The future of diagnosis in clinical neurosciences: Comparing multiple sclerosis and schizophrenia

Unravelling early transdiagnostic dynamics of psychotic-like experiences in young adults: Results from a cross-lagged panel network analysis

BACKGROUND

Psychotic-like experiences (PLEs) are potential transdiagnostic markers of psychopathology. However, temporal patterns of associations between PLEs and other symptoms remain unclear. Moreover, it needs to be clarified as to whether PLEs might be primary targets for interventions. This study aimed to investigate longitudinal associations of PLEs with other psychopathological symptoms.

METHODS

A total of 1314 young adults (aged 29.3 ± 5.7, 49.2 % women) without a lifetime history of psychiatric treatment completed online assessments, measuring psychopathological symptoms, at baseline and after 6 months. A cross-lagged panel network was analyzed. Output (the sum of edge weights from a specific node to all other nodes) and input (the sum of edge weights to a specific node from all other nodes) centralities were estimated. Age, gender, education, employment, and place of residence were the covariates.

RESULTS

The highest output centrality was found for PLEs while the highest input centrality was observed for obsessive-compulsive symptoms. Centrality metrics of these symptom domains were significantly higher compared to centrality metrics of other psychopathological domains. PLEs showed cross-lagged associations with all other symptom domains. The strongest cross-lagged edge in the network led from PLEs to obsessive-compulsive symptoms (weight = 0.611). It was significantly stronger compared to all other cross-lagged edges in the network. The results were partially replicated in the network of specific symptoms.

CONCLUSIONS

The findings indicate that PLEs might precede the emergence of other domains of psychopathology. The highest output centrality of PLEs suggests their potential utility as primary targets for early interventions.

Psychoses onset in multiple sclerosis: A systematic review and meta-analysis

BACKGROUND

Psychotic symptoms in multiple sclerosis (MS) have been infrequently studied, despite the existence of numerous case reports showing inconsistent findings. Our aim was to assess the timing of psychosis onset and examine its characteristics in MS cases.

MATERIAL AND METHODS

We conducted a systematic review and meta-analysis according to PRISMA 2020. We searched for case reports and case series of psychosis in MS on MEDLINE through PubMed, Google Scholar, Web of Science, and Cochrane. SPSS 26 was used to perform the data analysis.

RESULTS

Overall, 43 cases were reviewed. Bipolar disorder and schizophrenia (SCZ) were the most frequently observed types. Psychosis was often present before or at the time of MS diagnosis. For patients with prior psychosis before MS diagnosis, those with SCZ were less likely to develop neurologic symptoms compared to those with other psychosis types. Polymorphic delusions were significantly associated with psychosis onset either after or concurrently with MS. Extensive periventricular white matter lesions, cerebellar peduncles, and cerebellar lesions were significantly associated with the onset of psychosis following MS diagnosis. Resistant-treatment psychosis occurred in 59.4% of cases. A favorable outcome was significantly more common in patients with relapsing-remitting MS compared to those with other forms of MS.

CONCLUSION

Our study highlights the importance of considering MS in patients with psychoses, especially those with SCZ or treatment-resistant psychosis. Some white matter lesions may trigger psychosis after MS diagnosis. While managing psychosis in MS can be challenging, MS-specific treatments have proven effective.

A systematic review of studies using network analysis to assess dynamics of psychotic-like experiences in community samples

Several studies have used a network analysis to recognize the dynamics and determinants of psychotic-like experiences (PLEs) in community samples. Their synthesis has not been provided so far. A systematic review of studies using a network analysis to assess the dynamics of PLEs in community samples was performed. Altogether, 27 studies were included. The overall percentage ranks of centrality metrics for PLEs were 23.5% for strength (20 studies), 26.0% for betweenness (5 studies), 29.7% for closeness (6 studies), 26.9% for expected influence (7 studies), and 29.1% for bridge expected influence (3 studies). Included studies covered three topics: phenomenology of PLEs and associated symptom domains (14 studies), exposure to stress and PLEs (7 studies), and PLEs with respect to suicide-related outcomes (6 studies). Several other symptom domains were directly connected to PLEs. A total of 6 studies investigated PLEs with respect to childhood trauma (CT) history. These studies demonstrated that PLEs are directly connected to CT history (4 studies) or a cumulative measure of environmental exposures (1 study). Moreover, CT was found to moderate the association of PLEs with other symptom domains (1 study). Two studies that revealed direct connections of CT with PLEs also found potential mediating effects of cognitive biases and general psychopathology. PLEs were also directly connected to suicide-related outcomes across all studies included within this topic. The findings imply that PLEs are transdiagnostic phenomena that do not represent the most central domain of psychopathology in community samples. Their occurrence might be associated with CT and suicide risk.

The future of diagnosis in mental health: Promises and challenges of biomarkers to identify reliable and highly predictive biosignatures of affective disorders

Current evidence points to a research-practice gap in mental health. There is a specific unmet need to identify novel strategies to improve diagnostic criteria, especially when clinical manifestations overlap as in the case of bipolar (BD) and major depressive disorder (MDD). Based on the rapidly evolving notion that affective disorders are characterized by disrupted brain-body communication, current efforts of neuropsychiatric research are converging towards the identification of specific clusters of peripheral interconnected biomarkers. We argue that these can capture the complexity of the disease as they are linked to the fundamental pathophysiological mechanisms underlying BD or MDD, and can thus deliver an unbiased biosignature. Here we provide a critical viewpoint on the promises and challenges of biomarkers to identify reliable biosignatures of affective disorders. Novel methodological insight and relevant biomarkers are discussed with a main focus on immunometabolic derangements and disrupted redox balance. Major advancements are reviewed taking into consideration that an unbiased diagnosis can only derive from a deep understanding of how biological, psychological, and social factors interact ultimately affecting the clinical manifestation of affective disorders.

Precision neurology

Over the past several decades, high-resolution brain imaging, blood and cerebrospinal fluid analyses, and other advanced technologies have changed diagnosis from an exercise depending primarily on the history and physical examination to a computer- and online resource-aided process that relies on larger and larger quantities of data. In addition, randomized controlled trials (RCT) at a population level have led to many new drugs and devices to treat neurological disease, including disease-modifying therapies. We are now at a crossroads. Combinatorially profound increases in data about individuals has led to an alternative to population-based RCTs. Genotyping and comprehensive "deep" phenotyping can sort individuals into smaller groups, enabling precise medical decisions at a personal level. In neurology, precision medicine that includes prediction, prevention and personalization requires that genomic and phenomic information further incorporate imaging and behavioral data. In this article, we review the genomic, phenomic, and computational aspects of precision medicine for neurology. After defining biological markers, we discuss some applications of these "-omic" and neuroimaging measures, and then outline the role of computation and ultimately brain simulation. We conclude the article with a discussion of the relation between precision medicine and value-based care.

Role of Medicinal Plants in the Management of Multiple Sclerosis

There is a rapid spread of Multiple Sclerosis disorder across the globe, around 2.8 million cases of Multiple Sclerosis in the world. Multiple Sclerosis (MS) is a chronic autoimmune disease of the central nervous system characterized by demyelination, neuroinflammation, and a wide spectrum of clinical manifestations. Many drugs have been tested on MS patients but there is no effective treatment for MS till now. So to inhibit the symptoms caused by MS we performed a study in which we identified various naturally occurring materials with neuroprotective effects on the body that can treat Multiple Sclerosis. The therapeutic strategies portion of the paper reviews the array of disease-modifying therapies currently available for MS management. This paper evaluated their mechanisms of action, efficacy, and safety profiles. It also addressed emerging treatment paradigms by using different naturally occurring materials, including personalized medicine approaches and novel therapies in development. This paper provides a comprehensive overview of the current state of knowledge regarding MS, focusing on its pathogenesis, diagnostic approaches, and therapeutic strategies.

The association between systemic lupus erythematosus (SLE) and early psychiatric background

BACKGROUND

The etiology of Systemic Lupus Erythematosus (SLE) remains elusive. Research has established links between SLE and various mental health issues, including associations with psychiatric illness, unique symptomatology in SLE, a relationship between stress and disease exacerbation, and improvement in SLE patients after psychiatric and psychological treatment. However, the hypothesis that psychiatric conditions might precede SLE onset by long periods has not been empirically established. This study aims to address this gap.

METHODS

This matched cohort study conducted a retrospective analysis using the electronic database of Clalit Health Services (CHS), Israel's largest HMO, comparing 2786 individuals diagnosed with SLE with 8358 non-SLE matched controls.

RESULTS

Two logistic regression analysis tests revealed significant associations between SLE diagnosis and prior psychiatric conditions. the first (p < 0.001) showed a 120% higher likelihood of psychiatric history among those diagnosed at least 10 years later with SLE compared to controls, and the second (p = 0.008) showed a 61% greater likelihood of a psychiatric history among those diagnosed at least 15 years with SLE. Investigation into the association between specific psychiatric indices and the later development of SLE found significant correlations between an SLE diagnosis and four psychiatric indices 10 years prior: dispensing of antipsychotics, anxiolytics, hypnotics, and sedatives; dispensing of antidepressants, psychostimulants, ADHD agents, and nootropics; diagnosis of mood disorders; and phobic and anxiety disorders.

CONCLUSIONS

The increased probability of pre-existing mental health issues preceding SLE onset by extended durations suggests a potential etiological role in SLE development.

Psychoses in Pediatric-Onset Multiple Sclerosis: A Case Report and Systematic Review

PROBLEM

The association of pediatric-onset multiple sclerosis (POMS) and psychosis remains rare and unclear in the literature. We aim to elucidate the association between POMS and psychosis across case reports.

METHODS

We report a case of schizophrenia (SCZ) revealing POMS. We conducted a systematic review of case reports adhered to PRISMA 2020. We searched PubMed, Google Scholar, Web of Science, and Cochrane for case reports describing psychoses in POMS cases.

FINDINGS

We presented a 21-year-old male who developed psychotic symptoms at 16 and was diagnosed with SCZ at 18. Regarding the treatment-resistant SCZ, neurological assessment led to POMS. The patient had a favorable outcome after POMS management. Moreover, our systematic review of nine cases revealed that most psychoses began before or concomitant to the POMS diagnosis, highlighting a delay in identifying POMS. SCZ and BP were the most common types of psychosis observed. We observed a predominance of males with a median age at psychosis onset was 15 years (12.5-16.5 years). Treatment-resistant SCZ was noted in one study along aside with our case. All cases had a good evolution after POMS management.

CONCLUSION

Our study suggested a critical link between POMS and psychosis emphasizing the need for thorough evaluation, early diagnosis, and prompt management. This association highlights the importance of recognizing psychotic symptoms as potential indicators of POMS, particularly in males.

Close, yet so far away: a phenomenology of the praecox feeling in the diagnosis of schizophrenia as intercorporeal alienness

Debates concerning the reliability and validity of operationalized criteria and diagnostic tools have surrounded the issue of schizophrenia diagnosis and clinical decision-making related to the disorder. The notion of the praecox feeling (PF) has played a prominent role in the discussions as an example of the possibility of a rapid and potentially valid diagnosis based solely on "intuition" or a peculiar emotional experience or impression arising in a physician during an interaction with a patient with schizophrenia. In this paper, we argue that PF is enabled by the (phenomenologically understood) intercorporeal dimension of the clinical encounter. Intercorporeality in this sense denotes intertwinement between embodied expressions that may lead to feelings of connection but also, as in the case of PF, of disconnection and strangeness-the experience of alienness. Following Waldenfels, alienness ranges from the average social encounter to more extreme and peculiar forms-such as PF. To prove our point, we analyze the metaphors used by physicians in various cultural contexts (the United States, the United Kingdom, and Poland) to express the apparently ineffable experience of the PF. We focus on two dominant metaphors of distance: the first expressing spatial distance by referring to an "object in-between" the physician and the patient and the second expressing mental distance by referring to the "other-worldliness" of the patient. We interpret the object in-between metaphors as reflecting the sense of separateness and the other-worldliness metaphors as reflecting the sense of strangeness, with both meanings unified in the notion of "close remoteness." Such unsettling but speculation-provoking feeling of close remoteness may be rendered by the concept of "the eerie" (Mark Fisher). We conclude that metaphor and phenomenological analysis facilitate an understanding of the experiential profile of PF in the clinical encounter, outlining relevant clinical implications.

The association between multiple sclerosis and early psychiatric background

BACKGROUND

The exact cause of Multiple Sclerosis (MS) is unclear. Since its definition in the late 19th century, researchers have repeatedly suggested a connection between the disease and mental state. Studies have shown that mental symptoms tend to precede the initiation of the disease by up to ten years. However, the hypothesis that psychiatric issues might precede MS onset by longer periods has not been empirically established. This study seeks to fill this research gap. The current matched cohort study investigated the possibility that psychiatric conditions may precede the initiation of multiple sclerosis by 15 years or more METHODS: A retrospective analysis utilizing the electronic database of Clalit Health Services (CHS), Israel's largest HMO, compared a group of 9,533 MS-diagnosed female and male individuals with 28,599 non-MS matched controls RESULTS: Logistic regression analysis revealed a significant association (p < 0.001) between MS diagnosis and prior psychiatric conditions, indicating a 93% increased likelihood of psychiatric history among those later diagnosed with MS compared with those who were not CONCLUSIONS: The heightened probability of mental health issues preceding the onset of MS by extended durations suggests a potential etiological role in the development of MS, rather than solely representing a component of the prodromal stage of the disease. Limitations include the retrospective design and the need for prospective studies to validate these associations.

The Genomic Intersection of Oligodendrocyte Dynamics in Schizophrenia and Aging Unravels Novel Pathological Mechanisms and Therapeutic Potentials

Schizophrenia is a significant worldwide health concern, affecting over 20 million individuals and contributing to a potential reduction in life expectancy by up to 14.5 years. Despite its profound impact, the precise pathological mechanisms underlying schizophrenia continue to remain enigmatic, with previous research yielding diverse and occasionally conflicting findings. Nonetheless, one consistently observed phenomenon in brain imaging studies of schizophrenia patients is the disruption of white matter, the bundles of myelinated axons that provide connectivity and rapid signalling between brain regions. Myelin is produced by specialised glial cells known as oligodendrocytes, which have been shown to be disrupted in post-mortem analyses of schizophrenia patients. Oligodendrocytes are generated throughout life by a major population of oligodendrocyte progenitor cells (OPC), which are essential for white matter health and plasticity. Notably, a decline in a specific subpopulation of OPC has been identified as a principal factor in oligodendrocyte disruption and white matter loss in the aging brain, suggesting this may also be a factor in schizophrenia. In this review, we analysed genomic databases to pinpoint intersections between aging and schizophrenia and identify shared mechanisms of white matter disruption and cognitive dysfunction.

Associations of gut microbiota alterations with clinical, metabolic, and immune-inflammatory characteristics of chronic schizophrenia

The present study had the following aims: 1) to compare gut microbiota composition in patients with schizophrenia and controls and 2) to investigate the association of differentially abundant bacterial taxa with markers of inflammation, intestinal permeability, lipid metabolism, and glucose homeostasis as well as clinical manifestation. A total of 115 patients with schizophrenia during remission of positive and disorganization symptoms, and 119 controls were enrolled. Altogether, 32 peripheral blood markers were assessed. A higher abundance of Eisenbergiella, Family XIII AD3011 group, Eggerthella, Hungatella, Lactobacillus, Olsenella, Coprobacillus, Methanobrevibacter, Ligilactobacillus, Eubacterium fissicatena group, and Clostridium innocuum group in patients with schizophrenia was found. The abundance of Paraprevotella and Bacteroides was decreased in patients with schizophrenia. Differentially abundant genera were associated with altered levels of immune-inflammatory markers, zonulin, lipid profile components, and insulin resistance. Moreover, several correlations of differentially abundant genera with cognitive impairment, higher severity of negative symptoms, and worse social functioning were observed. The association of Methanobrevibacter abundance with the level of negative symptoms, cognition, and social functioning appeared to be mediated by the levels of interleukin-6 and RANTES. In turn, the association of Hungatella with the performance of attention was mediated by the levels of zonulin. The findings indicate that compositional alterations of gut microbiota observed in patients with schizophrenia correspond with clinical manifestation, intestinal permeability, subclinical inflammation, lipid profile alterations, and impaired glucose homeostasis. Subclinical inflammation and impaired gut permeability might mediate the association of gut microbiota alterations with psychopathological symptoms and cognitive impairment.

Modelling the effects of the exposome score within the extended psychosis phenotype

It has been reported that cumulative measures of risk factors for psychosis might help to predict its development. However, it remains unknown as to whether these measures are also associated with the extended psychosis phenotype that refers to a continuum of features bridging subclinical symptoms with clinically relevant outcomes. In this study, we aimed to investigate the association of the exposome score (ES) with psychosis risk in a non-clinical population. A total of 1100 non-clinical adults (aged 18-35 years, 51.4% females) with a negative history of psychiatric treatment were recruited. The Prodromal Questionnaire-16 (PQ-16) was used to screen for psychosis risk. Self-reports were used to record environmental exposures. The ES was significantly higher in participants with the positive PQ-16 screening. Specifically, the prevalence of obstetric complications, non-right handedness, all categories of childhood trauma, and problematic cannabis use was significantly higher in this group of participants. A network analysis demonstrated that the ES was directly connected not only to items representing psychotic experiences ("paranoid thoughts", "a lack of control over own ideas or thoughts", "thought echo", and "being distracted by distant sounds") but also those covering depressive or anxiety symptoms ("uninterested in things used to enjoy" and "feeling anxious when meeting people for the first time"). In conclusion, the ES is associated with the extended psychosis phenotype, suggesting its potential to identify individuals who may benefit from further psychosis risk assessment. The ES appears to contribute to non-specific psychopathology, which may, in some cases, progress to psychosis.