimitrakopoulos S, Foteli S, Kosteletos I, Mantonakis L, Selakovic M, Soldatos RF, Vlachos I, Xenaki LA, Smyrnis N, Stefanis NC. Familial and socioeconomic contributions to premorbid functioning in psychosis: Impact on age at onset and treatment response. Eur Psychiatry 2020; 63:e44. [PMID: 32345391 PMCID: PMC7355181 DOI: 10.1192/j.eurpsy.2020.41] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background. Premorbid adjustment (PA) abnormalities in psychotic disorders are associated with an earlier age at onset (AAO) and unfavorable clinical outcomes, including treatment resistance. Prior family studies suggest that familial liability, likely reflecting increased genetic risk, and socioeconomic status (SES) contribute to premorbid maladjustment. However, their joint effect possibly indicating gene–environment interaction has not been evaluated. Methods. We examined whether family history of psychosis (FHP) and parental SES may predict PA and AAO in unrelated cases with first-episode psychosis (n = 108) and schizophrenia (n = 104). Premorbid academic and social functioning domains during childhood and early adolescence were retrospectively assessed. Regression analyses were performed to investigate main effects of FHP and parental SES, as well as their interaction. The relationships between PA, AAO, and response to antipsychotic medication were also explored. Results. Positive FHP associated with academic PA difficulties and importantly interacted with parental SES to moderate social PA during childhood (interaction p = 0.024). Positive FHP and parental SES did not predict differences in AAO. Nevertheless, an earlier AAO was observed among cases with worse social PA in childhood (β = −0.20; p = 0.005) and early adolescence (β = −0.19; p = 0.007). Further, confirming evidence emerged for an association between deficient childhood social PA and poor treatment response (p = 0.04). Conclusions. Familial risk for psychosis may interact with parental socioeconomic position influencing social PA in childhood. In addition, this study supports the link between social PA deviations, early psychosis onset, and treatment resistance, which highlights premorbid social functioning as a promising clinical indicator.
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Affiliation(s)
- Alex Hatzimanolis
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 11528 Athens, Greece.,Neurobiology Research Institute, Theodor-Theohari Cozzika Foundation, 11521 Athens, Greece
| | - Pentagiotissa Stefanatou
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 11528 Athens, Greece
| | - Emmanouil Kattoulas
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 11528 Athens, Greece
| | - Irene Ralli
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 11528 Athens, Greece
| | - Stefanos Dimitrakopoulos
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 11528 Athens, Greece
| | - Stefania Foteli
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 11528 Athens, Greece
| | - Ioannis Kosteletos
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 11528 Athens, Greece
| | - Leonidas Mantonakis
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 11528 Athens, Greece
| | - Mirjana Selakovic
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 11528 Athens, Greece
| | - Rigas-Filippos Soldatos
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 11528 Athens, Greece
| | - Ilias Vlachos
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 11528 Athens, Greece
| | - Lida-Alkisti Xenaki
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 11528 Athens, Greece
| | - Nikolaos Smyrnis
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 11528 Athens, Greece.,University Mental Health, Neurosciences and Precision Medicine Research Institute, 11527 Athens, Greece
| | - Nicholas C Stefanis
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 11528 Athens, Greece.,Neurobiology Research Institute, Theodor-Theohari Cozzika Foundation, 11521 Athens, Greece.,University Mental Health, Neurosciences and Precision Medicine Research Institute, 11527 Athens, Greece
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7
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Age of onset group characteristics in forensic patients with schizophrenia. Eur Psychiatry 2020; 29:149-52. [DOI: 10.1016/j.eurpsy.2012.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/14/2012] [Accepted: 11/23/2012] [Indexed: 11/30/2022] Open
Abstract
AbstractThis study aims to empirically identify age of onset groups and their clinical and background characteristics in forensic patients with schizophrenia. Hospital charts were reviewed of all 138 forensic patients with schizophrenia admitted to Geha Psychiatric Hospital that serves a catchment area of approximately 500,000 people, from 2000 to 2009 inclusive. Admixture analysis empirically identified early- (M = 19.99, SD = 3.31) and late-onset groups (M = 36.13, SD = 9.25). Early-onset was associated with more suicide attempts, violence before the age of 15, and early conduct problems, whereas late-onset was associated with a greater likelihood of violence after the age of 18 and marriage (P < 0.01). The current findings provide clinicians with a unique direction for risk assessment and indicate differences in violence between early- and late-onset schizophrenia, particularly co-occurrence of harmful behavioral phenotypes.
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Ku BS, Pauselli L, Manseau M, Compton MT. Neighborhood-level predictors of age at onset and duration of untreated psychosis in first-episode psychotic disorders. Schizophr Res 2020; 218:247-254. [PMID: 31948900 PMCID: PMC7299734 DOI: 10.1016/j.schres.2019.12.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/20/2019] [Accepted: 12/27/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Recent years have witnessed growing interest in the role of the social environment in the development and outcomes of schizophrenia. We investigated whether neighborhood characteristics are associated with two important prognostic factors in early-course psychosis, age at onset of psychosis (AOP) and duration of untreated psychosis (DUP). METHODS Data were collected from patients admitted to the hospital for first-episode schizophrenia-spectrum disorder. We collected data on perceived neighborhood disorder during childhood/adolescence and extracted data on 13 neighborhood characteristics from the American Community Survey based upon individual addresses. Four neighborhood-level factors were derived from factor analysis. Multiple logistic regression analyses assessed the association between specific neighborhood characteristics and the two prognostic factors (earlier AOP and longer DUP) in early-course psychosis. RESULTS 143 participants had valid addresses geo-coded. Neighborhood-level residential instability was associated with an earlier AOP (OR = 1.760; p = 0.022) even after controlling for known risk factors (OR = 2.026; p = 0.020) and also after controlling for individual-level residential instability (OR = 1.917; p = 0.037). The general socioeconomic status neighborhood factor (OR = 1.119; p = 0.019) and perceived neighborhood disorder (OR = 1.075; p = 0.005) were associated with a longer DUP. But only perceived neighborhood disorder (OR = 1.146; p = 0.011) remained significant, and general socioeconomic status was close to significant (OR = 1.215; p = 0.062), after controlling for individual-level predictors and socioeconomic status. CONCLUSIONS This study found evidence that neighborhood-level characteristics (in this case, residential instability) may be associated with earlier AOP, and perceptions of neighborhood disorder are associated with a longer treatment delay. Socioenvironmental factors should be more consistently considered going forward in research on early psychotic disorders.
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Affiliation(s)
- Benson S. Ku
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA,Corresponding author: Benson Ku, M.D., , 100 Woodruff Circle Suite 327, Atlanta, GA 30322, (404) 727-8381, Fax: 289-802-1992
| | - Luca Pauselli
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA,Icahn School of Medicine at Mount Sinai, St. Luke’s/West Hospital Center, Department of Psychiatry, New York, NY, USA
| | - Marc Manseau
- New York University School of Medicine, Department of Psychiatry, New York, NY, USA
| | - Michael T. Compton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
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9
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Tanskanen A, Tiihonen J, Taipale H. Mortality in schizophrenia: 30-year nationwide follow-up study. Acta Psychiatr Scand 2018; 138:492-499. [PMID: 29900527 DOI: 10.1111/acps.12913] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Recent reports suggest that the mortality gap between persons with schizophrenia and the general population is increasing. We investigated the mortality, age at death, and causes of death among persons diagnosed with schizophrenia and the general population in Finland during 1984-2014. METHODS All persons with schizophrenia in Finland were identified from hospital discharge register, and compared with the Finnish population aged 16 years and older during 1984-2014, based on data from Statistics Finland. Age at death and standardized mortality ratio (SMR) were calculated for each follow-up year. RESULTS Mean age at death increased from 57.6 years in 1984 to 70.1 years in 2014 in persons with schizophrenia, and from 70.9 to 77.5 years in the general population. All-cause SMR remained stable during the follow-up (2.6 in 1984 and 2.7 in 2014). A major change was observed in SMR for suicides which decreased from 11.0 in 1984 to 6.6 in 2014 (-40%). The SMRs for cardiovascular and cancer deaths showed increasing trends. CONCLUSION The longevity of persons with schizophrenia is improving at approximately the same rate as the general population but suicide rates have declined substantially. However, there is still a major disparity in mortality compared with general population.
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Affiliation(s)
- A Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - J Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - H Taipale
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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10
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Association between family history of mental disorders and outcome in psychotic disorders. Psychiatry Res 2018; 270:616-621. [PMID: 30384280 DOI: 10.1016/j.psychres.2018.10.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 01/20/2023]
Abstract
We investigated the association of family history of mental disorders, especially psychosis, with occupational and clinical outcome in psychotic disorders in a longitudinal population-based cohort. The Northern Finland Birth Cohort 1986 (n = 9432) was used to gather the data. In total 189 individuals with psychosis were identified by age of 28. The outcome was assessed by using register information regarding occupational activity, disability pension and hospital treatments due to psychiatric cause. Parental psychosis and any psychiatric disorder were used as predictors of outcome. The results showed that presence of any parental psychiatric disorder was associated with higher number of days spent at hospital and higher number of hospitalizations in psychotic disorders, but was not associated with occupational outcome or disability pension. The presence of parental psychosis was not associated with outcome. These findings suggest that the presence of any psychiatric disorder among parents may increase the risk of poorer outcome in psychoses in terms of need of hospitalisations. Based on this study the presence of parental psychosis is not associated with outcome, but the result should be interpreted with caution due to the small sample size and conflict with the results of earlier studies.
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11
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Pepper EJ, Pathmanathan S, McIlrae S, Rehman FU, Cardno AG. Associations between risk factors for schizophrenia and concordance in four monozygotic twin samples. Am J Med Genet B Neuropsychiatr Genet 2018; 177:503-510. [PMID: 30134083 DOI: 10.1002/ajmg.b.32640] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 11/08/2022]
Abstract
Concordance for schizophrenia is high in monozygotic twins but the extent to which concordance varies according to the presence of other schizophrenia risk factors is not well established. We aimed to investigate this in systematically ascertained twin samples. DSM-III-R/DSM-IV diagnoses were made from original data or published case histories from four systematically ascertained monozygotic twin samples. Probandwise concordance for schizophrenia was calculated according to the presence of psychotic disorder in first-degree relatives, birth order, gender, and age-at-onset. Logistic regression analysis was also performed to adjust for potential confounders. Psychotic disorder in parents and earlier age-at-onset were significantly associated with higher probandwise concordance for schizophrenia, including after adjustment for potential confounders. For example, when no parents had a psychotic disorder concordance was 34/88 (38.6%) versus 10/16 (62.5%) when one parent was affected; and for age-at-onset <23 years concordance was 25/46 (54.3%), declining to 13/44 (29.5%) for age-at-onset >30 years. These results are consistent with psychotic disorder in parents and age-at-onset being markers of the level of familial liability to schizophrenia and these factors may be useful in genetic counseling of monozygotic twins and in identifying and managing those at particularly high risk, if these findings are further replicated.
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Affiliation(s)
- Edward J Pepper
- Division of Psychiatry and Behavioural Sciences, Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Sasi Pathmanathan
- Division of Psychiatry and Behavioural Sciences, Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Shona McIlrae
- Division of Psychiatry and Behavioural Sciences, Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Faiz-Ur Rehman
- Lancashire Care NHS Foundation Trust, Preston, United Kingdom
| | - Alastair G Cardno
- Division of Psychiatry and Behavioural Sciences, Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
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Fujimaki K, Toki S, Yamashita H, Oyamada T, Yamawaki S. Predictors of negative symptoms in the chronic phase of schizophrenia: A cross-sectional study. Psychiatry Res 2018; 262:600-608. [PMID: 28965809 DOI: 10.1016/j.psychres.2017.09.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 09/19/2017] [Accepted: 09/22/2017] [Indexed: 11/15/2022]
Abstract
This study was designed to investigate the relationship between negative symptoms and key indicators for long-term hospital stays among inpatients with schizophrenia. A further aim was to elucidate the clinical determinants of negative symptoms. The following were used as index factors: age, duration of illness, duration of hospitalization, age at onset, years of education, smoking status, body mass index, concentrations of serum triglycerides, total cholesterol, uric acid, QTc interval duration from electrocardiography, dose equivalents of antipsychotic and anticholinergic agents, neurocognitive function, drug-induced extrapyramidal symptoms, involuntary movements, and psychiatric symptoms. Spearman's rank correlation coefficients were calculated and regression analyses were performed to examine associations between these factors and negative symptoms. Positive symptoms correlated positively with negative symptoms as rated on the Brief Psychiatric Rating Scale. Age at onset correlated negatively with negative symptoms. Multiple regression analysis showed that dose equivalents of atypical antipsychotics and positive symptoms predicted negative symptoms. Increasing our understanding of these predictors as key indicators of the severity of negative symptoms may aid in the reconsideration of therapeutic programs for chronic schizophrenia.
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Affiliation(s)
- Koichiro Fujimaki
- Faculty of Health and Welfare, Prefectural University of Hiroshima, Mihara, Japan.
| | | | - Hidehisa Yamashita
- Department of Psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Shigeto Yamawaki
- Department of Psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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13
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Scully PJ, Quinn JF, Morgan MG, Kinsella A, O'Callaghan E, Owens JM, Waddington JL. First-episode schizophrenia, bipolar disorder and other psychoses in a rural Irish catchment area: Incidence and gender in the Cavan–Monaghan study at 5 years. Br J Psychiatry 2018; 43:s3-9. [PMID: 12271797 DOI: 10.1192/bjp.181.43.s3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BackgroundThe potential of first-episode studies in schizophrenia is maximised through systematic epidemiological, clinical and biological comparisons between homogeneous populations of the psychoses.AimsTo conduct prolonged accrual of ‘all’ cases of non-affective and affective psychotic illness on an epidemiologically complete basis.MethodWithin the region covered by Cavan–Monaghan psychiatric service (population 102 810), all putative cases of first-episode psychosis were diagnosed using DSM–IV.ResultsFrom 1995 to 2000, 69 cases of psychosis were ascertained, the incidence being 2.3-fold lower in females than in males. On resolving the ‘core’ diagnoses of schizophrenia and bipolar disorder, incidence of schizophrenia among women was 7.5-fold lower than among men whereas incidence of bipolar disorder among women was 6.6-fold lower than among men.ConclusionsThis homogeneous population, which eliminates factors associated with urbanicity and minimises confounding factors such as socioeconomic, ethnic and geographical diversity, shows a markedly reduced incidence among females both of schizophrenia and of bipolar disorder.
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Affiliation(s)
- Paul J Scully
- Stanley Research Unit, St Davnet's Hospital, Monaghan, Ireland
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Byrne M, Agerbo E, Mortensen PB. Family history of psychiatric disorders and age at first contact in schizophrenia: An epidemiological study. Br J Psychiatry 2018; 43:s19-25. [PMID: 12271795 DOI: 10.1192/bjp.181.43.s19] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BackgroundThe risk for schizophrenia has been associated with a family history of this and other psychiatric disorders. The relationship between age at first contact and family history of psychiatric illness is not certain.AimsTo estimate the risks for schizophrenia associated with a range of psychiatric diagnoses in family members and to investigate the relationship between these risks and age at first contact for schizophrenia.MethodA nested case–control study design was employed. Psychiatric admission data and socio-economic data were available for 7704 cases admitted between 1981 and 1998 in Denmark, 192 590 gender- and age-matched controls, and for the parents and siblings of all subjects.ResultsControlling for socio-economic factors, risk for schizophrenia was associated with a family history of all psychiatric disorders except substance misuse and independently with a family history of suicide. The risk for schizophrenia associated with a family history of psychiatric disorders decreased as age at first contact increased.ConclusionsRisk for schizophrenia is associated with a range of psychiatric disorders in family members and these risks are not constant across the risk period.
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Affiliation(s)
- Majella Byrne
- National Centre for Register-Based Research, Aarhus University, Taasingegade 1, Aarhus 8000 C, Denmark.
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15
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Immonen J, Jääskeläinen E, Korpela H, Miettunen J. Age at onset and the outcomes of schizophrenia: A systematic review and meta-analysis. Early Interv Psychiatry 2017; 11:453-460. [PMID: 28449199 PMCID: PMC5724698 DOI: 10.1111/eip.12412] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/25/2016] [Indexed: 12/03/2022]
Abstract
The aim of this study was to analyse the effect of age at onset on the long-term clinical, social and global outcomes of schizophrenia through a systematic review and a meta-analysis. Original studies were searched from Web of Science, PsycINFO, Pubmed and Scopus, as well as manually. Naturalistic studies with at least a 2-year follow-up were included. Of the 3509 search results, 81 articles fulfilled the inclusion criteria. The meta-analysis was performed in Stata as a random-effect analysis with correlation coefficients between age at onset and the outcomes (categorized into remission, relapse, hospitalization, positive symptoms, negative symptoms, total symptoms, general clinical outcome, employment, social/occupational functioning and global outcome). There was a statistically significant (P < .05) correlation between younger age at onset and more hospitalizations (number of studies, n = 9; correlation, r = 0.17; 95% confidence interval, CI 0.09-0.25), more negative symptoms (n = 7; r = 0.14; 95% CI 0.01-0.27), more relapses (n = 3; r = 0.11; 95% CI 0.02-0.20), poorer social/occupational functioning (n = 12; r = 0.15; 95% CI 0.05-0.25) and poorer global outcome (n = 13; r = 0.14; 95% CI 0.07-0.22). Other relationships were not significant. This was the first systematic review of the effects of age at onset on the long-term outcomes of schizophrenia. The results show that age at onset has a small, but significant impact on some of the outcomes of schizophrenia.
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Affiliation(s)
- Johanna Immonen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Erika Jääskeläinen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
- Oulu Occupational HealthOuluFinland
| | - Hanna Korpela
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Jouko Miettunen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
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16
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Paruk S, Jhazbhay K, Singh K, Sartorius B, Burns JK. The clinical impact of a positive family history of psychosis or mental illness in psychotic and non-psychotic mentally ill adolescents. J Child Adolesc Ment Health 2017; 29:219-229. [PMID: 29092669 DOI: 10.2989/17280583.2017.1389741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND A family history of psychosis is associated with negative clinical characteristics of psychosis. AIM We aimed to determine the relationship between a family history (in first-degree relatives) of psychosis (FHP) or of any mental illness (FHM), and the clinical features (including cannabis use) of first episode early onset psychosis (EOP). METHOD Forty-five adolescents with first episode EOP presenting to psychiatric services were assessed by clinical interview with the following tools: socio-demographic questionnaire, Positive and Negative Syndrome Scale (PANSS), Symptom Onset in Schizophrenia (SOS) inventory, and the World Health Organisation's (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) for cannabis misuse. Forty-five gender and age matched controls with incident non-psychotic mental illness were recruited from the same clinical sites. RESULTS While there was evidence of trend associations, EOP adolescents and controls did not differ in terms of either FHP or FHM. However, adolescents with a non-psychotic mental illness (controls) were significantly more likely to have a family history of non-psychotic mental illness (EOP = 13%; controls = 47%, p = 0.001). In EOP adolescents, a positive FHP was associated with a significantly lower mean PANSS positive score (p = 0.009), but not with other clinical features. CONCLUSION FHP may be a diagnostic clue in adolescents and is not necessarily associated with negative clinical characteristics at disease onset in EOP. However, this requires further research.
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Affiliation(s)
- Saeeda Paruk
- a Department of Psychiatry , University of KwaZulu-Natal , Durban , South Africa
| | - Khatija Jhazbhay
- a Department of Psychiatry , University of KwaZulu-Natal , Durban , South Africa
| | - Keshika Singh
- a Department of Psychiatry , University of KwaZulu-Natal , Durban , South Africa
| | - Benn Sartorius
- a Department of Psychiatry , University of KwaZulu-Natal , Durban , South Africa
| | - Jonathan K Burns
- a Department of Psychiatry , University of KwaZulu-Natal , Durban , South Africa
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17
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Tsai IN, Lin JJ, Lu MK, Tan HP, Jang FL, Gan ST, Lin SH. Improving risk assessment and familial aggregation of age at onset in schizophrenia using minor physical anomalies and craniofacial measures. Medicine (Baltimore) 2016; 95:e4406. [PMID: 27472737 PMCID: PMC5265874 DOI: 10.1097/md.0000000000004406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Age at onset is the most important feature of schizophrenia that could indicate its origin. Minor physical anomalies (MPAs) characterize potential marker indices of disturbances in early neurodevelopment. However, the association between MPAs and age at onset of schizophrenia is still unclear. We aimed to compare risk assessment and familial aggregation in patients with early-onset schizophrenia (EOS) and adult-onset schizophrenia (AOS) with MPAs and craniofacial measures.We estimated the risk assessment of MPAs among patients with EOS (n = 68), patients with AOS (n = 183), nonpsychotic relatives (n = 147), and healthy controls (n = 241) using 3 data-mining algorithms. In addition, we assessed the magnitude of familial aggregation of MPAs with respect to the age at onset of schizophrenia.The performance of EOS was superior to that of AOS, with discrimination accuracies of 89% and 76%, respectively. Combined MPA scores as the risk assessment were significantly higher in all schizophrenia subgroups and the nonpsychotic relatives of EOS patients than in the healthy controls. The recurrence risk ratio for familial aggregation of the MPA scores of EOS families (odds ratio 9.27) was substantially higher than that of AOS families (odds ratio 2.47).The results highlight that EOS improves risk assessment and has a severe magnitude of familial aggregation of MPAs. These findings indicate that EOS might result from a stronger genetic susceptibility to neurodevelopmental deficits.
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Affiliation(s)
- I-Ning Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
| | - Jin-Jia Lin
- Department of Psychiatry, Chimei Medical Center
| | - Ming-Kun Lu
- Department of Health, Jianan Mental Hospital
- Department of Applied Life Science and Health, Chia Nan University of Pharmacy and Science
| | - Hung-Pin Tan
- Department of Psychiatry, Kaohsiung Veterans General Hospital Tainan Branch
- Department of Acupressure Technology, Chung Hwa University of Medical Technology
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University
| | | | - Shu-Ting Gan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
- Biostatistics Consulting Center, National Cheng Kung University Hospital, Tainan, Taiwan
- Correspondence: Sheng-Hsiang Lin, Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138, Shengli Road, Tainan, Taiwan (e-mail: )
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18
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Distinct disruptions of resting-state functional brain networks in familial and sporadic schizophrenia. Sci Rep 2016; 6:23577. [PMID: 27032817 PMCID: PMC4817042 DOI: 10.1038/srep23577] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/08/2016] [Indexed: 01/24/2023] Open
Abstract
Clinical and brain structural differences have been reported between patients with familial and sporadic schizophrenia; however, little is known about the brain functional differences between the two subtypes of schizophrenia. Twenty-six patients with familial schizophrenia (PFS), 26 patients with sporadic schizophrenia (PSS) and 26 healthy controls (HC) underwent a resting-state functional magnetic resonance imaging. The whole-brain functional network was constructed and analyzed using graph theoretical approaches. Topological properties (including global, nodal and edge measures) were compared among the three groups. We found that PFS, PSS and HC exhibited common small-world architecture of the functional brain networks. However, at a global level, only PFS showed significantly lower normalized clustering coefficient, small-worldness, and local efficiency, indicating a randomization shift of their brain networks. At a regional level, PFS and PSS disrupted different neural circuits, consisting of abnormal nodes (increased or decreased nodal centrality) and edges (decreased functional connectivity strength), which were widely distributed throughout the entire brain. Furthermore, some of these altered network measures were significantly correlated with severity of psychotic symptoms. These results suggest that familial and sporadic schizophrenia had segregated disruptions in the topological organization of the intrinsic functional brain network, which may be due to different etiological contributions.
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19
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Moran LV, Masters GA, Pingali S, Cohen BM, Liebson E, Rajarethinam R, Ongur D. Prescription stimulant use is associated with earlier onset of psychosis. J Psychiatr Res 2015; 71:41-7. [PMID: 26522870 PMCID: PMC4630672 DOI: 10.1016/j.jpsychires.2015.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/14/2015] [Accepted: 09/17/2015] [Indexed: 10/23/2022]
Abstract
A childhood history of attention deficit hyperactivity disorder (ADHD) is common in psychotic disorders, yet prescription stimulants may interact adversely with the physiology of these disorders. Specifically, exposure to stimulants leads to long-term increases in dopamine release. We therefore hypothesized that individuals with psychotic disorders previously exposed to prescription stimulants will have an earlier onset of psychosis. Age of onset of psychosis (AOP) was compared in individuals with and without prior exposure to prescription stimulants while controlling for potential confounding factors. In a sample of 205 patients recruited from an inpatient psychiatric unit, 40% (n = 82) reported use of stimulants prior to the onset of psychosis. Most participants were prescribed stimulants during childhood or adolescence for a diagnosis of ADHD. AOP was significantly earlier in those exposed to stimulants (20.5 vs. 24.6 years stimulants vs. no stimulants, p < 0.001). After controlling for gender, IQ, educational attainment, lifetime history of a cannabis use disorder or other drugs of abuse, and family history of a first-degree relative with psychosis, the association between stimulant exposure and earlier AOP remained significant. There was a significant gender × stimulant interaction with a greater reduction in AOP for females, whereas the smaller effect of stimulant use on AOP in males did not reach statistical significance. In conclusion, individuals with psychotic disorders exposed to prescription stimulants had an earlier onset of psychosis, and this relationship did not appear to be mediated by IQ or cannabis.
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Affiliation(s)
- Lauren V. Moran
- McLean Hospital, Psychotic Disorders Division, Belmont, Massachusetts; Harvard Medical School,Correspondence to Dr. Lauren Moran, McLean Hospital, Admissions Building, 115 Mill Street, Belmont, MA 02478, Office: (617) 855-3395,
| | - Grace A. Masters
- McLean Hospital, Psychotic Disorders Division, Belmont, Massachusetts; Harvard Medical School
| | - Samira Pingali
- McLean Hospital, Psychotic Disorders Division, Belmont, Massachusetts; Harvard Medical School
| | - Bruce M. Cohen
- McLean Hospital, Psychotic Disorders Division, Belmont, Massachusetts; Harvard Medical School
| | - Elizabeth Liebson
- McLean Hospital, Psychotic Disorders Division, Belmont, Massachusetts; Harvard Medical School
| | - R.P. Rajarethinam
- McLean Hospital, Psychotic Disorders Division, Belmont, Massachusetts; Harvard Medical School
| | - Dost Ongur
- McLean Hospital, Psychotic Disorders Division, Belmont, Massachusetts; Harvard Medical School
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20
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Cuesta MJ, Zarzuela A, Sánchez-Torres AM, Lorente-Omeñaca R, Moreno-Izco L, Sanjuán J, Peralta V. Familial liability to schizophrenia and mood disorders and cognitive impairment in psychosis. Psychiatry Res 2015; 227:258-64. [PMID: 25908262 DOI: 10.1016/j.psychres.2015.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 03/03/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
Abstract
Schizophrenia and other psychoses are complex disorders with high rates of cognitive impairment and a considerable degree of genetic and environmental influence on its etiology. Whether cognitive impairment is related to dimensional scores of familial liability is still matter of debate. We conducted a cross-sectional study including 169 patients with psychotic disorders and 26 healthy controls. Attention, memory and executive functions were assessed, and familial loading scores for schizophrenia and mood disorders were calculated. The relationships between familial liability and neuropsychological performance were examined with Spearman׳s correlation coefficients. In addition, patients were classified into three groups by family loading tertiles, and comparisons were performed between the patients in the top and bottom tertiles. Low familial loading scores for schizophrenia showed a significant association with poor executive functioning and delayed visual memory. And these results were also achieved when the subset of psychotic patients in the two extreme tertiles of family loadings of schizophrenia and mood disorders were compared. Low familial liability to schizophrenia seems to be a contributing factor for the severity of cognitive impairment in patients with a broad putative schizophrenia spectrum diagnosis.
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Affiliation(s)
- Manuel J Cuesta
- Psychiatric Department, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Spain.
| | - Amalia Zarzuela
- Psychiatric Department, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Spain.
| | - Ana M Sánchez-Torres
- Psychiatric Department, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Spain; Department of Basic Psychology I, Faculty of Psychology, National Distance Education University (UNED), Madrid, Spain.
| | - Ruth Lorente-Omeñaca
- Psychiatric Department, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Spain; Department of Basic Psychology I, Faculty of Psychology, National Distance Education University (UNED), Madrid, Spain.
| | - Lucía Moreno-Izco
- Psychiatric Department, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Spain.
| | - Julio Sanjuán
- Spanish Mental Health Network (CIBERSAM), University of Valencia, Valencia, Spain; Clinic Hospital (INCLIVA), Valencia, Spain.
| | - Victor Peralta
- Psychiatric Department, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Spain.
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21
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Özdemir O, Boysan M, Özdemir PG, Coşkun S, Özcan H, Yılmaz E, Atilla E. Family patterns of psychopathology in psychiatric disorders. Compr Psychiatry 2015; 56:161-74. [PMID: 25308406 DOI: 10.1016/j.comppsych.2014.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/10/2014] [Accepted: 09/16/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Familial loading and crucial outcomes of family history of psychopathology in psychiatric disorders have long been recognized. There has been ample literature providing convincing evidence for the importance of family psychopathology in development of emotional disturbances in children as well as worse outcomes in the course of psychiatric disorders. More often, maternal psychopathology seems to have been an issue of interest rather than paternal psychopathology while effects of second-degree familiality have received almost no attention. In this study, we addressed the relations between affected first- and second-degree relatives of probands and categories of psychiatric disorders. METHOD Subjects were 350 hospitalized psychiatric inpatients, consecutively admitted to psychiatry clinics in Van, Turkey. Mean age was 34.16 (SD±12) and 51.4% of the sample consisted of male patients. Assessment of psychopathology in psychiatric probands was conducted based on DSM-IV TR. Familial loading of psychiatric disorders amongst first- and second-degree relatives of patients were initially noted primarily relying on patients' retrospective reports, and confirmed by both phone call and following official health records via the Medical Knowledge System. We analyzed the data using latent class analysis approach. RESULTS We found four patterns of familial psychopathology. Latent homogeneous subsets of patients due to familial characteristics were as paternal kinship psychopathology with schizophrenia, paternal kinship psychopathology with mood disorders, maternal kinship psychopathology and core family psychopathology. CONCLUSION Family patterns were critical to exerting variation in psychiatric disorders of probands and affected relatives. Probands with a core family pattern of psychopathology exhibited the most colorful clinical presentations in terms of variation in psychopathology. We observed a specificity of intergenerational transmission of psychiatric disorders when family patterns of psychopathology were taken into consideration, even second-degree relatives of psychiatric probands.
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Affiliation(s)
- Osman Özdemir
- Department of Psychiatry, Yuzuncu Yil University, Van, Turkey.
| | - Murat Boysan
- Department of Psychology, Faculty of Art, Yuzuncu Yil University, Van, Turkey.
| | | | - Salih Coşkun
- Department of Medical Genetics, Dicle University, Diyarbakır, Turkey.
| | - Halil Özcan
- Department of Psychiatry, Atatürk University, Erzurum, Turkey.
| | - Ekrem Yılmaz
- Department of Psychiatry, Yuzuncu Yil University, Van, Turkey.
| | - Ercan Atilla
- Department of Psychiatry, Yuzuncu Yil University, Van, Turkey.
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The genome-wide supported microRNA-137 variant predicts phenotypic heterogeneity within schizophrenia. Mol Psychiatry 2013; 18:443-50. [PMID: 23459466 DOI: 10.1038/mp.2013.17] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We examined the influence of the genome-wide significant schizophrenia risk variant rs1625579 near the microRNA (miRNA)-137 (MIR137) gene on well-established sources of phenotypic variability in schizophrenia: age-at-onset of psychosis and brain structure. We found that the MIR137 risk genotype strongly predicts an earlier age-at-onset of psychosis across four independently collected samples of patients with schizophrenia (n=510; F1,506=17.7, P=3.1 × 10(-5)). In an imaging-genetics subsample that included additional matched controls (n=213), patients with schizophrenia who had the MIR137 risk genotype had reduced white matter integrity (F3,209=13.6, P=3.88 × 10(-8)) throughout the brain as well as smaller hippocampi and larger lateral ventricles; the brain structure of patients who were carriers of the protective allele was no different from healthy control subjects on these neuroimaging measures. Our findings suggest that MIR137 substantially influences variation in phenotypes that are thought to have an important role in clinical outcome and treatment response. Finally, the possible consequences of genetic risk factors may be distinct in patients with schizophrenia compared with healthy controls.
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A protective-compensatory model may reconcile the genetic and the developmental findings in schizophrenia. Schizophr Res 2013; 144:9-15. [PMID: 23360726 DOI: 10.1016/j.schres.2012.12.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 12/12/2012] [Accepted: 12/14/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The neurodevelopmental, the multifactorial-oligogenic and the gene-environment diathesis models have provoked advances in schizophrenia research, yet the exact pathophysiology remains indefinable. We broadened our analysis of 20years of findings in adults and children descending from densely affected families in the Québec population with a founder effect. The goal was to inspect the link between these family-genetic and developmental findings. METHOD 48 multigenerational families affected by schizophrenia or bipolar disorder represented a quasi-total sample of affected kindreds in the Eastern-Quebec catchment area. Among the 1274 adult family members with lifetime best-estimate diagnoses, 341 had DSM-IV schizophrenia or bipolar disorder. Young offspring of an affected parent were studied with the same clinical, physiological and cognitive measures as the adults. RESULTS Four new observations emerged: 1. A striking resemblance between the clinical, neuropsychological and genetic findings in these densely affected families and those reported in sporadic samples; 2. A high degree of heterogeneity despite the origin from a founder-effect population; 3. Cognitive deficits in some non-affected adult relatives as severe as those in patients; 4. Children descending from kindreds displayed neurodevelopmental endophenotypic anomalies comparable to those of adult patients. CONCLUSION These four observations could be reconciled under the hypothesis that highly familial and sporadic cases share mechanisms based on defective protective genes, a model to an extent similar to cancer findings. These defective protective genes running in families would longitudinally disturb the compensatory mechanisms in children inheriting them and might be at the core of the schizophrenia process.
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van der Werf M, Köhler S, Verkaaik M, Verhey F, van Os J. Cognitive functioning and age at onset in non-affective psychotic disorder. Acta Psychiatr Scand 2012; 126:274-81. [PMID: 22582732 DOI: 10.1111/j.1600-0447.2012.01873.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Age at psychosis onset has been related to variability in cognitive functioning, but its effect may be mediated by demographic and clinical factors. The aim of the current study was to study the contribution of age at onset, as well as demographic and illness characteristics, to variation in cognitive functioning in patients with schizophrenia spectrum disorder. METHOD Patients (n = 1053) and healthy controls (n = 631) underwent comprehensive neuropsychological and clinical assessments. The effect of age at onset on age-standardized cognitive test scores was assessed with multiple linear regression analyses. Mediation by illness and demographic factors was tested using a multiple mediation Sobel test. RESULTS A diagnosis of schizophrenia, higher antipsychotic dose, and more negative symptoms were associated with earlier onset of illness, while female sex and a more chronic course were associated with later illness onset. Furthermore, earlier onset was associated with worse performance on immediate recall and sustained attention. However, male sex, more negative symptoms, and higher antipsychotic dose mediated the effect of age at onset on memory, while negative symptoms explained its association with attention/vigilance. CONCLUSION Greater impairment in memory and attention in early-onset psychosis may be explained by features indicative of underlying neurodevelopmental vulnerability.
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Affiliation(s)
- M van der Werf
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON Graduate School of Neuroscience, Maastricht University, The Netherlands
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Gershon ES, Badner JA. Incorporation of molecular data and redefinition of phenotype: new approaches to genetic epidemiology of bipolar manic depressive illness and schizophrenia. DIALOGUES IN CLINICAL NEUROSCIENCE 2012. [PMID: 22034205 PMCID: PMC3181639 DOI: 10.31887/dcns.2001.3.1/esgershon] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Considerable advances have been made in identifying specific genetic components of bipolar manic depressive illness (BP) and schizophrenia (SZ), despite their complex inheritance. Meta-analysis of all published whole-genome linkage scans reveals overall support for illness genes in several chromosomal regions. In two of these regions, on the lonq arm of chromosome 13 and on the long arm of chromosome 22, the combined studies of BP and SZ are consistent with a common susceptibility locus for the two disorders. This lends some plausibility to the hypothesis of some shared genetic predispositions for BP and SZ. Other linkages are supported by multiple studies of specific chromosomal regions, most notably two regions on chromosome 6 in SZ. The velocardiofacial syndrome is associated with deletions very close to the linkage region on chromosome 22, and with psychiatric manifestations of both BP and SZ. Endophenotypes of SZ, previously demonstrated to be heritable, have been found to have chromosomal linkage in at least one study. These include eye-tracking abnormalities linked to the short arm of chromosome 6, and abnormality of the P50 cortical evoked potential linked to chromosome 15. Variants in specific genes have been associated with susceptibility to illness, and other genes have been associated with susceptibility to side effects of pharmacological treatment. These genetic findings may eventually be part of an integrated genetic, environmental, and interactive-factor epidemiology of the major mental illnesses.
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Affiliation(s)
- E S Gershon
- Department of Psychiatry, University of Chicago, Chicago, III, USA
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Derks EM, Boks MPM, Vermunt JK. The identification of family subtype based on the assessment of subclinical levels of psychosis in relatives. BMC Psychiatry 2012; 12:71. [PMID: 22759464 PMCID: PMC3504553 DOI: 10.1186/1471-244x-12-71] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 06/08/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Schizophrenia is a complex psychiatric disorder characterized by high phenotypic heterogeneity. Previous studies have distinguished between familial and sporadic forms of schizophrenia and have suggested clinical differentiation between patients and relatives from sporadic and multiplex families. We will introduce a more refined method to distinguish between family subtypes based on psychosis dimension profiles in the relatives of schizophrenia patients. METHODS Positive, negative, disorganization, mania, and depression scores were assessed in 1,392 relatives. Mixed Model Latent Class Analysis was used to identify family subtypes. A family subtype is a relatively homogeneous group of families with similar symptom profiles in the relatives in these families. Next, we investigated in 616 schizophrenia patients whether family subtype was associated with symptom profiles, IQ, cannabis dependence/abuse, or age of onset of psychosis. RESULTS Based on the data of relatives, we identified two different family types: "healthy" and "at risk for psychiatric disorder". Patients from at risk families obtained higher positive scores compared to patients from healthy families (Wald(1) =6.6293, p=0.010). No significant differences were found in any of the remaining variables. CONCLUSIONS Our findings confirm the existence of high-risk families and although we did not establish an etiological basis for the distinction between family types, genetic studies might reveal whether family subtype is associated with genetic heterogeneity.
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Affiliation(s)
- Eske M Derks
- University Medical Center Utrecht, Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, AMC-APC, room PA1-179 Meibergdreef, Amsterdam, AZ 51105, The Netherlands.
| | - Marco PM Boks
- University Medical Center Utrecht, Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, AMC-APC, room PA1-179 Meibergdreef, Amsterdam, AZ 51105, The Netherlands
| | - Jeroen K Vermunt
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
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Edad de inicio de los síntomas y sexo en pacientes con trastorno del espectro esquizofrénico. BIOMÉDICA 2012. [DOI: 10.7705/biomedica.v32i2.423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Esterberg M, Compton M. Family history of psychosis negatively impacts age at onset, negative symptoms, and duration of untreated illness and psychosis in first-episode psychosis patients. Psychiatry Res 2012; 197:23-8. [PMID: 22503358 PMCID: PMC3612976 DOI: 10.1016/j.psychres.2012.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 12/08/2011] [Accepted: 03/01/2012] [Indexed: 11/25/2022]
Abstract
Family history (FH) of psychosis has been a focus of investigations attempting to explain the heterogeneity in schizophrenia. Previous studies have demonstrated that FH is associated with earlier age at onset, severity of positive and negative symptoms, and the duration of untreated illness (DUI). The current study examined the impact of FH on the clinical presentation and help-seeking behaviors of a well-characterized, first-episode sample. The present study utilized the Symptom Onset in Schizophrenia (SOS) Inventory, the Positive and Negative Syndrome Scale (PANSS), and structured interviews on FH to examine these relationships in a large (n=152) sample of predominantly African American patients. Results showed that patients with a first-degree FH of psychosis had a younger age at onset of both the prodrome and psychosis, but did not differ in duration of prodromal period. Furthermore, FH and sex interacted to influence severity of negative, but not positive symptoms. Finally, FH interacted with sex to influence both the DUI and DUP in that only males with FH had longer DUI and DUP. The findings have implications for understanding the impact of specific family-related mechanisms on both clinical and help-seeking factors, as well as for informing future family-based intervention efforts.
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Affiliation(s)
- Michelle Esterberg
- VA Puget Sound Health Care System, Center for Excellence in Substance Abuse Treatment and Education, Mental Health Service, Mail Stop S-116, 1660 South Columbian Way, Seattle, WA 98108, TEL: 206-277-1027
| | - Michael Compton
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, 2150 Pennsylvania Avenue, N.W., Room #8-429, Washington, DC, 20037, TEL: 202-741-3554, FAX: 202-741-2891
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Scherr M, Hamann M, Schwerthöffer D, Froböse T, Vukovich R, Pitschel-Walz G, Bäuml J. Environmental risk factors and their impact on the age of onset of schizophrenia: Comparing familial to non-familial schizophrenia. Nord J Psychiatry 2012; 66:107-14. [PMID: 21879797 DOI: 10.3109/08039488.2011.605171] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS Several risk factors for schizophrenia have yet been identified. The aim of our study was to investigate how certain childhood and adolescent risk factors predict the age of onset of psychosis in patients with and without a familial component (i.e. a relative with schizophrenia or schizoaffective disorder). METHODS Aside from the age of onset of psychosis, we examined the risk factors for schizophrenia including obstetric complications, birth during winter or spring, behavioral deviances or delayed motor and speech development, exposure to adverse life events and exposure to substance use within a group of 100 patients (45 female, 55 male) with a mean age (± standard deviation) of 35.15 ± 13.21. RESULTS Birth complications and cannabis abuse are predictors for an earlier onset of schizophrenia in patients with non-familial schizophrenia. No environmental risk factors for an earlier age of onset in familial schizophrenia have been identified. CONCLUSIONS Certain environmental risk factors for schizophrenia seem to have an impact on the age of onset of psychosis in non-familial schizophrenia, they do not seem to have an impact on familial schizophrenia.
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Affiliation(s)
- Martin Scherr
- Department of Psychiatry und Psychotherapy , Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, Munich, Germany
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Hamshere ML, Holmans PA, McCarthy GM, Jones LA, Murphy KC, Sanders RD, Gray MY, Zammit S, Williams NM, Norton N, Williams HJ, McGuffin P, O'Donovan MC, Craddock N, Owen MJ, Cardno AG. Phenotype evaluation and genomewide linkage study of clinical variables in schizophrenia. Am J Med Genet B Neuropsychiatr Genet 2011; 156B:929-40. [PMID: 21960518 DOI: 10.1002/ajmg.b.31240] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 09/14/2011] [Indexed: 12/21/2022]
Abstract
Genetic factors are likely to influence clinical variation in schizophrenia, but it is unclear which variables are most suitable as phenotypes and which molecular genetic loci are involved. We evaluated clinical variable phenotypes and applied suitable phenotypes in genome-wide covariate linkage analysis. We ascertained 170 affected relative pairs (168 sibling-pairs and two avuncular pairs) with DSM-IV schizophrenia or schizoaffective disorder from the United Kingdom. We defined psychotic symptom dimensions, age at onset (AAO), and illness course using the OPCRIT checklist. We evaluated phenotypes using within sibling-pair correlations and applied suitable phenotypes in multipoint covariate linkage analysis based on 372 microsatellite markers at ∼10 cM intervals. The statistical significance of linkage results was assessed by simulation. The positive and disorganized symptom dimensions, AAO, and illness course qualified as suitable phenotypes. There were no genome-wide significant linkage results. There was suggestive evidence of linkage for the positive dimension on chromosomes 2q32, 10q26, and 20q12; the disorganized dimension on 8p21 and 17q21; and illness course on 2q33 and 22q11. The linkage peak for disorganization on 17q21 remained suggestive after correction for multiple testing. To our knowledge, this is the first study to integrate phenotype evaluation and genome-wide covariate linkage analysis for symptom dimensions and illness history variables in sibling-pairs with schizophrenia. The significant within-pair correlations strengthen the evidence that some clinical variables within schizophrenia are suitable phenotypes for molecular genetic investigations. At present there are no genome-wide significant linkage results for these phenotypes, but a number of suggestive findings warrant further investigation.
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Affiliation(s)
- Marian L Hamshere
- MRC Centre for Neuropsychiatric Genetics and Genomics, Department of Psychological Medicine and Neurology, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
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Miller B, Suvisaari J, Miettunen J, Järvelin MR, Haukka J, Tanskanen A, Lönnqvist J, Isohanni M, Kirkpatrick B. Advanced paternal age and parental history of schizophrenia. Schizophr Res 2011; 133:125-32. [PMID: 21937198 PMCID: PMC5594741 DOI: 10.1016/j.schres.2011.08.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 08/18/2011] [Accepted: 08/22/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Advanced paternal age (APA) is a risk factor for nonaffective psychosis (NAP) in the offspring, although the mechanism(s) of this association are not clear. The aim of this study was to examine whether later childbearing can be explained by parental schizophrenia, and in doing so, further evaluate the "de novo mutation" hypothesis for the association between APA and NAP. METHODS Using binary logistic regression, the association between APA and parental history of schizophrenia in the offspring, considering maternal and paternal history separately, was examined in 1) all persons with NAP born in Finland between 1950 and 1969 (Finnish NAP Cohort, n = 13,712), and 2) members of the Northern Finland 1966 Birth Cohort (NFBC 1966, n = 10,224), a general population birth cohort. RESULTS In the Finnish NAP Cohort, having a mother with schizophrenia was associated with APA (Odds Ratio [OR] for linear trend = 1.20, 95% confidence interval 1.12-1.29, p < 0.01). In the NFBC 1966 sample, having a mother with schizophrenia was associated with APA at the trend level (OR = 1.14, 0.99-1.31, p = 0.07). By contrast, there was no association between having a father with schizophrenia and APA. DISCUSSION In both a general population cohort and a birth cohort of subjects with nonaffective psychosis, APA was associated with maternal, but not paternal, schizophrenia. These findings suggest that increased genetic risk from the mother may explain the association between APA and nonaffective psychosis, and argue against the "de novo mutation" hypothesis.
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Affiliation(s)
- Brian Miller
- Department of Psychiatry and Health Behavior, Medical College of Georgia Health Sciences University, Augusta, Georgia 30912, United States.
| | - Jaana Suvisaari
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Jouko Miettunen
- Department of Psychiatry, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Marjo-Riitta Järvelin
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom,Institute of Health Sciences, University of Oulu, Finland
| | - Jari Haukka
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland,Hjelt Institute, Department of Public Health, University of Helsinki, Finland
| | - Antti Tanskanen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Jouko Lönnqvist
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Matti Isohanni
- Department of Psychiatry, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Science, Texas A&M University and Scott & White Healthcare, Temple, Texas, United States
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Wang KS, Liu X, Zhang Q, Aragam N, Pan Y. Genome-wide association analysis of age at onset in schizophrenia in a European-American sample. Am J Med Genet B Neuropsychiatr Genet 2011; 156B:671-80. [PMID: 21688384 DOI: 10.1002/ajmg.b.31209] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 05/26/2011] [Indexed: 12/19/2022]
Abstract
We performed a genome-wide association analysis to identify genetic variants influencing age at onset (AAO) and examine gene × gender interactions for AAO in schizophrenia (SCZ) using a European-American sample (1,162 cases). Linear regression model in PLINK was used to test for associations with AAO while the GxE option was chosen to test for the influence of gene × gender interactions. The most significant association with AAO was observed with SNP rs7819815 (P = 3.10×10(-7)) at 8q24.22. The next best signal was at 4q25 in COL25A1 gene (rs17039583, P = 4.30×10(-6)) and the third region was at 4p16.1 (rs17407555, P = 4.56×10(-6) , near RAF1P1, and rs4697924, P = 1.23×10(-5) within WDR1 gene). Conditional analysis on chromosome 4 indicated that 4p16.1 and 4q25 loci were independent. Furthermore, 2 SNPs (rs16834822 and rs16834824) at 1q43 in RYR2 showed strong associations in the female sample (P = 2.10×10(-6) and 2.33×10(-6) , respectively) and strong gene × gender interactions in influencing AAO (P = 9.23×10(-7) and 1.15×10(-6) , respectively) while the second best region showing gene × gender interaction was at 7q22.3 (rs179863, P = 2.33×10(-6) ). Using an independent sample of 1,068 cases, we could not replicate the associations for above top SNPs; however, we found nominal significance associations for their flanking SNPs (P < 0.05). These findings provide evidence of several genetic variants influencing AAO of SCZ.
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Affiliation(s)
- Ke-Sheng Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, 37614-1700, USA.
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Torniainen M, Suvisaari J, Partonen T, Castaneda AE, Kuha A, Perälä J, Saarni S, Lönnqvist J, Tuulio-Henriksson A. Sex differences in cognition among persons with schizophrenia and healthy first-degree relatives. Psychiatry Res 2011; 188:7-12. [PMID: 21126773 DOI: 10.1016/j.psychres.2010.11.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 06/23/2010] [Accepted: 11/03/2010] [Indexed: 02/01/2023]
Abstract
Previous research suggests differences between women and men in the clinical features of schizophrenia, but studies examining sex differences in neuropsychological functioning have reached inconsistent results. In the present study, sex differences in cognition and clinical features were investigated in population-based samples of participants with schizophrenia (n=218), their healthy first-degree relatives (n=438) and controls (n=123). Sex differences in illness features were small; nevertheless, women with schizophrenia had less negative symptoms and lived independently more often than men. The schizophrenia group had impairments in all studied neuropsychological domains, and the relatives were impaired in processing speed and set-shifting. In all groups, women performed better than men in processing speed, set-shifting and verbal episodic memory, whereas men outperformed women in visual working memory. The group-by-sex interaction was significant in two variables: women outperformed men in the relatives group in immediate verbal reproduction and in the use of semantic clustering as a learning strategy, while there was no sex difference in the schizophrenia group. In conclusion, sex differences in cognition are mostly similar in schizophrenia to those among controls, despite sex differences in illness features. The preservation of sex differences also in first-degree relatives supports the conclusion.
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Affiliation(s)
- Minna Torniainen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland.
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Nafissi S, Ansari-Lari M, Saadat M. Parental consanguineous marriages and age at onset of schizophrenia. Schizophr Res 2011; 126:298-9. [PMID: 21185696 DOI: 10.1016/j.schres.2010.11.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Revised: 11/13/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
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Kao YC, Liu YP. Effects of age of onset on clinical characteristics in schizophrenia spectrum disorders. BMC Psychiatry 2010; 10:63. [PMID: 20718964 PMCID: PMC2933645 DOI: 10.1186/1471-244x-10-63] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 08/18/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the last few decades, research regarding the age of onset of schizophrenia and its relationship with other clinical variables has been incorporated into clinical practices. However, reports of potential differences in demographic and clinical characteristics between early- and adult-onset schizophrenia spectrum disorders have been controversial. Thus, this study aims to assess differences in demographic and clinical characteristics correlated with age of illness onset in schizophrenia spectrum disorders. METHODS Data were collected from 104 patients with schizophrenia and schizoaffective disorder. Diagnosis was made via structured clinical interviews. Assessments of psychiatric symptoms and social and global functioning were completed. The effect of age of onset on demographic and clinical variables was examined using correlation analyses and binary logistic regression models. We chose 17 years of age as the cut-off for early-onset schizophrenia spectrum disorders based on a recent clinical consensus. We further investigated differences in the severity of psychopathology and other clinical variables between the early- and adult-onset groups. RESULTS The binary logistic regression analysis showed that age of onset was significantly related to the cognitive component of the Positive and Negative Syndrome Scale (PANSS) (odds ratio, OR = 0.58; 95% confidence interval, CI = 0.872-0.985; p < 0.001) and Barratt Impulsiveness Scale (BIS) score (OR = 0.94; 95% CI = 0.447-0.744; p = 0.015). Patients with early onset of schizophrenia spectrum disorders had significantly greater levels of cognitive impairment and higher impulsivity. There were significant differences between several demographic and clinical variables, including the negative symptom component of the PANSS (p < 0.001), cognitive component of the PANSS (p < 0.001), BIS score (p = 0.05), and psychological domain of quality of life (QOL) (p = 0.05), between patients with early- and adult-onset schizophrenia spectrum disorders, having controlled for the effect of the current age and duration of illness. CONCLUSIONS Our findings support the hypothesis of an influence of age of onset on illness course in patients with schizophrenia spectrum disorders. This finding may in fact be part of a separate domain worthy of investigation for the development of interventions for early symptoms of schizophrenia.
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Affiliation(s)
- Yu-Chen Kao
- Department of Psychiatry, Songshan Armed Forces General Hospital, Taipei, Taiwan
| | - Yia-Ping Liu
- Department of Physiology and Biophysics, National Defense Medical Center, No.161, Section 6, Min-Chuan East Road, Taipei 114, Taiwan
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Esterberg ML, Trotman HD, Holtzman C, Compton MT, Walker EF. The impact of a family history of psychosis on age-at-onset and positive and negative symptoms of schizophrenia: a meta-analysis. Schizophr Res 2010; 120:121-30. [PMID: 20303240 DOI: 10.1016/j.schres.2010.01.011] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Revised: 01/15/2010] [Accepted: 01/19/2010] [Indexed: 01/31/2023]
Abstract
The results of research on the relation of family history (FH) of psychosis with clinical presentation in schizophrenia have been mixed. To date, there have been no comprehensive reviews that have examined this body of research. The current review quantitatively evaluates research on the relation of FH with two aspects of schizophrenia, age-at-onset and symptom presentation. Studies investigating the influence of a FH on age-at-onset (N=15 studies), age-at-onset and sex (N=12 studies), and/or positive (N=11 studies) and negative symptoms (N=12 studies) in patients with schizophrenia were included in the meta-analyses. Results showed that FH has a small but significant impact on age-at-onset as well as negative symptoms. Of most interest was the finding that sex differences in age-at-onset are not observed in samples with a FH. Furthermore, there was a significant interaction between FH and sex with respect to negative symptoms. The findings of the current review are discussed in light of the diathesis-stress model. Theoretical assumptions and empirical research are reviewed to support the notion that FH influences susceptibility and presentation through similar mechanisms. Implications of the current findings, limitations of the review, and directions for future research are highlighted.
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Affiliation(s)
- Michelle L Esterberg
- Emory University Graduate School of Arts and Sciences, Department of Psychology, 36 Eagle Row, Atlanta, Georgia 30322, USA.
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Saugstad LF. Kraepelin's dichotomy is true: contrasting brain dysfunction at the extremes of human growth and maturation. Excitability, the fundamental property of nervous tissue, is affected. World J Biol Psychiatry 2010; 10:998-1015. [PMID: 17886163 DOI: 10.1080/15622970701405821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The distribution of Kraepelin's ubiquitous dichotomy varies with standard of living and pubertal age: when one rises, the other declines. The universal similar clinical picture--mortality risk, manic depressive psychosis, episodic dysfunction of brainstem control systems (sleep-wake cycle, food, mood control mechanism)--is caused by abridged pubertal pruning of excitatory synapses, which is treated with anti-epileptics, as opposed to convulsant neuroleptics in dementia praecox, where the clinical variation reflects varying degrees of excessive pruning and deficit in excitability. Localization of cortical breakdown of circuitry, silent spots and persistent dysfunction due to insufficient fill-in mechanisms, determine the clinical picture. This ranges from dementia praecox in late puberty and poor living standards, to cognitive dysfunction (mainly with higher standards of living) with earlier puberty. This variation is the most likely explanation why the acceptance of dementia praecox as a disease entity was complicated. Kraepelin's dichotomy, episodic dysfunction against a clinical deterioration, is at the extremes of brain maturation; the fundamental property of nervous tissue, excitability, is affected. To reduce the risk of psychotic episodes, omega-3 might also be given, as it normalizes excitation at all levels. The neo-Kraepelinian atheoretical quantitative scoring systems have eliminated disease entities and neglected endogeneity in psychiatry. We are back to a pre-Kraepelinian state, without his systematic observations. What is psychiatry without Kraepelin's dichotomy? Mood stability is a fundamental personality trait with a normal distribution; what is considered within or outside normal variation is arbitrary. Given the mood-stabilizing effect of anti-epileptics and omega-3, these will increasingly dominate psychiatric treatment.
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Allan CL, Cardno AG, Rijsdijk FV, Kalidindi S, Farmer A, Murray RM, McGuffin P. Twin study of illness history variables in psychosis. Schizophr Res 2009; 115:237-44. [PMID: 19786340 DOI: 10.1016/j.schres.2009.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 09/03/2009] [Accepted: 09/04/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Genetic factors are important in the aetiology of psychotic disorders, but it is unclear how far they influence aspects of illness history within psychoses. AIMS To investigate the extent, and type of familial aggregation for a range of illness history variables in psychosis. METHODS Two-hundred-and-twenty-four proband-wise twin pairs (106 monozygotic, 118 same-sex dizygotic), where probands had psychosis, were ascertained from the Maudsley Twin Register in London. We investigated the following illness history variables, rated using the OPCRIT checklist: age at onset; chronicity of course; mode of onset; psychotic/affective predominance; pre-morbid social adjustment; and the presence of a psychosocial precipitant. We used Mx statistical modelling software to analyse correlations of variables within pairs of monozygotic twins concordant for psychosis; and relationships between variables in probands and risk of psychosis in monozygotic and dizygotic co-twins. RESULTS There was a high monozygotic within-pair correlation for age at onset (intra-class correlation=0.9); moderate correlations for chronicity of course (polychoric correlation=0.4) and psychotic/affective predominance (polychoric correlation=0.5); and lower non-significant correlations for other variables. No variables consistently predicted risk of psychosis in co-twins. CONCLUSIONS Illness history variables in psychosis show a broad range of familial aggregation. It is likely that familial influences are predominantly modifying effects, independent of susceptibility factors for psychosis.
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Affiliation(s)
- Charlotte L Allan
- Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, UK.
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Webb S, Yágüez L, Langdon PE. Factors associated with multiple re-admission to a psychiatric hospital. J Ment Health 2009. [DOI: 10.1080/09638230701494845] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Derks EM, Verweij KHW, Kahn RS, Cahn WC. The calculation of familial loading in schizophrenia. Schizophr Res 2009; 111:198-9. [PMID: 19268542 DOI: 10.1016/j.schres.2009.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 01/19/2009] [Accepted: 02/15/2009] [Indexed: 11/25/2022]
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Treutlein J, Mühleisen TW, Frank J, Mattheisen M, Herms S, Ludwig KU, Treutlein T, Schmael C, Strohmaier J, Bösshenz KV, Breuer R, Paul T, Witt SH, Schulze TG, Schlösser RGM, Nenadic I, Sauer H, Becker T, Maier W, Cichon S, Nöthen MM, Rietschel M. Dissection of phenotype reveals possible association between schizophrenia and Glutamate Receptor Delta 1 (GRID1) gene promoter. Schizophr Res 2009; 111:123-30. [PMID: 19346103 DOI: 10.1016/j.schres.2009.03.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 02/25/2009] [Accepted: 03/04/2009] [Indexed: 12/21/2022]
Abstract
Recent linkage and association data have implicated the Glutamate Receptor Delta 1 (GRID1) locus in the etiology of schizophrenia. In this study, we sought to test whether variants in the promoter region are associated with this disorder. The distribution of CpG islands, which are known to be relevant for transcriptional regulation, was computationally determined at the GRID1 locus, and the putative transcriptional regulatory region at the 5'-terminus was systematically tagged using HapMap data. Genotype analyses were performed with 22 haplotype-tagging single nucleotide polymorphisms (htSNPs) in a German sample of 919 schizophrenia patients and 773 controls. The study also included two SNPs in intron 2 and one in intron 3 which have been found to be significantly associated with schizophrenia in previous studies. For the transcriptional regulatory region, association was obtained with rs3814614 (p=0.0193), rs10749535 (p=0.0245), and rs11201985 (p=0.0222). For all further analyses, the patient samples were divided into more homogeneous subgroups according to sex, age at onset, positive family history of schizophrenia and lifetime history of major depression. The p-value of the schizophrenia association finding for the three markers decreased by approximately one order of magnitude, despite the reduction in the total sample size. Marker rs3814614 (unadjusted p=0.0005), located approximately 2.0 kb from the transcriptional start point, also withstood a two-step correction for multiple testing (p=0.030). No support was obtained for previously reported associations with the intronic markers. Our results suggest that genetic variants in the GRID1 transcriptional regulatory region may play a role in the etiology of schizophrenia, and that future association studies of schizophrenia may require stratification to ensure more homogeneous patient subgroups.
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Affiliation(s)
- Jens Treutlein
- Department of Genetic Epidemiology, Central Institute of Mental Health, J5, D-68159 Mannheim, Germany
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Neuroanatomical differences between familial and sporadic schizophrenia and their parents: an optimized voxel-based morphometry study. Psychiatry Res 2009; 171:71-81. [PMID: 19168334 DOI: 10.1016/j.pscychresns.2008.02.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Revised: 01/24/2008] [Accepted: 02/13/2008] [Indexed: 02/05/2023]
Abstract
Symptomatic differences have been reported between patients with familial and sporadic schizophrenia. The present study examined neuroanatomical differences between the two subgroups and their parents using voxel-based morphometry. High-resolution T1-weighted images were obtained using 3 Tesla magnetic resonance imaging from 20 patients with schizophrenia (familial subgroup, n=10; sporadic subgroup, n=10), 20 of their parents (familial subgroup, n=10; sporadic subgroup, n=10) and 20 healthy volunteers. Gray matter density (GMD) was compared between groups on a voxel-by-voxel basis. Compared with the sporadic patients, the familial patients had significantly reduced GMD in the thalamus bilaterally. Reduction of GMD in bilateral thalami was also found in familial parents in comparison with sporadic parents. Compared with controls, both familial and sporadic patients had lower GMD involving bilateral insula, right temporal lobe, right occipital lobe, left lenticular nucleus and right cerebellum. However, only familial patients showed lower GMD than controls in the right thalamus. Compared with controls, only familial parents showed lower GMD in the right insula extending to the right temporal lobe and the right parietal lobule. The present data suggest that familial schizophrenia is associated with more severe structural abnormalities than sporadic schizophrenia, especially in the thalamus.
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Jääskeläinen E, Miettunen J, Veijola J, McGrath JJ, Murray GK, Jones PB, Isohanni M. Associations between early development and outcome in schizophrenia--A 35-year follow-up of the Northern Finland 1966 Birth Cohort. Schizophr Res 2008; 99:29-37. [PMID: 18180143 DOI: 10.1016/j.schres.2007.11.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 11/13/2007] [Accepted: 11/18/2007] [Indexed: 11/18/2022]
Abstract
Delayed neuromotor development carries an increased risk of developing schizophrenia, and some authors have assumed that risk factors for schizophrenia such as delayed development are also prognostic indicators for patients with established illness. In those who do develop schizophrenia, it is not clear if these same early developmental markers influence the outcome of illness. Our aim was to examine the association between infant developmental milestones and a range of outcomes in patients with schizophrenia. Our sample was drawn from Northern Finland 1966 Birth Cohort and included 109 subjects for whom prospectively collected information on age of learning to stand, walk and talk was available and who had developed schizophrenia by the age 35 years. By utilizing national registers we examined outcomes related to service utilization, educational achievement, and occupational status. Age of illness onset was also analyzed. Based on the diagnostic interview, a subgroup of 59 cases was assessed in clinical examinations on functioning and quality of life. Contrary to a widespread assumption within the field of schizophrenia research, later attainment of developmental milestones was not associated with poor outcome. We conclude that risk factors for schizophrenia are not necessarily prognostic factors.
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Affiliation(s)
- Erika Jääskeläinen
- Department of Psychiatry, University of Oulu, Finland, P.O. BOX 5000, 90014 University of Oulu, Finland.
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Pihlajamaa J, Suvisaari J, Henriksson M, Heilä H, Karjalainen E, Koskela J, Cannon M, Lönnqvist J. The validity of schizophrenia diagnosis in the Finnish Hospital Discharge Register: findings from a 10-year birth cohort sample. Nord J Psychiatry 2008; 62:198-203. [PMID: 18609031 DOI: 10.1080/08039480801983596] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to investigate the diagnostic validity of schizophrenia in the Finnish Hospital Discharge Register (FHDR) with a large, epidemiologically representative sample using a multidiagnostic approach (DSM-III-R, DSM-IV, ICD-10), and to find additional criteria that could be used to improve the validity of schizophrenia diagnosis in future register-based research that utilizes the FHDR. The study population consisted of all individuals (n=877) who were born in Helsinki, Finland, between 1 January 1951 and 31 December 1960, and who had had at least one diagnosis of schizophrenia, schizophreniform disorder or schizoaffective disorder in the FHDR. All their available hospital case notes were collected. The total number of subjects for whom case notes were obtained was 806. We used the OPCRIT system (version 3.4) to produce diagnoses according to ICD-10, DSM-III-R and DSM-IV criteria based on the information extracted from the hospital case notes. We examined the distribution of the DSM-III-R, DSM-IV and ICD-10 diagnoses generated by the OPCRIT and calculated the proportion of individuals who received the same diagnosis in the FHDR and in the OPCRIT assessment. The proportion of subjects who received a core schizophrenia spectrum diagnosis (schizophrenia, schizoaffective disorder or schizophreniform disorder) in both the FHDR and OPCRIT assessment varied between 75% (DSM-III-R criteria) and 78% (ICD-10 criteria). Of the subjects with a narrow schizophrenia diagnosis in the FHDR, between 74% (DSM-IV) and 78% (ICD-10) received a diagnosis of schizophrenia in the reassessment depending on the diagnostic criteria applied. Eighty per cent of those who had received a core schizophrenia spectrum FHDR diagnosis after 1982 (vs. 56% of those who had received their last schizophrenia diagnosis in 1982 or before) received a DSM-IV diagnosis of core schizophrenia spectrum disorder. Of the 58 subjects in the sample who had been given at various times diagnoses of both core schizophrenia diagnosis and bipolar I diagnosis in FHDR, 43% received a core schizophrenia spectrum diagnosis according to DSM-IV criteria. The validity of the FHDR schizophrenia diagnosis is acceptable for large-scale register studies and comparable with that of other Nordic registers. Diagnostic validity can be further improved by selecting subjects who have core schizophrenia spectrum disorder as the latest diagnosis, by omitting cases diagnosed before 1982, and by excluding cases with a register diagnoses of both a core schizophrenia spectrum and bipolar I disorder.
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Affiliation(s)
- Johanna Pihlajamaa
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
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Jakobsen KD, Hansen T, Werge T. Diagnostic stability among chronic patients with functional psychoses: an epidemiological and clinical study. BMC Psychiatry 2007; 7:41. [PMID: 17705843 PMCID: PMC1978203 DOI: 10.1186/1471-244x-7-41] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Accepted: 08/16/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnostic stability and illness course of chronic non-organic psychoses are complex phenomena and only few risk factors or predictors are known that can be used reliably. This study investigates the diagnostic stability during the entire course of illness in patients with non-organic psychoses and attempts to identify non-psychopathological risk factors or predictors. METHOD 100 patients with functional psychosis were initially characterised using the Operational Criteria Checklist for Psychotic Illness and Affective Illness (OPCRIT), medical records and health registers. To study the stability of diagnoses (i.e. shifts per time), we used registry data to define four measures of diagnostic variation that were subsequently examined in relation to four possible measures of time (i.e. observation periods or hospitalisation events). Afterwards, we identified putative co-variables and predictors of the best measures of diagnostic stability. RESULTS All four measures of diagnostic variation are very strongly associated with numbers-of-hospitalisations and less so with duration-of-illness, duration-of-hospitalisation and with year-of-first-admission. The four measures of diagnostic variation corrected for numbers-of-hospitalisations were therefore used to study the diagnostic stability. Conventional predictors of illness course - e.g. age-of-onset and premorbid-functioning - are not significantly associated with stability. Only somatic-comorbidity is significantly associated with two measures of stability, while family-history-of-psychiatric-illness and global-assessment-of-functioning (GAF) scale score show a trend. However, the traditional variables age-of-first-admission, civil-status, first-diagnosis-being-schizophrenia and somatic-comorbidity are able to explain two-fifth of the variation in numbers-of-hospitalisations. CONCLUSION Diagnostic stability is closely linked with the contact between patient and the healthcare system. This could very likely be due to fluctuation of disease manifestation over time or presence of co-morbid psychiatric illness in combination with rigid diagnostic criteria that are unable to capture the multiple psychopathologies of the functional psychoses that results in differential diagnoses and therefore diagnostic instability. Not surprisingly, somatic-comorbidity was found to be a predictor of diagnostic variation thereby being a non-psychiatric confounder.
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Affiliation(s)
- Klaus D Jakobsen
- Research Institute of Biological Psychiatry, Sct. Hans Hospital, DK-4000 Roskilde, Denmark
- University Department of Psychiatry, Psychiatric Centre Hvidovre, DK-2605 Broendby, Denmark
- Center for Pharmacogenomics, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Thomas Hansen
- Research Institute of Biological Psychiatry, Sct. Hans Hospital, DK-4000 Roskilde, Denmark
- Center for Pharmacogenomics, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Thomas Werge
- Research Institute of Biological Psychiatry, Sct. Hans Hospital, DK-4000 Roskilde, Denmark
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Miettunen J, Lauronen E, Veijola J, Koponen H, Saarento O, Taanila A, Isohanni M. Socio-demographic and clinical predictors of occupational status in schizophrenic psychoses--follow-up within the Northern Finland 1966 Birth Cohort. Psychiatry Res 2007; 150:217-25. [PMID: 17316827 DOI: 10.1016/j.psychres.2006.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 06/16/2006] [Accepted: 08/30/2006] [Indexed: 10/23/2022]
Abstract
We studied occupational status of persons with schizophrenic psychoses by age 34 in a longitudinal population-based cohort and predicted which demographic and illness-related factors could support the patients to maintain their occupational capacity. Subjects of the Northern Finland 1966 Birth Cohort with the diagnosis of DSM-III-R schizophrenic psychoses (n=113) by the year 1997 were followed until the end of year 2000. Various illness and socio-demographic factors at the time of onset of illness were used as predictors. At the end of the follow-up time 50 (44%) of patients were not pensioned and 22 (20%) were also working at least half of the time during year 2000. After adjusting for gender, being unemployed at onset, educational level and proportion of time spent in psychiatric hospitals, those who were married or cohabiting at the time of onset of illness were less often on pension than those who were single (OR 6.51; 95% CI 1.83-23.12). Thus, nearly half of the patients with schizophrenic psychoses were not pensioned after an average 10 years follow-up. Based on our findings, those who were single at time of their onset of illness probably need most support to retain their contacts to work life.
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Affiliation(s)
- Jouko Miettunen
- Department of Psychiatry, University of Oulu, P.O.Box 5000, 90014 Oulun Yliopisto, Finland.
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Rabinowitz J, Levine SZ, Häfner H. A population based elaboration of the role of age of onset on the course of schizophrenia. Schizophr Res 2006; 88:96-101. [PMID: 16962742 DOI: 10.1016/j.schres.2006.07.007] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Revised: 06/22/2006] [Accepted: 07/17/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite suggestions that an earlier age of onset and being male confer to a poorer course of schizophrenia, evidence regarding when these effects are most salient appears to be ambiguous. AIMS To examine the relationship of age of first hospitalization and sex with the course of hospitalization in a population based cohort. METHOD All first admissions for schizophrenia in a national population based cohort in Israel from 1978 to 1992 were followed through 1996 (n=12,071) using data from the National Psychiatric Hospitalization Case Registry of the State of Israel, a complete national registry of psychiatric admissions. Recursive partitioning was conducted to empirically determine cut-off points for age groups showing the greatest difference on the variables of interest. RESULTS A younger age of first hospital admission was associated with a greater likelihood of having more than one hospital admission, longer first admissions, more hospital admissions and more inpatient days per year. Of patients with age of first admission below 17, 82.5% had more than one admission which decreased for subsequent age groups to 73.54% (18-28), 69.36% (29-31), 62.88% (32-45), and 50.77% (over 45). Men had an earlier first admission than women, and had slightly more cut-off values. Irrespective of sex, the relationship between age at first admission and later hospitalization conformed to a linear trend. CONCLUSIONS An earlier onset corresponds linearly with the severity of the course of illness and appears to have prognostic value.
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Lauronen E, Miettunen J, Veijola J, Karhu M, Jones PB, Isohanni M. Outcome and its predictors in schizophrenia within the Northern Finland 1966 Birth Cohort. Eur Psychiatry 2006; 22:129-36. [PMID: 17129711 DOI: 10.1016/j.eurpsy.2006.07.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Accepted: 07/26/2006] [Indexed: 11/25/2022] Open
Abstract
PURPOSE We report clinical and social outcomes of schizophrenia in the longitudinal, population-based Northern Finland 1966 Birth Cohort, and describe associated demographic, developmental and illness-related factors. SUBJECTS AND METHODS Subjects with DSM-III-R schizophrenia (n=59) were followed prospectively from mid-gestation up to age 35 years. Outcome measures included positive and negative symptoms, psychiatric hospitalisations, social and occupational functioning. Several definitions of good and poor outcome were explored, and developmental, socio-demographic and clinical predictors of outcomes were analysed. RESULTS Good clinical outcome varied from 10% to 59%, and good social outcome 15-46%, depending on definition. Poor clinical outcome varied 41-77% and poor social 37-54%. Lack of friends in childhood, father's high social class, lower school performance and earlier age of illness onset predicted poor outcomes. DISCUSSION The outcomes of schizophrenia in this study depended on definitions used but were relatively poor. The age of illness onset, father's social class, school performance and poor social contacts in childhood were only statistically significant predictors. CONCLUSION Definitions of outcome have a major effect on estimates for proportions of good and bad outcomes and on the predictors of outcomes. However, regardless of which definitions were used, the outcome of schizophrenia in this population-based sample was generally bleak.
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Affiliation(s)
- E Lauronen
- Department of Psychiatry, University of Oulu, P.O. Box 5000, FIN-90014 University of Oulu, Finland.
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Husted JA, Greenwood CMT, Bassett AS. Heritability of schizophrenia and major affective disorder as a function of age, in the presence of strong cohort effects. Eur Arch Psychiatry Clin Neurosci 2006; 256:222-9. [PMID: 16331352 PMCID: PMC3130033 DOI: 10.1007/s00406-005-0629-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Accepted: 09/28/2005] [Indexed: 10/25/2022]
Abstract
It remains unclear whether age at onset for major psychiatric disorders is a useful marker of etiologic and genetic heterogeneity. The authors examined how heritability of schizophrenia and major affective disorders varied with age at onset. The sample was drawn from a large archival data set collected by Lionel Penrose, comprising 3,109 families with two or more members first hospitalized in Ontario between 1874 and 1944. The authors studied 1,295 sibships with schizophrenia (n = 487), major affective disorder (n = 378), both (n = 234) or neither (n = 196) of these disorders. Proportional hazards models were used to estimate how the hazard of hospitalization for each disorder (schizophrenia or major affective disorder) varied with proband age at onset, adjusted for changes in age at onset distribution between 1874 and 1944. A sibling's risk of hospitalization for the same illness significantly increased for each 10-year decrease in age at onset of the proband both for schizophrenia (hazard ratio = 1.21, 95 % confidence interval: 1.06, 1.39), and for affective disorder (hazard ratio = 1.29,95 % CI: 1.14, 1.45). Gender of proband was unrelated to sibling risk of the same illness, and tests of interaction effects between proband age at onset and gender on sibling risk were nonsignificant.
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Affiliation(s)
- Janice A Husted
- Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada.
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Miettunen J, Lauronen E, Veijola J, Koponen H, Saarento O, Isohanni M. Patterns of psychiatric hospitalizations in schizophrenic psychoses within the Northern Finland 1966 Birth Cohort. Nord J Psychiatry 2006; 60:286-93. [PMID: 16923637 DOI: 10.1080/08039480600790168] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report patterns of hospitalization in schizophrenic psychoses by age 34 in a longitudinal population-based cohort. We test the predictive ability of various demographic and illness-related variables on patterns of hospitalization, with a special focus on the length of the first psychiatric hospitalization. All living subjects of the Northern Finland 1966 Birth Cohort with DSM-III-R schizophrenia (n=88) and other schizophrenia spectrum cases (n=27) by the year 1997 in the Finnish Hospital Discharge Register were followed for an average of 10.5 years. Measures of psychiatric hospitalization included time to re-hospitalization (as continuous and as re-hospitalization within 2 years) and the number of hospital episodes. Length of the first hospitalization, other illness-related and various socio-demographic predictors were used to predict hospitalization patterns. After adjusting for gender, age at first admission and number of hospital days a short (1-14 days) first hospitalization (reference >30 days; adjusted odds ratio 6.39; 95% CI 2.00-20.41) and familial risk of psychosis (OR 3.36; 1.09-10.39) predicted re-hospitalization within 2 years. A short first hospitalization also predicted frequent psychiatric admissions defined as the first three admissions within 3 years (OR 13.77; 3.92-48.36). A short first hospitalization was linked to increased risk of re-hospitalizations. Although short hospitalization is recommended by several guidelines, there may be a group of patients with schizophrenic psychoses in which too short a hospitalization may lead to inadequate treatment response.
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Affiliation(s)
- Jouko Miettunen
- Department of Psychiatry, University of Oulu, PO Box 5000, FIN-90014, Finland.
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