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Saccaro LF, Tassone M, Tozzi F, Rutigliano G. Proton magnetic resonance spectroscopy of N-acetyl aspartate in first depressive episode and chronic major depressive disorder: A systematic review and meta-analysis. J Affect Disord 2024; 355:265-282. [PMID: 38554884 DOI: 10.1016/j.jad.2024.03.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
N-acetyl aspartate (NAA) is a marker of neuronal integrity and metabolism. Deficiency in neuronal plasticity and hypometabolism are implicated in Major Depressive Disorder (MDD) pathophysiology. To test if cerebral NAA concentrations decrease progressively over the MDD course, we conducted a pre-registered meta-analysis of Proton Magnetic Resonance Spectroscopy (1H-MRS) studies comparing NAA concentrations in chronic MDD (n = 1308) and first episode of depression (n = 242) patients to healthy controls (HC, n = 1242). Sixty-two studies were meta-analyzed using a random-effect model for each brain region. NAA concentrations were significantly reduced in chronic MDD compared to HC within the frontal lobe (Hedges' g = -0.330; p = 0.018), the occipital lobe (Hedges' g = -0.677; p = 0.007), thalamus (Hedges' g = -0.673; p = 0.016), and frontal (Hedges' g = -0.471; p = 0.034) and periventricular white matter (Hedges' g = -0.478; p = 0.047). We highlighted a gap of knowledge regarding NAA levels in first episode of depression patients. Sensitivity analyses indicated that antidepressant treatment may reverse NAA alterations in the frontal lobe. We highlighted field strength and correction for voxel grey matter as moderators of NAA levels detection. Future studies should assess NAA alterations in the early stages of the illness and their longitudinal progression.
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Affiliation(s)
- Luigi F Saccaro
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Campus Biotech, 9 Chemin des Mines, 1202 Geneva, Switzerland; Department of Psychiatry, Geneva University Hospital, 1205 Geneva, Switzerland.
| | - Matteo Tassone
- Department of Pathology, University of Pisa, via Savi 10, 56126 Pisa, Italy
| | - Francesca Tozzi
- Bio@SNS laboratory, Scuola Normale Superiore, 56124 Pisa, Italy
| | - Grazia Rutigliano
- Department of Pathology, University of Pisa, via Savi 10, 56126 Pisa, Italy; Institute of Clinical Sciences, Imperial College London, MRI Steiner Unit, Hammersmith Hospital Campus, Du Cane Road, W12 0NN London, United Kingdom of Great Britain and Northern Ireland
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2
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Belloli A, Saccaro LF, Landi P, Spera M, Zappa MA, Dell’Osso B, Rutigliano G. Emotion dysregulation links pathological eating styles and psychopathological traits in bariatric surgery candidates. Front Psychiatry 2024; 15:1369720. [PMID: 38606413 PMCID: PMC11006956 DOI: 10.3389/fpsyt.2024.1369720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Objectives Approximately one-third of bariatric surgery patients experience weight regain or suboptimal weight loss within five years post-surgery. Pathological eating styles and psychopathological traits (e.g., emotion dysregulation) are recognized as potential hindrances to sustain weight loss efforts and are implicated in obesity development. A comprehensive understanding of these variables and their interplays is still lacking, despite their potential significance in developing more effective clinical interventions for bariatric patients. We investigate the prevalence of and interactions between pathological eating styles and psychopathological traits in this population. Materials and methods 110 bariatric surgery candidates were characterized using the Binge Eating Scale (BES), Hamilton Depression/Anxiety Scales (HAM-D/A), Barratt Impulsiveness Scale (BIS-11), Experiences in Close Relationships (ECR), Difficulties in Emotion Regulation Scale (DERS). We analyzed these variables with multiple logistic regression analyses and network analysis. Results Patients with pathological eating styles showed more pronounced anxiety/depressive symptoms and emotion dysregulation. Network analysis revealed strong connections between BES and DERS, with DERS also displaying robust connections with HAM-A/D and ECR scales. DERS and attention impulsivity (BIS-11-A) emerged as the strongest nodes in the network. Discussion Our findings demonstrate the mediating role of emotion dysregulation between pathological eating styles and psychopathological traits, supporting existing literature on the association between psychopathological traits, insecure attachment styles, and pathological eating behaviors. This research emphasizes the significance of emotion regulation in the complex network of variables contributing to obesity, and its potential impact on bariatric surgery outcomes. Interventions focusing on emotion regulation may thus lead to improved clinical outcomes for bariatric patients.
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Affiliation(s)
- Arianna Belloli
- Department of Psychiatry, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, Italy
- Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Luigi F. Saccaro
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Psychiatry, Geneva University Hospital, Geneva, Switzerland
| | - Paola Landi
- Department of Psychiatry, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, Italy
| | - Milena Spera
- Department of Psychiatry, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, Italy
| | - Marco Antonio Zappa
- Department of General Surgery, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, Italy
| | - Bernardo Dell’Osso
- Department of Psychiatry, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, Italy
| | - Grazia Rutigliano
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
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Davies C, Martins D, Dipasquale O, McCutcheon RA, De Micheli A, Ramella-Cravaro V, Provenzani U, Rutigliano G, Cappucciati M, Oliver D, Williams S, Zelaya F, Allen P, Murguia S, Taylor D, Shergill S, Morrison P, McGuire P, Paloyelis Y, Fusar-Poli P. Connectome dysfunction in patients at clinical high risk for psychosis and modulation by oxytocin. Mol Psychiatry 2024:10.1038/s41380-024-02406-x. [PMID: 38243074 DOI: 10.1038/s41380-024-02406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 01/21/2024]
Abstract
Abnormalities in functional brain networks (functional connectome) are increasingly implicated in people at Clinical High Risk for Psychosis (CHR-P). Intranasal oxytocin, a potential novel treatment for the CHR-P state, modulates network topology in healthy individuals. However, its connectomic effects in people at CHR-P remain unknown. Forty-seven men (30 CHR-P and 17 healthy controls) received acute challenges of both intranasal oxytocin 40 IU and placebo in two parallel randomised, double-blind, placebo-controlled cross-over studies which had similar but not identical designs. Multi-echo resting-state fMRI data was acquired at approximately 1 h post-dosing. Using a graph theoretical approach, the effects of group (CHR-P vs healthy control), treatment (oxytocin vs placebo) and respective interactions were tested on graph metrics describing the topology of the functional connectome. Group effects were observed in 12 regions (all pFDR < 0.05) most localised to the frontoparietal network. Treatment effects were found in 7 regions (all pFDR < 0.05) predominantly within the ventral attention network. Our major finding was that many effects of oxytocin on network topology differ across CHR-P and healthy individuals, with significant interaction effects observed in numerous subcortical regions strongly implicated in psychosis onset, such as the thalamus, pallidum and nucleus accumbens, and cortical regions which localised primarily to the default mode network (12 regions, all pFDR < 0.05). Collectively, our findings provide new insights on aberrant functional brain network organisation associated with psychosis risk and demonstrate, for the first time, that oxytocin modulates network topology in brain regions implicated in the pathophysiology of psychosis in a clinical status (CHR-P vs healthy control) specific manner.
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Affiliation(s)
- Cathy Davies
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Daniel Martins
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychiatry, University Hospitals of Genève, Geneva, Switzerland
| | - Ottavia Dipasquale
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Robert A McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Andrea De Micheli
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Outreach And Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Valentina Ramella-Cravaro
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Umberto Provenzani
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Grazia Rutigliano
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marco Cappucciati
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Dominic Oliver
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Steve Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fernando Zelaya
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Allen
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Silvia Murguia
- Tower Hamlets Early Detection Service, East London NHS Foundation Trust, London, UK
| | - David Taylor
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Sukhi Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Kent and Medway Medical School, Canterbury, UK
| | - Paul Morrison
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Yannis Paloyelis
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK
- Outreach And Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Rutigliano G, Bertolini A, Grittani N, Frascarelli S, Carnicelli V, Ippolito C, Moscato S, Mattii L, Kusmic C, Saba A, Origlia N, Zucchi R. Effect of Combined Levothyroxine (L-T 4) and 3-Iodothyronamine (T 1AM) Supplementation on Memory and Adult Hippocampal Neurogenesis in a Mouse Model of Hypothyroidism. Int J Mol Sci 2023; 24:13845. [PMID: 37762153 PMCID: PMC10530993 DOI: 10.3390/ijms241813845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Mood alterations, anxiety, and cognitive impairments associated with adult-onset hypothyroidism often persist despite replacement treatment. In rodent models of hypothyroidism, replacement does not bring 3-iodothyronamine (T1AM) brain levels back to normal. T1AM is a thyroid hormone derivative with cognitive effects. Using a pharmacological hypothyroid mouse model, we investigated whether augmenting levothyroxine (L-T4) with T1AM improves behavioural correlates of depression, anxiety, and memory and has an effect on hippocampal neurogenesis. Hypothyroid mice showed impaired performance in the novel object recognition test as compared to euthyroid mice (discrimination index (DI): 0.02 ± 0.09 vs. 0.29 ± 0.06; t = 2.515, p = 0.02). L-T4 and L-T4+T1AM rescued memory (DI: 0.27 ± 0.08 and 0.34 ± 0.08, respectively), while T1AM had no effect (DI: -0.01 ± 0.10). Hypothyroidism reduced the number of neuroprogenitors in hippocampal neurogenic niches by 20%. L-T4 rescued the number of neuroprogenitors (mean diff = 106.9 ± 21.40, t = 4.99, pcorr = 0.003), while L-T4+T1AM produced a 30.61% rebound relative to euthyroid state (mean diff = 141.6 ± 31.91, t = 4.44, pcorr = 0.004). We performed qPCR analysis of 88 genes involved in neurotrophic signalling pathways and found an effect of treatment on the expression of Ngf, Kdr, Kit, L1cam, Ntf3, Mapk3, and Neurog2. Our data confirm that L-T4 is necessary and sufficient for recovering memory and hippocampal neurogenesis deficits associated with hypothyroidism, while we found no evidence to support the role of non-canonical TH signalling.
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Affiliation(s)
- Grazia Rutigliano
- Institute of Clinical Science, Imperial College London, London SW7 2AZ, UK
- Department of Pathology, University of Pisa, 56126 Pisa, Italy; (A.B.); (N.G.); (S.F.); (V.C.); (A.S.); (R.Z.)
- CNR Institute of Clinical Physiology, 56124 Pisa, Italy;
| | - Andrea Bertolini
- Department of Pathology, University of Pisa, 56126 Pisa, Italy; (A.B.); (N.G.); (S.F.); (V.C.); (A.S.); (R.Z.)
| | - Nicoletta Grittani
- Department of Pathology, University of Pisa, 56126 Pisa, Italy; (A.B.); (N.G.); (S.F.); (V.C.); (A.S.); (R.Z.)
| | - Sabina Frascarelli
- Department of Pathology, University of Pisa, 56126 Pisa, Italy; (A.B.); (N.G.); (S.F.); (V.C.); (A.S.); (R.Z.)
| | - Vittoria Carnicelli
- Department of Pathology, University of Pisa, 56126 Pisa, Italy; (A.B.); (N.G.); (S.F.); (V.C.); (A.S.); (R.Z.)
| | - Chiara Ippolito
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.I.); (S.M.); (L.M.)
| | - Stefania Moscato
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.I.); (S.M.); (L.M.)
| | - Letizia Mattii
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.I.); (S.M.); (L.M.)
| | - Claudia Kusmic
- CNR Institute of Clinical Physiology, 56124 Pisa, Italy;
| | - Alessandro Saba
- Department of Pathology, University of Pisa, 56126 Pisa, Italy; (A.B.); (N.G.); (S.F.); (V.C.); (A.S.); (R.Z.)
| | | | - Riccardo Zucchi
- Department of Pathology, University of Pisa, 56126 Pisa, Italy; (A.B.); (N.G.); (S.F.); (V.C.); (A.S.); (R.Z.)
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5
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Siafis S, McCutcheon R, Chiocchia V, Ostinelli EG, Wright S, Stansfield C, Juma DO, Mantas I, Howes OD, Rutigliano G, Ramage F, Tinsdeall F, Friedrich C, Milligan L, Moreno C, Elliott JH, Thomas J, Macleod MR, Sena ES, Seedat S, Salanti G, Potts J, Cipriani A, Leucht S. Trace amine-associated receptor 1 (TAAR1) agonists for psychosis: protocol for a living systematic review and meta-analysis of human and non-human studies. Wellcome Open Res 2023; 8:365. [PMID: 38634067 PMCID: PMC11021884 DOI: 10.12688/wellcomeopenres.19866.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND There is an urgent need to develop more effective and safer antipsychotics beyond dopamine 2 receptor antagonists. An emerging and promising approach is TAAR1 agonism. Therefore, we will conduct a living systematic review and meta-analysis to synthesize and triangulate the evidence from preclinical animal experiments and clinical studies on the efficacy, safety, and underlying mechanism of action of TAAR1 agonism for psychosis. METHODS Independent searches will be conducted in multiple electronic databases to identify clinical and animal experimental studies comparing TAAR1 agonists with licensed antipsychotics or other control conditions in individuals with psychosis or animal models for psychosis, respectively. The primary outcomes will be overall psychotic symptoms and their behavioural proxies in animals. Secondary outcomes will include side effects and neurobiological measures. Two independent reviewers will conduct study selection, data extraction using predefined forms, and risk of bias assessment using suitable tools based on the study design. Ontologies will be developed to facilitate study identification and data extraction. Data from clinical and animal studies will be synthesized separately using random-effects meta-analysis if appropriate, or synthesis without meta-analysis. Study characteristics will be investigated as potential sources of heterogeneity. Confidence in the evidence for each outcome and source of evidence will be evaluated, considering the summary of the association, potential concerns regarding internal and external validity, and reporting biases. When multiple sources of evidence are available for an outcome, an overall conclusion will be drawn in a triangulation meeting involving a multidisciplinary team of experts. We plan trimonthly updates of the review, and any modifications in the protocol will be documented. The review will be co-produced by multiple stakeholders aiming to produce impactful and relevant results and bridge the gap between preclinical and clinical research on psychosis. PROTOCOL REGISTRATION PROSPERO-ID: CRD42023451628.
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Affiliation(s)
- Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Robert McCutcheon
- Department of Psychiatry, University of Oxford, Oxford, England, UK
- Oxford Health NHS Foundation Trust, Oxford, England, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - Virginia Chiocchia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Canton of Bern, Switzerland
| | - Edoardo G. Ostinelli
- Department of Psychiatry, University of Oxford, Oxford, England, UK
- Oxford Health NHS Foundation Trust, Oxford, England, UK
- Oxford Precision Psychiatry Lab, University of Oxford, Oxford, England, UK
| | - Simonne Wright
- Department of Psychiatry, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Claire Stansfield
- EPPI Centre, Social Research Institute, University College London, London, England, UK
| | | | - Ioannis Mantas
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Oliver D. Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - Grazia Rutigliano
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, England, UK
| | - Fiona Ramage
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Francesca Tinsdeall
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Claire Friedrich
- Department of Psychiatry, University of Oxford, Oxford, England, UK
- Oxford Precision Psychiatry Lab, University of Oxford, Oxford, England, UK
| | | | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense de Madrid, Madrid, Community of Madrid, Spain
| | - Julian H. Elliott
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Future Evidence Foundation, Melbourne, Australia
| | - James Thomas
- EPPI Centre, Social Research Institute, University College London, London, England, UK
| | - Malcolm R. Macleod
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Emily S. Sena
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Canton of Bern, Switzerland
| | - Jennifer Potts
- Department of Psychiatry, University of Oxford, Oxford, England, UK
- Oxford Precision Psychiatry Lab, University of Oxford, Oxford, England, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, England, UK
- Oxford Health NHS Foundation Trust, Oxford, England, UK
- Oxford Precision Psychiatry Lab, University of Oxford, Oxford, England, UK
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - the GALENOS team
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Psychiatry, University of Oxford, Oxford, England, UK
- Oxford Health NHS Foundation Trust, Oxford, England, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
- Institute of Social and Preventive Medicine, University of Bern, Bern, Canton of Bern, Switzerland
- Oxford Precision Psychiatry Lab, University of Oxford, Oxford, England, UK
- Department of Psychiatry, Stellenbosch University, Stellenbosch, Western Cape, South Africa
- EPPI Centre, Social Research Institute, University College London, London, England, UK
- My Mind Our Humanity, Mombasa, Kenya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, England, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
- MQ Mental Health Research, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense de Madrid, Madrid, Community of Madrid, Spain
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Future Evidence Foundation, Melbourne, Australia
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6
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Nordio G, Easmin R, Giacomel A, Dipasquale O, Martins D, Williams S, Turkheimer F, Howes O, Veronese M, Jauhar S, Rogdaki M, McCutcheon R, Kaar S, Vano L, Rutigliano G, Angelescu I, Borgan F, D’Ambrosio E, Dahoun T, Kim E, Kim S, Bloomfield M, Egerton A, Demjaha A, Bonoldi I, Nosarti C, Maccabe J, McGuire P, Matthews J, Talbot PS. An automatic analysis framework for FDOPA PET neuroimaging. J Cereb Blood Flow Metab 2023; 43:1285-1300. [PMID: 37026455 PMCID: PMC10369152 DOI: 10.1177/0271678x231168687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/23/2023] [Accepted: 02/05/2023] [Indexed: 04/08/2023]
Abstract
In this study we evaluate the performance of a fully automated analytical framework for FDOPA PET neuroimaging data, and its sensitivity to demographic and experimental variables and processing parameters. An instance of XNAT imaging platform was used to store the King's College London institutional brain FDOPA PET imaging archive, alongside individual demographics and clinical information. By re-engineering the historical Matlab-based scripts for FDOPA PET analysis, a fully automated analysis pipeline for imaging processing and data quantification was implemented in Python and integrated in XNAT. The final data repository includes 892 FDOPA PET scans organized from 23 different studies. We found good reproducibility of the data analysis by the automated pipeline (in the striatum for the Kicer: for the controls ICC = 0.71, for the psychotic patients ICC = 0.88). From the demographic and experimental variables assessed, gender was found to most influence striatal dopamine synthesis capacity (F = 10.7, p < 0.001), with women showing greater dopamine synthesis capacity than men. Our automated analysis pipeline represents a valid resourse for standardised and robust quantification of dopamine synthesis capacity using FDOPA PET data. Combining information from different neuroimaging studies has allowed us to test it comprehensively and to validate its replicability and reproducibility performances on a large sample size.
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Affiliation(s)
- Giovanna Nordio
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Rubaida Easmin
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Alessio Giacomel
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ottavia Dipasquale
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Daniel Martins
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Steven Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Federico Turkheimer
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- MRC London Institute of Medical Sciences, Hammersmith Hospital, London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, UK
| | - Mattia Veronese
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Information Engineering (DEI), University of Padua, Padua, Italy
| | - and the FDOPA PET imaging working group:
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- MRC London Institute of Medical Sciences, Hammersmith Hospital, London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, UK
- Department of Information Engineering (DEI), University of Padua, Padua, Italy
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College, Imperial College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- COMPASS Pathways plc, London, UK
- Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Department of Psychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Brain & Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
- Division of Psychiatry, Faculty of Brain Sciences, University College of London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosicences, King’s College London, London, UK
- Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- Early Intervention Psychosis Clinical Academic Group, South London & Maudsley NHS Trust, London, UK
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Sameer Jauhar
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College, Imperial College London, London, UK
| | - Maria Rogdaki
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Robert McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College, Imperial College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephen Kaar
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Luke Vano
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - Grazia Rutigliano
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - Ilinca Angelescu
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Faith Borgan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- COMPASS Pathways plc, London, UK
| | - Enrico D’Ambrosio
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Tarik Dahoun
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College, Imperial College London, London, UK
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Euitae Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Brain & Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
| | - Seoyoung Kim
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Micheal Bloomfield
- Division of Psychiatry, Faculty of Brain Sciences, University College of London, London, UK
| | - Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Arsime Demjaha
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Chiara Nosarti
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosicences, King’s College London, London, UK
- Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - James Maccabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Early Intervention Psychosis Clinical Academic Group, South London & Maudsley NHS Trust, London, UK
| | - Julian Matthews
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Peter S Talbot
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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7
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Polini B, Ricardi C, Bertolini A, Carnicelli V, Rutigliano G, Saponaro F, Zucchi R, Chiellini G. T1AM/TAAR1 System Reduces Inflammatory Response and β-Amyloid Toxicity in Human Microglial HMC3 Cell Line. Int J Mol Sci 2023; 24:11569. [PMID: 37511328 PMCID: PMC10380917 DOI: 10.3390/ijms241411569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Microglial dysfunction is one of the hallmarks and leading causes of common neurodegenerative diseases (NDDs), including Alzheimer's disease (AD) and Parkinson's disease (PD). All these pathologies are characterized by aberrant aggregation of disease-causing proteins in the brain, which can directly activate microglia, trigger microglia-mediated neuroinflammation, and increase oxidative stress. Inhibition of glial activation may represent a therapeutic target to alleviate neurodegeneration. Recently, 3-iodothyronamine (T1AM), an endogenous derivative of thyroid hormone (TH) able to interact directly with a specific GPCR known as trace amine-associated receptor 1 (TAAR1), gained interest for its ability to promote neuroprotection in several models. Nevertheless, T1AM's effects on microglial disfunction remain still elusive. In the present work we investigated whether T1AM could inhibit the inflammatory response of human HMC3 microglial cells to LPS/TNFα or β-amyloid peptide 25-35 (Aβ25-35) stimuli. The results of ELISA and qPCR assays revealed that T1AM was able to reduce microglia-mediated inflammatory response by inhibiting the release of proinflammatory factors, including IL-6, TNFα, NF-kB, MCP1, and MIP1, while promoting the release of anti-inflammatory mediators, such as IL-10. Notably, T1AM anti-inflammatory action in HMC3 cells turned out to be a TAAR1-mediated response, further increasing the relevance of the T1AM/TAAR1 system in the management of NDDs.
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Affiliation(s)
- Beatrice Polini
- Department of Pathology, University of Pisa, 56100 Pisa, Italy; (C.R.); (A.B.); (V.C.); (F.S.); (R.Z.)
| | - Caterina Ricardi
- Department of Pathology, University of Pisa, 56100 Pisa, Italy; (C.R.); (A.B.); (V.C.); (F.S.); (R.Z.)
| | - Andrea Bertolini
- Department of Pathology, University of Pisa, 56100 Pisa, Italy; (C.R.); (A.B.); (V.C.); (F.S.); (R.Z.)
| | - Vittoria Carnicelli
- Department of Pathology, University of Pisa, 56100 Pisa, Italy; (C.R.); (A.B.); (V.C.); (F.S.); (R.Z.)
| | - Grazia Rutigliano
- Institute of Clinical Sciences, Imperial College London, London SW7 2AZ, UK;
| | - Federica Saponaro
- Department of Pathology, University of Pisa, 56100 Pisa, Italy; (C.R.); (A.B.); (V.C.); (F.S.); (R.Z.)
| | - Riccardo Zucchi
- Department of Pathology, University of Pisa, 56100 Pisa, Italy; (C.R.); (A.B.); (V.C.); (F.S.); (R.Z.)
| | - Grazia Chiellini
- Department of Pathology, University of Pisa, 56100 Pisa, Italy; (C.R.); (A.B.); (V.C.); (F.S.); (R.Z.)
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8
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Cesari V, Frumento S, Leo A, Baroni M, Rutigliano G, Gemignani A, Menicucci D. Functional correlates of subliminal stimulation in Posttraumatic Stress Disorder: Systematic review and meta-analysis. J Affect Disord 2023:S0165-0327(23)00682-1. [PMID: 37236272 DOI: 10.1016/j.jad.2023.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
Patients with Post-traumatic stress disorder (PTSD) exposed to traumatic reminders show hyperreactivity in brain areas (e.g., amygdala) belonging or related to the Innate Alarm System (IAS), allowing the rapid processing of salient stimuli. Evidence that IAS is activated by subliminal trauma-reminders could shed a new light on the factors precipitating and perpetuating PTSD symptomatology. Thus, we systematically reviewed studies investigating neuroimaging correlates of subliminal stimulation in PTSD. Twenty-three studies were selected from the MEDLINE and Scopus® databases for a qualitative synthesis, 5 of which allowed a further meta-analysis of fMRI data. The intensity of IAS responses to subliminal trauma-related reminders ranged from a minimum in healthy controls to a maximum in the PTSD patients with the most severe (e.g., dissociative) symptoms or the least responsiveness to treatment. Comparisons with other disorders (e.g., phobias) revealed contrasting results. Our findings demonstrate the hyperactivation of areas belonging or related to IAS in response to unconscious threats that should be integrated in diagnostic as well as in therapeutic protocols.
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Affiliation(s)
- Valentina Cesari
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126 Pisa, Italy
| | - Sergio Frumento
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126 Pisa, Italy
| | - Andrea Leo
- Department of translational research and advanced technologies in medicine and surgery, University of Pisa, Via Risorgimento, 36, Pisa, Italy
| | - Marina Baroni
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126 Pisa, Italy; Institute of Clinical Physiology (IFC), National Research Council, via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Grazia Rutigliano
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126 Pisa, Italy; Clinical Psychology branch, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Danilo Menicucci
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126 Pisa, Italy.
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Saccaro LF, Rutigliano G, Landi P, Spera M, Kraslavski A, Zappa MA, Mencacci C. Emotional Regulation Underlies Gender Differences in Pathological Eating Behavior Styles of Bariatric Surgery Candidates. Women 2023. [DOI: 10.3390/women3020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Almost a third of bariatric surgery patients present suboptimal weight loss or important weight regain in the first five postoperative years. While the reasons underlying this are not fully understood, it is known that pathological eating styles (such as emotional or binge eating) can thwart efforts to maintain weight loss. However, detailed characterization and understanding of these eating styles have yet to be achieved. In particular, research on gender differences in pathological eating styles and psychiatric symptoms before bariatric surgery is lacking. To characterize gender differences in eating styles and their association with clinical symptoms, we prospectively enrolled 110 bariatric surgery candidates, collecting eating styles and clinical scores. Women displayed a higher frequency of emotional eating as compared to men (x2 = 9.07, p = 0.003), while men showed a higher frequency of quantitative eating behavioral style (x2 = 4.58, p = 0.044). Binge eating style was associated with higher Difficulties in Emotion Regulation Scale (DERS), Hamilton Depression Scale (HAM-D), and Hamilton Anxiety Scale (HAM-A) scores (p < 0.05). Emotional eating style was associated with higher HAM-D and HAM-A scores (p < 0.05). The present findings highlight the importance of understanding the role of gender differences in emotion regulation processes involved in the development and maintenance of pathological eating styles in bariatric surgery candidates. This paves the way to gender- and symptoms-specific interventions on eating behaviors to improve surgery long-term outcomes.
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Affiliation(s)
- Luigi F. Saccaro
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Campus Biotech, 9 Chemin des Mines, 1202 Geneva, Switzerland
- Department of Psychiatry, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Grazia Rutigliano
- Institute of Clinical Sciences, Imperial College London, MRI Steiner Unit, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
- Department of Pathology, University of Pisa, via Savi 10, 56126 Pisa, Italy
| | - Paola Landi
- Dipartimento di Salute Mentale e Dipendenze, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Milena Spera
- Dipartimento di Salute Mentale e Dipendenze, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Alexandra Kraslavski
- Dipartimento di Salute Mentale e Dipendenze, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Marco Antonio Zappa
- UOC di Chirurgia Generale, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20121 Milano, Italy
| | - Claudio Mencacci
- Dipartimento di Salute Mentale e Dipendenze, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
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10
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Prada I, Gabrielli M, Joshi P, Falcicchia C, D'Arrigo G, Rutigliano G, Tonoli E, Battocchio E, Zenatelli R, Tozzi F, Verderio‐Edwards E, Radeghieri A, Arancio O, Origlia N, Verderio C. Role of extracellular vesicles in early synaptic dysfunction in AD. Alzheimers Dement 2022. [DOI: 10.1002/alz.065992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ilaria Prada
- CNR‐Institute of Neuroscience, Vedano al Lambro (MB) Italy
| | | | - Pooja Joshi
- CNR‐Institute of Neuroscience, Vedano al Lambro (MB) Italy
| | | | | | - Grazia Rutigliano
- NeuroscienceInstitute of Life Sciences ‐ Sant'Anna School of Advanced Studies Pisa Italy
- CNR Institute of Clinical Physiology Pisa Italy
| | - Elisa Tonoli
- Nottingham Trent University, School of Science and Technology Nottingham United Kingdom
| | - Elisabetta Battocchio
- CNR‐Institute of Neuroscience, Vedano al Lambro (MB) Italy
- CAA and AD Translational Research and Biomarkers Lab, University of Milano ‐ Bicocca Monza Italy
| | - Rossella Zenatelli
- Department of Molecular and Translational Medicine, University of Brescia Brescia Italy
| | | | | | - Annalisa Radeghieri
- Department of Molecular and Translational Medicine, University of Brescia Brescia Italy
- Consorzio Sistemi a Grande Interfase (CSGI), Department of Chemistry, University of Florence (FI) Sesto Fiorentino Italy
| | - Ottavio Arancio
- Department of Pathology and Cell Biology ‐ Columbia University New York NY USA
- The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain ‐ Columbia University New York NY USA
- Department of Medicine ‐ Columbia University, New York NY USA
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11
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Saccaro LF, Gasparini S, Rutigliano G. Applications of Mendelian randomization in psychiatry: a comprehensive systematic review. Psychiatr Genet 2022; 32:199-213. [PMID: 36354137 PMCID: PMC9648985 DOI: 10.1097/ypg.0000000000000327] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/31/2022] [Indexed: 11/11/2022]
Abstract
Psychiatric diseases exact a heavy socioeconomic toll, and it is particularly difficult to identify their risk factors and causative mechanisms due to their multifactorial nature, the limited physiopathological insight, the many confounding factors, and the potential reverse causality between the risk factors and psychiatric diseases. These characteristics make Mendelian randomization (MR) a precious tool for studying these disorders. MR is an analytical method that employs genetic variants linked to a certain risk factor, to assess if an observational association between that risk factor and a health outcome is compatible with a causal relationship. We report the first systematic review of all existing applications and findings of MR in psychiatric disorders, aiming at facilitating the identification of risk factors that may be common to different psychiatric diseases, and paving the way to transdiagnostic MR studies in psychiatry, which are currently lacking. We searched Web of Knowledge, Scopus, and Pubmed databases (until 3 May 2022) for articles on MR in psychiatry. The protocol was preregistered in PROSPERO (CRD42021285647). We included methodological details and results from 50 articles, mainly on schizophrenia, major depression, autism spectrum disorders, and bipolar disorder. While this review shows how MR can offer unique opportunities for unraveling causal links in risk factors and etiological elements of specific psychiatric diseases and transdiagnostically, some methodological flaws in the existing literature limit reliability of results and probably underlie their heterogeneity. We highlight perspectives and recommendations for future works on MR in psychiatry.
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Affiliation(s)
- Luigi F. Saccaro
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Campus Biotech, Geneva, Switzerland
- Department of Psychiatry, Geneva University Hospital, Geneva, Switzerland
| | - Simone Gasparini
- Institute of Life Sciences, Sant’Anna School of Advanced Studies, Pisa, Italy
| | - Grazia Rutigliano
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
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12
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Gabrielli M, Prada I, Joshi P, Falcicchia C, D’Arrigo G, Rutigliano G, Battocchio E, Zenatelli R, Tozzi F, Radeghieri A, Arancio O, Origlia N, Verderio C. OUP accepted manuscript. Brain 2022; 145:2849-2868. [PMID: 35254410 PMCID: PMC9420022 DOI: 10.1093/brain/awac083] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/17/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022] Open
Abstract
Synaptic dysfunction is an early mechanism in Alzheimer’s disease that involves progressively larger areas of the brain over time. However, how it starts and propagates is unknown. Here we show that amyloid-β released by microglia in association with large extracellular vesicles (Aβ-EVs) alters dendritic spine morphology in vitro, at the site of neuron interaction, and impairs synaptic plasticity both in vitro and in vivo in the entorhinal cortex–dentate gyrus circuitry. One hour after Aβ-EV injection into the mouse entorhinal cortex, long-term potentiation was impaired in the entorhinal cortex but not in the dentate gyrus, its main target region, while 24 h later it was also impaired in the dentate gyrus, revealing a spreading of long-term potentiation deficit between the two regions. Similar results were obtained upon injection of extracellular vesicles carrying Aβ naturally secreted by CHO7PA2 cells, while neither Aβ42 alone nor inflammatory extracellular vesicles devoid of Aβ were able to propagate long-term potentiation impairment. Using optical tweezers combined to time-lapse imaging to study Aβ-EV–neuron interaction, we show that Aβ-EVs move anterogradely at the axon surface and that their motion can be blocked through annexin-V coating. Importantly, when Aβ-EV motility was inhibited, no propagation of long-term potentiation deficit occurred along the entorhinal–hippocampal circuit, implicating large extracellular vesicle motion at the neuron surface in the spreading of long-term potentiation impairment. Our data indicate the involvement of large microglial extracellular vesicles in the rise and propagation of early synaptic dysfunction in Alzheimer’s disease and suggest a new mechanism controlling the diffusion of large extracellular vesicles and their pathogenic signals in the brain parenchyma, paving the way for novel therapeutic strategies to delay the disease.
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Affiliation(s)
| | - Ilaria Prada
- CNR Institute of Neuroscience, Vedano al Lambro, MB 20854, Italy
| | - Pooja Joshi
- CNR Institute of Neuroscience, Vedano al Lambro, MB 20854, Italy
| | | | - Giulia D’Arrigo
- CNR Institute of Neuroscience, Vedano al Lambro, MB 20854, Italy
| | - Grazia Rutigliano
- Institute of Life Sciences, Sant’Anna School of Advanced Studies, Pisa 56127, Italy
- CNR Institute of Clinical Physiology, Pisa 56124, Italy
| | - Elisabetta Battocchio
- CNR Institute of Neuroscience, Vedano al Lambro, MB 20854, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Rossella Zenatelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia 25123, Italy
| | - Francesca Tozzi
- Bio@SNS Laboratory, Scuola Normale Superiore, Pisa, 56124, Italy
| | - Annalisa Radeghieri
- Department of Molecular and Translational Medicine, University of Brescia, Brescia 25123, Italy
- Consorzio Sistemi a Grande Interfase (CSGI), Department of Chemistry, University of Florence, Sesto Fiorentino, FI 50019, Italy
| | - Ottavio Arancio
- Department of Pathology and Cell Biology, Columbia University, New York, NY 10032, USA
- The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York 10032, NY, USA
- Department of Medicine, Columbia University, New York, NY 10032, USA
| | - Nicola Origlia
- Correspondence may also be addressed to: Nicola Origlia CNR Institute of Neuroscience, via Moruzzi 1 Pisa, 56124, Italy E-mail:
| | - Claudia Verderio
- Correspondence to: Claudia Verderio CNR Institute of Neuroscience via Raoul Follereau 3, Vedano al Lambro MB, 20854, Italy E-mail:
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13
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Dedic N, Dworak H, Zeni C, Rutigliano G, Howes OD. Therapeutic Potential of TAAR1 Agonists in Schizophrenia: Evidence from Preclinical Models and Clinical Studies. Int J Mol Sci 2021; 22:ijms222413185. [PMID: 34947997 PMCID: PMC8704992 DOI: 10.3390/ijms222413185] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 12/14/2022] Open
Abstract
Trace amine-associated receptor 1 (TAAR1) has emerged as a promising therapeutic target for neuropsychiatric disorders due to its ability to modulate monoaminergic and glutamatergic neurotransmission. In particular, agonist compounds have generated interest as potential treatments for schizophrenia and other psychoses due to TAAR1-mediated regulation of dopaminergic tone. Here, we review unmet needs in schizophrenia, the current state of knowledge in TAAR1 circuit biology and neuropharmacology, including preclinical behavioral, imaging, and cellular evidence in glutamatergic, dopaminergic and genetic models linked to the pathophysiology of psychotic, negative and cognitive symptoms. Clinical trial data for TAAR1 drug candidates are reviewed and contrasted with antipsychotics. The identification of endogenous TAAR1 ligands and subsequent development of small-molecule agonists has revealed antipsychotic-, anxiolytic-, and antidepressant-like properties, as well as pro-cognitive and REM-sleep suppressing effects of TAAR1 activation in rodents and non-human primates. Ulotaront, the first TAAR1 agonist to progress to randomized controlled clinical trials, has demonstrated efficacy in the treatment of schizophrenia, while another, ralmitaront, is currently being evaluated in clinical trials in schizophrenia. Coupled with the preclinical findings, this provides a rationale for further investigation and development of this new pharmacological class for the treatment of schizophrenia and other psychiatric disorders.
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Affiliation(s)
- Nina Dedic
- Sunovion Pharmaceuticals, Marlborough, MA 01752, USA; (H.D.); (C.Z.)
- Correspondence:
| | - Heather Dworak
- Sunovion Pharmaceuticals, Marlborough, MA 01752, USA; (H.D.); (C.Z.)
| | - Courtney Zeni
- Sunovion Pharmaceuticals, Marlborough, MA 01752, USA; (H.D.); (C.Z.)
| | - Grazia Rutigliano
- Department of Pathology, University of Pisa, via Savi 10, 56126 Pisa, Italy;
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK;
| | - Oliver D. Howes
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK;
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London SE5 8AF, UK
- Psychiatric Imaging Group, Medical Research Council, London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK
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14
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Saccaro LF, Amatori G, Cappelli A, Mazziotti R, Dell'Osso L, Rutigliano G. Portable technologies for digital phenotyping of bipolar disorder: A systematic review. J Affect Disord 2021; 295:323-338. [PMID: 34488086 DOI: 10.1016/j.jad.2021.08.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/30/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bias-prone psychiatric interviews remain the mainstay of bipolar disorder (BD) assessment. The development of digital phenotyping promises to improve BD management. We present a systematic review of the evidence about the use of portable digital devices for the identification of BD, BD types and BD mood states and for symptom assessment. METHODS We searched Web of KnowledgeSM, Scopus ®, IEEE Xplore, and ACM Digital Library databases (until 5/1/2021) for articles evaluating the use of portable/wearable digital devices, such as smartphone apps, wearable sensors, audio and/or visual recordings, and multimodal tools. The protocol is registered in PROSPERO (CRD42020200086). RESULTS We included 62 studies (2325 BD; 724 healthy controls, HC): 27 using smartphone apps, either for recording self-assessments (n = 10) or for passively gathering metadata (n = 7) or both (n = 10); 15 using wearable sensors for physiological parameters; 17 analysing audio and/or video recordings; 3 using multiple technologies. Two thirds of the included studies applied artificial intelligence (AI)-based approaches. They achieved fair to excellent classification performances. LIMITATIONS The included studies had small sample sizes and marked heterogeneity. Evidence of overfitting emerged, limiting generalizability. The absence of clear guidelines about reporting classification performances, with no shared standard metrics, makes results hardly interpretable and comparable. CONCLUSIONS New technologies offer a noteworthy opportunity to BD digital phenotyping with objectivity and high granularity. AI-based models could deliver important support in clinical decision-making. Further research and cooperation between different stakeholders are needed for addressing methodological, ethical and socio-economic considerations.
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Affiliation(s)
- Luigi F Saccaro
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy; Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Raffaele Mazziotti
- Institute of Neuroscience of the Italian National Research Council (CNR), Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Damiani S, Rutigliano G, Fazia T, Merlino S, Berzuini C, Bernardinelli L, Politi P, Fusar-Poli P. Developing and Validating an Individualized Clinical Prediction Model to Forecast Psychotic Recurrence in Acute and Transient Psychotic Disorders: Electronic Health Record Cohort Study. Schizophr Bull 2021; 47:1695-1705. [PMID: 34172999 PMCID: PMC8530399 DOI: 10.1093/schbul/sbab070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Acute and transient psychotic disorders (ATPDs) include short-lived psychotic episodes with a high probability of developing psychotic recurrences. Clinical care for ATPD is currently limited by the inability to predict outcomes. Real-world electronic health record (EHR)-based retrospective cohort study STROBE/RECORD compliant included all individuals accessing the South London and Maudsley NHS Trust between 2006 and 2017 and receiving a first diagnosis of ATPD (F23, ICD-10). After imputing missing data, stepwise and LASSO Cox regression methods employing a priori predictors (n = 23) were compared to develop and internally validate an individualized risk prediction model to forecast the risk of psychotic recurrences following TRIPOD guidelines. The primary outcome was prognostic accuracy (area under the curve [AUC]). 3018 ATPD individuals were included (average age = 33.75 years, 52.7% females). Over follow-up (average 1042 ± 1011 days, up to 8 years) there were 1160 psychotic recurrences (events). Stepwise (n = 12 predictors) and LASSO (n = 17 predictors) regression methods yielded comparable prognostic accuracy, with an events per variable ratio >100 for both models. Both models showed an internally validated adequate prognostic accuracy from 4 years follow-up (AUC 0.70 for both models) and good calibration. A refined model was adapted in view of the new ICD-11 criteria on 307 subjects with polymorphic ATPD, showing fair prognostic accuracy at 4 years (AUC: stepwise 0.68; LASSO 0.70). This study presents the first clinically based prediction model internally validated to adequately predict long-term psychotic recurrence in individuals with ATPD. The model can be automatable in EHRs, supporting further external validations and refinements to improve its prognostic accuracy.
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Affiliation(s)
- Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Grazia Rutigliano
- Department of Pathology, University of Pisa, Pisa, Italy
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, London, UK
| | - Teresa Fazia
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Sergio Merlino
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, London, UK
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Carlo Berzuini
- Center for Biostatistics, The University of Manchester, Manchester, UK
| | - Luisa Bernardinelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
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Abstract
Context Acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been related to subacute thyroiditis (SAT). Objective We compared SAT cases during the SARS-CoV-2 pandemic to those observed in the previous years. Methods A cross-sectional, retrospective study was conducted at the Endocrinology Unit of University Hospital of Pisa, Italy. We included all patients observed from January 2016 to December 2020 because of an untreated SAT, who had developed the disease within 15 days prior to the visit. SAT cases from 2016 to 2019 (N = 152) are referred to as pre-SARS-CoV-2, while 2020 SAT patients are classified as pos-SARS-CoV-2 (N = 18) or neg-SARS-CoV-2 (N = 28), according to positive or negative SARS-CoV-2 testing performed up to 45 days from SAT onset. Results While during 2016-2019, most SAT cases were observed in the third quarter, in 2020, 2 peaks were seen, superimposable to the SARS-CoV-2 outbreaks in the second and the fourth quarters. In the second and fourth quarters of 2020, we observed higher levels of free thyroxine (FT4), C-reactive protein (CRP), and thyroglobulin (Tg) compared with the same quarters of the years 2016-2019. Pos-SARS-CoV-2 patients had higher FT4 (28.4 vs 24.1 nmol/L), CRP (8.5 vs 3.6 mg/L), and Tg (155 vs 60 µg/L) (P < 0.05 for all) and more frequently had hypothyroidism (13/15 vs 30/152 at 3 months) (P < 0.001) than pre-SARS-CoV-2 patients. Neg-SARS-CoV-2 patients showed a clinical picture intermediate between the other 2 groups. Conclusion The SARS-CoV-2 pandemic has caused a shift in the annual timing and severity of SAT cases.
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Affiliation(s)
- Alessandro Brancatella
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56127 Pisa, Italy
| | - Nicola Viola
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56127 Pisa, Italy
| | | | - Daniele Sgrò
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56127 Pisa, Italy
| | - Ferruccio Santini
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56127 Pisa, Italy
| | - Francesco Latrofa
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56127 Pisa, Italy
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Mazziotti R, Rutigliano G. Tele-Mental Health for Reaching Out to Patients in a Time of Pandemic: Provider Survey and Meta-analysis of Patient Satisfaction. JMIR Ment Health 2021; 8:e26187. [PMID: 34114956 PMCID: PMC8323764 DOI: 10.2196/26187] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/13/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic threatened to impact mental health by disrupting access to care due to physical distance measures and the unexpected pressure on public health services. Tele-mental health was rapidly implemented to deliver health care services. OBJECTIVE The aims of this study were (1) to present state-of-the-art tele-mental health research, (2) to survey mental health providers about care delivery during the pandemic, and (3) to assess patient satisfaction with tele-mental health. METHODS Document clustering was applied to map research topics within tele-mental health research. A survey was circulated among mental health providers. Patient satisfaction was investigated through a meta-analysis of studies that compared satisfaction scores between tele-mental health and face-to-face interventions for mental health disorders, retrieved from Web of Knowledge and Scopus. Hedges g was used as the effect size measure, and effect sizes were pooled using a random-effect model. Sources of heterogeneity and bias were examined. RESULTS Evidence on tele-mental health has been accumulating since 2000, especially regarding service implementation, depressive or anxiety disorders, posttraumatic stress disorder, and special populations. Research was concentrated in a few countries. The survey (n=174 respondents from Italy, n=120 international) confirmed that, after the onset of COVID-19 outbreak, there was a massive shift from face-to-face to tele-mental health delivery of care. However, respondents held skeptical views about tele-mental health and did not feel sufficiently trained and satisfied. Meta-analysis of 29 studies (n=2143) showed that patients would be equally satisfied with tele-mental health as they are with face-to-face interventions (Hedges g=-0.001, 95% CI -0.116 to 0.114, P=.98, Q=43.83, I2=36%, P=.03) if technology-related issues were minimized. CONCLUSIONS Mental health services equipped with tele-mental health will be better able to cope with public health crises. Both providers and patients need to be actively engaged in digitization, to reshape their reciprocal trust around technological innovations.
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Affiliation(s)
- Raffaele Mazziotti
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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18
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Baroni M, Frumento S, Cesari V, Gemignani A, Menicucci D, Rutigliano G. Unconscious processing of subliminal stimuli in panic disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021. [PMID: 34139247 DOI: 10.1016/j.neubiorev.2021.06.023.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Attentional biases to threat exist in panic disorder (PD), probably related to altered subliminal processing. We systematically reviewed studies investigating subliminal processing in PD. Studies were retrieved from MEDLINE and Scopus®. We meta-analytically compared PD (n = 167) and healthy controls (HC, n = 165) for processing of masked panic-related and neutral words. We also compared subliminal and supraliminal presentations of panic-related words relative to neutral words within PD subjects and HC. We found a significantly enhanced Stroop interference to masked panic-related words in PD vs HC (Hedges' g = 0.60, p = 0.03; Q = 14.83, I2 = 66.3 %, p = 0.01). While both PD subjects and HC tended to be slower to respond to supraliminal threat words than to neutral words, PD subjects only showed a marginally significant slower response to subliminal panic-related words vs neutral words. Findings remain inconclusive regarding comparison to other mental disorders, neural correlates, and the effect of psychotherapy. Even if possibly flawed by methodological weaknesses, our findings support the existence of a sensitivity to subliminal threat cues in PD, which could be targeted to improve treatment.
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Affiliation(s)
- Marina Baroni
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy; Institute of Clinical Physiology (IFC), National Research Council, via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Sergio Frumento
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Valentina Cesari
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Danilo Menicucci
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy.
| | - Grazia Rutigliano
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
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19
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Baroni M, Frumento S, Cesari V, Gemignani A, Menicucci D, Rutigliano G. Unconscious processing of subliminal stimuli in panic disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 128:136-151. [PMID: 34139247 DOI: 10.1016/j.neubiorev.2021.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 02/07/2023]
Abstract
Attentional biases to threat exist in panic disorder (PD), probably related to altered subliminal processing. We systematically reviewed studies investigating subliminal processing in PD. Studies were retrieved from MEDLINE and Scopus®. We meta-analytically compared PD (n = 167) and healthy controls (HC, n = 165) for processing of masked panic-related and neutral words. We also compared subliminal and supraliminal presentations of panic-related words relative to neutral words within PD subjects and HC. We found a significantly enhanced Stroop interference to masked panic-related words in PD vs HC (Hedges' g = 0.60, p = 0.03; Q = 14.83, I2 = 66.3 %, p = 0.01). While both PD subjects and HC tended to be slower to respond to supraliminal threat words than to neutral words, PD subjects only showed a marginally significant slower response to subliminal panic-related words vs neutral words. Findings remain inconclusive regarding comparison to other mental disorders, neural correlates, and the effect of psychotherapy. Even if possibly flawed by methodological weaknesses, our findings support the existence of a sensitivity to subliminal threat cues in PD, which could be targeted to improve treatment.
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Affiliation(s)
- Marina Baroni
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy; Institute of Clinical Physiology (IFC), National Research Council, via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Sergio Frumento
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Valentina Cesari
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Danilo Menicucci
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy.
| | - Grazia Rutigliano
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
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20
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Guzzolino E, Milella MS, Forini F, Borsò M, Rutigliano G, Gorini F, Zucchi R, Saba A, Bianchi F, Iervasi G, Pitto L. Thyroid disrupting effects of low-dose dibenzothiophene and cadmium in single or concurrent exposure: New evidence from a translational zebrafish model. Sci Total Environ 2021; 769:144703. [PMID: 33486188 DOI: 10.1016/j.scitotenv.2020.144703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
Thyroid hormones (THs) are major regulators of biological processes essential for correct development and energy homeostasis. Although thyroid disruptors can deeply affect human health, the impact of exogenous chemicals and in particular mixture of chemicals on different aspects of thyroid development and metabolism is not yet fully understood. In this study we have used the highly versatile zebrafish model to assess the thyroid axis disrupting effects of cadmium (Cd) and dibenzothiophene (DBT), two environmental endocrine disruptors found to be significantly correlated in epidemiological co-exposure studies. Zebrafish embryos (5hpf) were exposed to low concentrations of Cd (from 0.05 to 2 μM) and DBT (from 0.05 to 1 μM) and to mixtures of them. A multilevel assessment of the pollutant effects has been obtained by combining in vivo morphological analyses allowed by the use of transgenic fluorescent lines with liquid chromatography mass spectrometry determination of TH levels and quantification of the expression levels of key genes involved in the Hypothalamic-Pituitary-Thyroid Axis (HPTA) and TH metabolism. Our results underscore for the first time an important synergistic toxic effect of these pollutants on embryonic development and thyroid morphology highlighting differences in the mechanisms through which they can adversely impact on multiple physiological processes of the HPTA and TH disposal influencing also heart geometry and function.
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Affiliation(s)
- E Guzzolino
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - M S Milella
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - F Forini
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - M Borsò
- Department of Pathology, University of Pisa, Pisa, Italy
| | - G Rutigliano
- Department of Pathology, University of Pisa, Pisa, Italy
| | - F Gorini
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - R Zucchi
- Department of Pathology, University of Pisa, Pisa, Italy
| | - A Saba
- Department of Pathology, University of Pisa, Pisa, Italy
| | - F Bianchi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - G Iervasi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - L Pitto
- Institute of Clinical Physiology, National Research Council, Pisa, Italy.
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21
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Tozzi F, Rutigliano G, Borsò M, Falcicchia C, Zucchi R, Origlia N. T 1AM-TAAR1 signalling protects against OGD-induced synaptic dysfunction in the entorhinal cortex. Neurobiol Dis 2021; 151:105271. [PMID: 33482355 DOI: 10.1016/j.nbd.2021.105271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/04/2020] [Accepted: 01/15/2021] [Indexed: 02/07/2023] Open
Abstract
Abnormalities in thyroid hormones (TH) availability and/or metabolism have been hypothesized to contribute to Alzheimer's disease (AD) and to be a risk factor for stroke. Recently, 3-iodothyronamine (T1AM), an endogenous amine putatively derived from TH metabolism, gained interest for its ability to promote learning and memory in the mouse. Moreover, T1AM has been demonstrated to rescue the β-Amyloid dependent LTP impairment in the entorhinal cortex (EC), a brain area crucially involved in learning and memory and early affected during AD. In the present work, we have investigated the effect of T1AM on ischemia-induced EC synaptic dysfunction. In EC brain slices exposed to oxygen-glucose deprivation (OGD), we demonstrated that the acute perfusion of T1AM (5 μM) was capable of preventing ischemia-induced synaptic depression and that this protective effect was mediated by the trace amine-associated receptor 1 (TAAR1). Moreover, we demonstrated that activation of the BDNF-TrkB signalling is required for T1AM action during ischemia. The protective effect of T1AM was more evident when using EC slices from transgenic mutant human APP (mhAPP mice) that are more vulnerable to the effect of OGD. Our results confirm that the TH derivative T1AM can rescue synaptic function after transient ischemia, an effect that was also observed in a Aβ-enriched environment.
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Affiliation(s)
- Francesca Tozzi
- Bio@SNS laboratory, Scuola Normale Superiore, 56124 Pisa, Italy
| | | | - Marco Borsò
- Department of Pathology, University of Pisa, 56100 Pisa, Italy
| | - Chiara Falcicchia
- Institute of Neuroscience of the Italian National Research Council (CNR), Pisa, Italy
| | - Riccardo Zucchi
- Department of Pathology, University of Pisa, 56100 Pisa, Italy
| | - Nicola Origlia
- Institute of Neuroscience of the Italian National Research Council (CNR), Pisa, Italy.
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22
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Saponaro F, Rutigliano G, Sestito S, Bandini L, Storti B, Bizzarri R, Zucchi R. ACE2 in the Era of SARS-CoV-2: Controversies and Novel Perspectives. Front Mol Biosci 2020; 7:588618. [PMID: 33195436 PMCID: PMC7556165 DOI: 10.3389/fmolb.2020.588618] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/04/2020] [Indexed: 12/23/2022] Open
Abstract
Angiotensin-converting enzyme 2 (ACE2) is related to ACE but turned out to counteract several pathophysiological actions of ACE. ACE2 exerts antihypertensive and cardioprotective effects and reduces lung inflammation. ACE2 is subjected to extensive transcriptional and post-transcriptional modulation by epigenetic mechanisms and microRNAs. Also, ACE2 expression is regulated post-translationally by glycosylation, phosphorylation, and shedding from the plasma membrane. ACE2 protein is ubiquitous across mammalian tissues, prominently in the cardiovascular system, kidney, and intestine. ACE2 expression in the respiratory tract is of particular interest, in light of the discovery that ACE2 serves as the initial cellular target of severe acute respiratory syndrome (SARS)-coronaviruses, including the recent SARS-CoV2, responsible of the COronaVIrus Disease 2019 (COVID-19). Since the onset of the COVID-19 pandemic, an intense effort has been made to elucidate the biochemical determinants of SARS-CoV2-ACE2 interaction. It has been determined that SARS-CoV2 engages with ACE2 through its spike (S) protein, which consists of two subunits: S1, that mediates binding to the host receptor; S2, that induces fusion of the viral envelope with the host cell membrane and delivery of the viral genome. Owing to the role of ACE2 in SARS-CoV2 pathogenicity, it has been speculated that medical conditions, i.e., hypertension, and/or drugs, i.e., ACE inhibitors and angiotensin receptor blockers, known to influence ACE2 density could alter the fate of SARS-CoV-2 infection. The debate is still open and will only be solved when results of properly designed experimental and clinical investigations will be made public. An interesting observation is, however that, upon infection, ACE2 activity is reduced either by downregulation or by shedding. These events might precipitate the so-called "cytokine storm" that characterizes the most severe COVID-19 forms. As evidence accumulates, ACE2 appears a druggable target in the attempt to limit virus entry and replication. Strategies aimed at blocking ACE2 with antibodies, small molecules or peptides, or at neutralizing the virus by competitive binding with exogenously administered ACE2, are currently under investigations. In this review, we will present an overview of the state-of-the-art knowledge on ACE2 biochemistry and pathophysiology, outlining open issues in the context of COVID-19 disease and potential experimental and clinical developments.
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Affiliation(s)
| | | | - Simona Sestito
- Department of Pathology, University of Pisa, Pisa, Italy
- Department of Chemistry and Pharmacy, University of Sassari, Sassari, Italy
| | | | - Barbara Storti
- NEST, Scuola Normale Superiore and CNR-NANO, Pisa, Italy
| | - Ranieri Bizzarri
- Department of Pathology, University of Pisa, Pisa, Italy
- NEST, Scuola Normale Superiore and CNR-NANO, Pisa, Italy
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Schmidt A, Davies C, Paloyelis Y, Meyer N, De Micheli A, Ramella-Cravaro V, Provenzani U, Aoki Y, Rutigliano G, Cappucciati M, Oliver D, Murguia S, Zelaya F, Allen P, Shergill S, Morrison P, Williams S, Taylor D, Borgwardt S, Yamasue H, McGuire P, Fusar-Poli P. Acute oxytocin effects in inferring others' beliefs and social emotions in people at clinical high risk for psychosis. Transl Psychiatry 2020; 10:203. [PMID: 32572020 PMCID: PMC7308367 DOI: 10.1038/s41398-020-00885-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 12/19/2022] Open
Abstract
Social deficits are key hallmarks of the Clinical High Risk for Psychosis (CHR-P) state and of established psychotic disorders, and contribute to impaired social functioning, indicating a potential target for interventions. However, current treatments do not significantly ameliorate social impairments in CHR-P individuals. Given its critical role in social behaviour and cognition, the oxytocinergic (OT) system is a promising target for novel interventions in CHR-P subjects. In a double-blind, placebo-controlled, crossover design, 30 CHR-P males were studied using functional magnetic resonance imaging (fMRI) on two occasions, once after 40IU self-administered intranasal OT and once after placebo. A modified version of the Sally-Anne task was used to assess brain activation during inferring others' beliefs and social emotions. The Reading the Mind in the Eyes Test was acquired prior to the first scan to test whether OT effects were moderated by baseline social-emotional abilities. OT did not modulate behavioural performances but reduced activation in the bilateral inferior frontal gyrus compared with placebo while inferring others' social emotions. Furthermore, the relationship between brain activation and task performance after OT administration was moderated by baseline social-emotional abilities. While task accuracy during inferring others' social emotion increased with decreasing activation in the left inferior frontal gyrus in CHR-P individuals with low social-emotional abilities, there was no such relationship in CHR-P individuals with high social-emotional abilities. Our findings may suggest that acute OT administration enhances neural efficiency in the inferior frontal gyrus during inferring others' social emotions in those CHR-P subjects with low baseline social-emotional abilities.
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Affiliation(s)
- André Schmidt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland.
| | - Cathy Davies
- Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Yannis Paloyelis
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nicholas Meyer
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andrea De Micheli
- Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK
| | - Valentina Ramella-Cravaro
- Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Umberto Provenzani
- Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Yuta Aoki
- Department of Psychiatry, Hamamatsu University School of Medicine, Shizuoka, Japan
- Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan
- Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Grazia Rutigliano
- Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marco Cappucciati
- Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Silvia Murguia
- Tower Hamlets Early Detection Service (THEDS), East London NHS Foundation Trust, London, UK
| | - Fernando Zelaya
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychology, University of Roehampton, London, UK
| | - Sukhi Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Morrison
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Steve Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Taylor
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Hidenori Yamasue
- Department of Psychiatry, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK
- Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK
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Accorroni A, Rutigliano G, Sabatini M, Frascarelli S, Borsò M, Novelli E, Bandini L, Ghelardoni S, Saba A, Zucchi R, Origlia N. Exogenous 3-Iodothyronamine Rescues the Entorhinal Cortex from β-Amyloid Toxicity. Thyroid 2020; 30:147-160. [PMID: 31709926 DOI: 10.1089/thy.2019.0255] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: A novel form of thyroid hormone (TH) signaling is represented by 3-iodothyronamine (T1AM), an endogenous TH derivative that interacts with specific molecular targets, including trace amine-associated receptor 1 (TAAR1), and induces pro-learning and anti-amnestic effects in mice. Dysregulation of TH signaling has long been hypothesized to play a role in Alzheimer's disease (AD). In the present investigation, we explored the neuroprotective role of T1AM in beta amyloid (Aβ)-induced synaptic and behavioral impairment, focusing on the entorhinal cortex (EC), an area that is affected early by AD pathology. Methods: Field potentials were evoked in EC layer II, and long-term potentiation (LTP) was elicited by high frequency stimulation (HFS). T1AM (5 μM) and/or Aβ(1-42) (200 nM), were administered for 10 minutes, starting 5 minutes before HFS. Selective TAAR1 agonist RO5166017 (250 nM) and TAAR1 antagonist EPPTB (5 nM) were also used. The electrophysiological experiments were repeated in EC-slices taken from a mouse model of AD (mutant human amyloid precursor protein [mhAPP], J20 line). We also assessed the in vivo effects of T1AM on EC-dependent associative memory deficits, which were detected in mhAPP mice by behavioral evaluations based on the novel-object recognition paradigm. TAAR1 expression was determined by Western blot, whereas T1AM and its metabolite 3-iodothyroacetic acid (TA1) were assayed by high-performance liquid chromatography coupled to mass spectrometry. Results: We demonstrate the presence of endogenous T1AM and TAAR1 in the EC of wild-type and mhAPP mice. Exposure to Aβ(1-42) inhibited LTP, and T1AM perfusion (at a concentration of 5 μM, leading to an actual concentration in the perfusion buffer ranging from 44 to 298 nM) restored it, whereas equimolar amounts of 3,5,3'-triiodo-L-thyronine (T3) and TA1 were ineffective. The response to T1AM was abolished by the TAAR1 antagonist EPPTB, whereas it was mimicked by the TAAR1 agonist RO5166017. In the EC of APPJ20 mice, LTP could not be elicited, but it was rescued by T1AM. The intra-cerebro-ventricular administration of T1AM (0.89 μg/kg) also restored recognition memory that was impaired in mhAPP mice. Conclusions: Our results suggest that T1AM and TAAR1 are part of an endogenous system that can be modulated to prevent synaptic and behavioral deficits associated with Aβ-related toxicity.
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Affiliation(s)
- Alice Accorroni
- Scuola Superiore di Studi Universitari e di Perfezionamento Sant'Anna, Pisa, Italy
- Institute of Neuroscience of the Italian National Research Council (CNR), Pisa, Italy
| | - Grazia Rutigliano
- Scuola Superiore di Studi Universitari e di Perfezionamento Sant'Anna, Pisa, Italy
| | | | | | - Marco Borsò
- Department of Pathology, University of Pisa, Pisa, Italy
| | - Elena Novelli
- Institute of Neuroscience of the Italian National Research Council (CNR), Pisa, Italy
| | | | | | | | | | - Nicola Origlia
- Institute of Neuroscience of the Italian National Research Council (CNR), Pisa, Italy
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Rutigliano G, Chaumette B, Seeman MV. Editorial: Psychoneuroendocrinology of Psychosis Disorders. Front Psychiatry 2020; 11:607590. [PMID: 33240137 PMCID: PMC7680761 DOI: 10.3389/fpsyt.2020.607590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/16/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Boris Chaumette
- Université de Paris, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, GHU Paris Psychiatrie et Neurosciences, Paris, France.,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Abstract
The field of thyroid hormone signaling has grown more complex in recent years. In particular, it has been suggested that some thyroid hormone derivatives, tentatively named "novel thyroid hormones" or "active thyroid hormone metabolites", may act as independent chemical messengers. They include 3,5-diiodothyronine (T2), 3-iodothyronamine (T1AM), and several iodothyroacetic acids, i.e., 3,5,3',5'-thyroacetic acid (TA4), 3,5,3'-thyroacetic acid (TA3), and 3-thyroacetic acid (TA1). We summarize the present knowledge on these compounds, namely their biosynthetic pathways, endogenous levels, molecular targets, and the functional effects elicited in experimental preparations or intact animals after exogenous administration. Their physiological and pathophysiological role is discussed, and potential therapeutic applications are outlined. The requirements needed to qualify these substances as chemical messengers must still be validated, although promising evidence has been collected. At present, the best candidate to the role of independent chemical messenger appears to be T1AM, and its most interesting effects concern metabolism and brain function. The responses elicited in experimental animals have suggested potential therapeutic applications. TA3 has an established role in thyroid hormone resistance syndromes, and is under investigation in Allen-Herndon-Dudley syndrome. Other potential targets are represented by obesity and dyslipidemia (for T2 and T1AM); dementia and degenerative brain disease (for T1AM and TA1); cancer (for T1AM and TA4). Another intriguing and unexplored question is the potential relevance of these metabolites in the clinical picture of hypothyroidism and in the response to replacement therapy.
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Affiliation(s)
- Riccardo Zucchi
- Department of Pathology, Laboratory of Biochemistry, University of Pisa, Via Roma 55, Pisa, 56126, Italy.
| | | | - Federica Saponaro
- Department of Pathology, Laboratory of Biochemistry, University of Pisa, Via Roma 55, Pisa, 56126, Italy
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Rutigliano G, Bräunig J, Del Grande C, Carnicelli V, Masci I, Merlino S, Kleinau G, Tessieri L, Pardossi S, Paisdzior S, Dell'Osso L, Biebermann H, Zucchi R. Non-Functional Trace Amine-Associated Receptor 1 Variants in Patients With Mental Disorders. Front Pharmacol 2019; 10:1027. [PMID: 31572197 PMCID: PMC6753877 DOI: 10.3389/fphar.2019.01027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022] Open
Abstract
Background: The G protein–coupled receptor (GPCR) trace amine-associated receptor 1 (TAAR1) is expressed across brain areas involved in emotions, reward and cognition, and modulates monoaminergic and glutamatergic neurotransmissions. TAAR1 is stimulated with nanomolar affinity by 3-iodothyronamine (T1AM), an endogenous messenger considered a novel branch of thyroid hormone signaling. The human gene for TAAR1 maps to locus 6q23, within a region associated with major mental disorders. Materials and Methods: We screened a cohort of patients with major mental disorders (n = 104) and a group of healthy controls (n = 130) for TAAR1 variants. HEK293 cells were transiently transfected with: i) wild-type TAAR1 and ii) mutated TAAR1, either in homozygous or heterozygous state. Cell surface expression and Gs/adenylyl cyclase activation upon administration of β-phenylethylamine (PEA), T1AM, and RO5166017, were assessed. Results: We detected 13 missense variants in TAAR1 coding region, with a significant enrichment in patients as compared to healthy controls (11 vs. 1, 1 variant in both groups, p < 0.01). In silico analysis identified four dysfunctional variants, all in patients. Three of these—R23C, Y131C, and C263R—were functionally characterized. In cells co-transfected with wild-type and mutated TAAR1, we observed a significant reduction of cell surface expression. In heterozygosity, the three TAAR1 variants substantially dampened Gs signaling in response to PEA, and, more robustly, to T1AM. Co-stimulation with PEA and RO5166017 did not yield any improvement in Gs signaling. R23C, Y131C, and C263R are rare in the general population and map in functionally important highly conserved positions across TAAR1 orthologous and paralogous genes. Conclusions: Our findings suggest that disruptions of TAAR1 activity may be relevant to the pathophysiology of mental disorders, thereby providing a promising target for novel psychopharmacological interventions.
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Affiliation(s)
- Grazia Rutigliano
- Scuola Superiore Sant'Anna, Pisa, Italy.,National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Julia Bräunig
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute für Experimentelle Pädiatrische Endokrinology, Berlin, Germany
| | - Claudia Del Grande
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | | | - Isabella Masci
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Sergio Merlino
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Gunnar Kleinau
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Physics and Biophysics, Group Protein X-ray Crystallography and Signal Transduction, Berlin, Germany
| | | | | | - Sarah Paisdzior
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute für Experimentelle Pädiatrische Endokrinology, Berlin, Germany
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Heike Biebermann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute für Experimentelle Pädiatrische Endokrinology, Berlin, Germany
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Davies C, Paloyelis Y, Rutigliano G, Cappucciati M, De Micheli A, Ramella-Cravaro V, Provenzani U, Antoniades M, Modinos G, Oliver D, Stahl D, Murguia S, Zelaya F, Allen P, Shergill S, Morrison P, Williams S, Taylor D, McGuire P, Fusar-Poli P. Oxytocin modulates hippocampal perfusion in people at clinical high risk for psychosis. Neuropsychopharmacology 2019; 44:1300-1309. [PMID: 30626906 PMCID: PMC6784972 DOI: 10.1038/s41386-018-0311-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 11/27/2018] [Accepted: 12/18/2018] [Indexed: 12/15/2022]
Abstract
Preclinical and human studies suggest that hippocampal dysfunction is a key factor in the onset of psychosis. People at Clinical High Risk for psychosis (CHR-P) present with a clinical syndrome that can include social withdrawal and have a 20-35% risk of developing psychosis in the next 2 years. Recent research shows that resting hippocampal blood flow is altered in CHR-P individuals and predicts adverse clinical outcomes, such as non-remission/transition to frank psychosis. Previous work in healthy males indicates that a single dose of intranasal oxytocin has positive effects on social function and marked effects on resting hippocampal blood flow. The present study examined the effects of intranasal oxytocin on hippocampal blood flow in CHR-P individuals. In a double-blind, placebo-controlled, crossover design, 30 CHR-P males were studied using pseudo-continuous Arterial Spin Labelling on 2 occasions, once after 40IU intranasal oxytocin and once after placebo. The effects of oxytocin on left hippocampal blood flow were examined in a region-of-interest analysis of data acquired at 22-28 and at 30-36 minutes post-intranasal administration. Relative to placebo, administration of oxytocin was associated with increased hippocampal blood flow at both time points (p = .0056; p = .034), although the effect at the second did not survive adjustment for the effect of global blood flow. These data indicate that oxytocin can modulate hippocampal function in CHR-P individuals and therefore merits further investigation as a candidate novel treatment for this group.
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Grants
- G0901868 Medical Research Council
- 22593 Brain and Behavior Research Foundation (Brain & Behavior Research Foundation)
- Dominic Oliver is supported by the UK Medical Research Council (MR/N013700/1) and is a King’s College London member of the MRC Doctoral Training Partnership in Biomedical Sciences.
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
- DH | National Institute for Health Research (NIHR)
- This work was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King’s College London (PFP, PM, DS); by a Brain & Behaviour Research Foundation NARSAD Award (grant number 22593 to PFP); and by the Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The funders had no influence on the design, collection, analysis and interpretation of the data, writing of the report and decision to submit this article for publication.
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Affiliation(s)
- Cathy Davies
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Yannis Paloyelis
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Grazia Rutigliano
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marco Cappucciati
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andrea De Micheli
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK
| | - Valentina Ramella-Cravaro
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Umberto Provenzani
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Mathilde Antoniades
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gemma Modinos
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Dominic Oliver
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Silvia Murguia
- Tower Hamlets Early Detection Service (THEDS), East London NHS Foundation Trust, London, UK
| | - Fernando Zelaya
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychology, University of Roehampton, London, UK
| | - Sukhi Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Morrison
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Steve Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Taylor
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Philip McGuire
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Outreach And Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK.
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
- Outreach And Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK.
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Davies C, Rutigliano G, De Micheli A, Stone JM, Ramella-Cravaro V, Provenzani U, Cappucciati M, Scutt E, Paloyelis Y, Oliver D, Murguia S, Zelaya F, Allen P, Shergill S, Morrison P, Williams S, Taylor D, Lythgoe DJ, McGuire P, Fusar-Poli P. Neurochemical effects of oxytocin in people at clinical high risk for psychosis. Eur Neuropsychopharmacol 2019; 29:601-615. [PMID: 30928180 DOI: 10.1016/j.euroneuro.2019.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/10/2019] [Accepted: 03/07/2019] [Indexed: 01/12/2023]
Abstract
Alterations in neurochemical metabolites are thought to play a role in the pathophysiology of psychosis onset. Oxytocin, a neuropeptide with prosocial and anxiolytic properties, modulates glutamate neurotransmission in preclinical models but its neurochemical effects in people at high risk for psychosis are unknown. We used proton magnetic resonance spectroscopy (1H-MRS) to examine the effects of intranasal oxytocin on glutamate and other metabolites in people at Clinical High Risk for Psychosis (CHR-P) in a double-blind, placebo-controlled, crossover design. 30 CHR-P males were studied on two occasions, once after 40IU intranasal oxytocin and once after placebo. The effects of oxytocin on the concentration of glutamate, glutamate+glutamine and other metabolites (choline, N-acetylaspartate, myo-inositol) scaled to creatine were examined in the left thalamus, anterior cingulate cortex (ACC) and left hippocampus, starting approximately 75, 84 and 93 min post-dosing, respectively. Relative to placebo, administration of oxytocin was associated with an increase in choline levels in the ACC (p=.008, Cohen's d = 0.54). There were no other significant effects on metabolite concentrations (all p>.05). Our findings suggest that, at ∼75-99 min post-dosing, a single dose of intranasal oxytocin does not alter levels of neurochemical metabolites in the thalamus, ACC, or hippocampus in those at CHR-P, aside from potential effects on choline in the ACC.
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Affiliation(s)
- Cathy Davies
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK.
| | - Grazia Rutigliano
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Andrea De Micheli
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK; National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK
| | - James M Stone
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Valentina Ramella-Cravaro
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Umberto Provenzani
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marco Cappucciati
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Eleanor Scutt
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Yannis Paloyelis
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Dominic Oliver
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Silvia Murguia
- Tower Hamlets Early Detection Service (THEDS), East London NHS Foundation Trust, London, UK
| | - Fernando Zelaya
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychology, University of Roehampton, London, UK
| | - Sukhi Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Morrison
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Steve Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Taylor
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - David J Lythgoe
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Philip McGuire
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK; National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK
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Fusar-Poli P, Werbeloff N, Rutigliano G, Oliver D, Davies C, Stahl D, McGuire P, Osborn D. Transdiagnostic Risk Calculator for the Automatic Detection of Individuals at Risk and the Prediction of Psychosis: Second Replication in an Independent National Health Service Trust. Schizophr Bull 2019; 45:562-570. [PMID: 29897527 PMCID: PMC6483570 DOI: 10.1093/schbul/sby070] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The benefits of indicated primary prevention among individuals at Clinical High Risk for Psychosis (CHR-P) are limited by the difficulty in detecting these individuals. To overcome this problem, a transdiagnostic, clinically based, individualized risk calculator has recently been developed and subjected to a first external validation in 2 different catchment areas of the South London and Maudsley (SLaM) NHS Trust. METHODS Second external validation of real world, real-time electronic clinical register-based cohort study. All individuals who received a first ICD-10 index diagnosis of nonorganic and nonpsychotic mental disorder within the Camden and Islington (C&I) NHS Trust between 2009 and 2016 were included. The model previously validated included age, gender, ethnicity, age by gender, and ICD-10 index diagnosis to predict the development of any ICD-10 nonorganic psychosis. The model's performance was measured using Harrell's C-index. RESULTS This study included a total of 13702 patients with an average age of 40 (range 16-99), 52% were female, and most were of white ethnicity (64%). There were no CHR-P or child/adolescent services in the C&I Trust. The C&I and SLaM Trust samples also differed significantly in terms of age, gender, ethnicity, and distribution of index diagnosis. Despite these significant differences, the original model retained an acceptable predictive performance (Harrell's C of 0.73), which is comparable to that of CHR-P tools currently recommended for clinical use. CONCLUSIONS This risk calculator may pragmatically support an improved transdiagnostic detection of at-risk individuals and psychosis prediction even in NHS Trusts in the United Kingdom where CHR-P services are not provided.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,To whom correspondence should be addressed; Department of Psychosis Studies, 5th Floor, Institute of Psychiatry, Psychology & Neuroscience, PO63, 16 De Crespigny Park, SE5 8AF London, UK; tel: +44-02078-480900, fax: +44-02078-480976, e-mail:
| | - Nomi Werbeloff
- Division of Psychiatry, University College London, London, UK,Camden and Islington NHS Foundation Trust, London, UK
| | - Grazia Rutigliano
- Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Cathy Davies
- Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - David Osborn
- Division of Psychiatry, University College London, London, UK,Camden and Islington NHS Foundation Trust, London, UK
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Minichino A, Rutigliano G, Merlino S, Davies C, Oliver D, De Micheli A, Patel R, McGuire P, Fusar-Poli P. Unmet needs in patients with brief psychotic disorders: Too ill for clinical high risk services and not ill enough for first episode services. Eur Psychiatry 2019; 57:26-32. [PMID: 30658277 DOI: 10.1016/j.eurpsy.2018.12.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with acute and transient psychotic disorders (ATPDs) are by definition remitting, but have a high risk of developing persistent psychoses, resembling a subgroup of individuals at Clinical High Risk for Psychosis (CHR-P). Their pathways to care, treatment offered and long-term clinical outcomes beyond risk to psychosis are unexplored. We conducted an electronic health record-based retrospective cohort study including patients with ATPDs within the SLaM NHS Trust and followed-up to 8 years. METHODS A total of 2561 ATPDs were included in the study. A minority were detected (8%) and treated (18%) by Early Intervention services (EIS) and none by CHR-P services. Patients were offered a clinical follow-up of 350.40 ± 589.90 days. The cumulative incidence of discharges was 40% at 3 months, 60% at 1 year, 69% at 2 years, 77% at 4 years, and 82% at 8 years. Treatment was heterogeneous: the majority of patients received antipsychotics (up to 52%), only a tiny minority psychotherapy (up to 8%). RESULTS Over follow-up, 32.88% and 28.54% of ATPDS received at least one mental health hospitalization or one compulsory hospital admission under the Mental Health Act, respectively. The mean number of days spent in psychiatric hospital was 66.39 ± 239.44 days. CONCLUSIONS The majority of ATPDs are not detected/treated by EIS or CHR-P services, receive heterogeneous treatments and short-term clinical follow-up. ATPDs have a high risk of developing severe clinical outcomes beyond persistent psychotic disorders and unmet clinical needs that are not targeted by current mental health services.
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Affiliation(s)
- Amedeo Minichino
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Grazia Rutigliano
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Sergio Merlino
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Cathy Davies
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Dominic Oliver
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Andrea De Micheli
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Rashmi Patel
- Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; OASIS Service, South London and the Maudsley NHS Foundation Trust, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
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Fusar-Poli P, Davies C, Rutigliano G, Stahl D, Bonoldi I, McGuire P. Transdiagnostic Individualized Clinically Based Risk Calculator for the Detection of Individuals at Risk and the Prediction of Psychosis: Model Refinement Including Nonlinear Effects of Age. Front Psychiatry 2019; 10:313. [PMID: 31143134 PMCID: PMC6520657 DOI: 10.3389/fpsyt.2019.00313] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/23/2019] [Indexed: 12/19/2022] Open
Abstract
Background: The first rate-limiting step for primary indicated prevention of psychosis is the detection of young people who may be at risk. The ability of specialized clinics to detect individuals at risk for psychosis is limited. A clinically based, individualized, transdiagnostic risk calculator has been developed and externally validated to improve the detection of individuals at risk in secondary mental health care. This calculator employs core sociodemographic and clinical predictors, including age, which is defined in linear terms. Recent evidence has suggested a nonlinear impact of age on the probability of psychosis onset. Aim: To define at a meta-analytical level the function linking age and probability of psychosis onset. To incorporate this function in a refined version of the transdiagnostic risk calculator and to test its prognostic performance, compared to the original specification. Design: Secondary analyses on a previously published meta-analysis and clinical register-based cohort study based on 2008-2015 routine secondary mental health care in South London and Maudsley (SLaM) National Health Service (NHS) Foundation Trust. Participants: All patients receiving a first index diagnosis of non-organic/non-psychotic mental disorder within SLaM NHS Trust in the period 2008-2015. Main outcome measure: Prognostic accuracy (Harrell's C). Results: A total of 91,199 patients receiving a first index diagnosis of non-organic and non-psychotic mental disorder within SLaM NHS Trust were included in the derivation (33,820) or external validation (54,716) datasets. The mean follow-up was 1,588 days. The meta-analytical estimates showed that a second-degree fractional polynomial model with power (-2, -1: age1 = age-2 and age2 = age-1) was the best-fitting model (P < 0.001). The refined model that included this function showed an excellent prognostic accuracy in the external validation (Harrell's C = 0.805, 95% CI from 0.790 to 0.819), which was statistically higher than the original model, although of modest magnitude (Harrell's C change = 0.0136, 95% CIs from 0.006 to 0.021, P < 0.001). Conclusions: The use of a refined version of the clinically based, individualized, transdiagnostic risk calculator, which allows for nonlinearity in the association between age and risk of psychosis onset, may offer a modestly improved prognostic performance. This calculator may be particularly useful in young individuals at risk of developing psychosis who access secondary mental health care.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cathy Davies
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Grazia Rutigliano
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Daniel Stahl
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Ilaria Bonoldi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Philip McGuire
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Rutigliano G, Stazi M, Arancio O, Watterson DM, Origlia N. An isoform-selective p38α mitogen-activated protein kinase inhibitor rescues early entorhinal cortex dysfunctions in a mouse model of Alzheimer's disease. Neurobiol Aging 2018; 70:86-91. [PMID: 30007168 DOI: 10.1016/j.neurobiolaging.2018.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/24/2018] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Abstract
Neuroinflammation is a fundamental mechanism in Alzheimer's disease (AD) progression. The stress-induced activation of the p38α mitogen-activated protein kinase (MAPK) leads to increased production of proinflammatory cytokines and neurodegeneration. We investigated the effects of an isoform selective p38α MAPK inhibitor, MW01-18-150SRM (MW150), administered at 2.5 mg/kg/d (i.p.; 14 days) on early entorhinal cortex (EC) alterations in an AD mouse model carrying human mutations of the amyloid precursor protein (mhAPP). We used electrophysiological analyses with long-term potentiation induction in EC-containing brain slices and EC-relevant associative memory tasks. We found that MW150 was capable of rescuing long-term potentiation in 2-month old mhAPP mice. Acute delivery of MW150 to brain slices was similarly effective in rescuing long-term potentiation, with a comparable efficacy to that of the widely used multikinase inhibitor SB203580. MW150-treated mhAPP mice demonstrated improved ability to discriminate novel associations between objects and their position/context. Our findings suggest that the selective inhibition of the stress-activated p38α MAPK with MW150 can attenuate the EC dysfunctions associated with neuroinflammation in an early stage of AD progression.
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Affiliation(s)
- Grazia Rutigliano
- Scuola Superiore Sant'Anna, Pisa, Italy; National Research Council (CNR), Institute of Neuroscience, Pisa, Italy
| | - Martina Stazi
- National Research Council (CNR), Institute of Neuroscience, Pisa, Italy
| | - Ottavio Arancio
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | | | - Nicola Origlia
- National Research Council (CNR), Institute of Neuroscience, Pisa, Italy.
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Fusar-Poli P, De Micheli A, Rocchetti M, Cappucciati M, Ramella-Cravaro V, Rutigliano G, Bonoldi I, McGuire P, Falkenberg I. Semistructured Interview for Bipolar At Risk States (SIBARS). Psychiatry Res 2018; 264:302-309. [PMID: 29665559 DOI: 10.1016/j.psychres.2018.03.074] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/09/2018] [Accepted: 03/27/2018] [Indexed: 11/12/2022]
Abstract
The external prognostic accuracy of Bipolar At Risk (BAR) criteria is undetermined and no psychometric tools are available to measure them. We present here three studies that overcome these limitations. Study 1 and 2 investigated the prognostic accuracy (Harrell's C) of the original BAR and revised Bipolar At Risk States (BARS) criteria respectively for the prediction of bipolar disorders, using a retrospective cohort of individuals at Clinical High Risk for Psychosis (CHR-P). Study 3 validated externally the prognostic accuracy of a newly developed Semistructured Interview of At Risk Bipolar States (SIBARS) in an independent prospective CHR-P cohort. In study 1 (n = 205), those meeting BAR criteria had an increased risk of developing bipolar disorders (HR = 5.30) relative to those not meeting them, but the prognostic accuracy was poor (Harrell's C = 0.659). In study 2 (n = 205), those meeting the refined BARS criteria had a higher risk of developing bipolar disorders than those not meeting them (HR = 12.364), with an adequate prognostic accuracy (Harrell's C = 0.777). Study 3 (n = 71) confirmed that SIBARS criteria had an adequate prognostic accuracy (Harrell's C = 0.742) and clinical utility. Overall, these findings suggest that the SIBARS could be used for the detection of individuals at risk of developing bipolar disorders in CHR-P services.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK; NIHR Maudsley Biomedical Research Center, London, UK; OASIS Service, South London and the Maudsley NHS Foundation Trust, 190 Kennington Lane, London SE11 5DL, UK.
| | - Andrea De Micheli
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Matteo Rocchetti
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Marco Cappucciati
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Valentina Ramella-Cravaro
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Grazia Rutigliano
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ilaria Bonoldi
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Philip McGuire
- OASIS Service, South London and the Maudsley NHS Foundation Trust, 190 Kennington Lane, London SE11 5DL, UK; Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Irina Falkenberg
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry and Psychotherapy, Philipps-University, Rudolf-Bultmann-Str. 8, Marburg 35039, Germany
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Rutigliano G, Merlino S, Minichino A, Patel R, Davies C, Oliver D, De Micheli A, McGuire P, Fusar-Poli P. Long term outcomes of acute and transient psychotic disorders: The missed opportunity of preventive interventions. Eur Psychiatry 2018; 52:126-133. [PMID: 29787962 DOI: 10.1016/j.eurpsy.2018.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/05/2018] [Accepted: 05/08/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Acute and transient psychotic disorders (ATPD) are characterized by an acute onset and a remitting course, and overlap with subgroups of the clinical high-risk state for psychosis. The long-term course and outcomes of ATPD are not completely clear. METHODS Electronic health record-based retrospective cohort study, including all patients who received a first index diagnosis of ATPD (F23, ICD-10) within the South London and Maudsley (SLaM) National Health Service Trust, between 1 st April 2006 and 15th June 2017. The primary outcome was risk of developing persistent psychotic disorders, defined as the development of any ICD-10 diagnoses of non-organic psychotic disorders. Cumulative risk of psychosis onset was estimated through Kaplan-Meier failure functions (non-competing risks) and Greenwood confidence intervals. RESULTS A total of 3074 patients receiving a first index diagnosis of ATPD (F23, ICD-10) within SLaM were included. The mean follow-up was 1495 days. After 8-year, 1883 cases (61.26%) retained the index diagnosis of ATPD; the remaining developed psychosis. The cumulative incidence (Kaplan-Meier failure function) of risk of developing any ICD-10 non-organic psychotic disorder was 16.10% at 1-year (95%CI 14.83-17.47%), 28.41% at 2-year (95%CI 26.80-30.09%), 33.96% at 3-year (95% CI 32.25-35.75%), 36.85% at 4-year (95%CI 35.07-38.69%), 40.99% at 5-year (95% CI 39.12-42.92%), 42.58% at 6-year (95%CI 40.67-44.55%), 44.65% at 7-year (95% CI 42.66-46.69%), and 46.25% at 8-year (95% CI 44.17-48.37%). The cumulative risk of schizophrenia-spectrum disorder at 8-year was 36.14% (95% CI 34.09-38.27%). CONCLUSIONS Individuals with ATPD have a very high risk of developing persistent psychotic disorders and may benefit from early detection and preventive treatments to improve their outcomes.
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Affiliation(s)
- Grazia Rutigliano
- Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF, London, United Kingdom; Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
| | - Sergio Merlino
- Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF, London, United Kingdom; Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Amedeo Minichino
- Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF, London, United Kingdom
| | - Rashmi Patel
- Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF, London, United Kingdom
| | - Cathy Davies
- Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF, London, United Kingdom
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF, London, United Kingdom
| | - Andrea De Micheli
- Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF, London, United Kingdom
| | - Philip McGuire
- Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF, London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF, London, United Kingdom; OASIS Service, South London and Maudsley NHS Foundation Trust, 190 Kennington Ln, Lambeth, SE11, London, United Kingdom; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, De Crespigny Park, Camberwell, SE5 8AF, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Reilly TJ, Nottage JF, Studerus E, Rutigliano G, Micheli AID, Fusar-Poli P, McGuire P. Gamma band oscillations in the early phase of psychosis: A systematic review. Neurosci Biobehav Rev 2018; 90:381-399. [PMID: 29656029 DOI: 10.1016/j.neubiorev.2018.04.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 02/20/2018] [Accepted: 04/09/2018] [Indexed: 12/28/2022]
Abstract
Abnormal gamma oscillations, measured by electroencephalography (EEG), have been associated with chronic psychotic disorders, but their prevalence in the early phase of psychosis is less clear. We sought to address this by systematically reviewing the relevant literature. We searched for EEG studies of gamma band oscillations in subjects at high risk for psychosis and in patients with first episode psychosis. The following measures of gamma oscillations were extracted: resting power, evoked power, induced power, connectivity and peak frequency. Forty-five studies with a total of 3099 participants were included. There were potential sources of bias in the study designs and potential artefacts. Although there were few consistent findings, several studies reported decreased evoked or induced power in both high risk subjects and first episode patients. Studies using larger samples with serial EEG measurements, and designs that minimise artefacts that occur at the gamma frequency may advance work in this area.
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Affiliation(s)
- Thomas J Reilly
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Judith F Nottage
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Grazia Rutigliano
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK; Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Andrea I De Micheli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
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Fusar-Poli P, De Micheli A, Cappucciati M, Rutigliano G, Davies C, Ramella-Cravaro V, Oliver D, Bonoldi I, Rocchetti M, Gavaghan L, Patel R, McGuire P. Diagnostic and Prognostic Significance of DSM-5 Attenuated Psychosis Syndrome in Services for Individuals at Ultra High Risk for Psychosis. Schizophr Bull 2018; 44:264-275. [PMID: 28521060 PMCID: PMC5814820 DOI: 10.1093/schbul/sbx055] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The diagnostic and prognostic significance of the DSM-5-defined Attenuated Psychosis Syndrome (DSM-5-APS) in individuals undergoing an ultra high risk (UHR) clinical assessment for suspicion of psychosis risk is unknown. METHODS Prospective cohort study including all consecutive help-seeking individuals undergoing both a DSM-5-APS and a Comprehensive Assessment of At Risk Mental States (CAARMS 12/2006) assessment for psychosis risk at the Outreach and Support in South London (OASIS) UHR service (March 2013-April 2014). The diagnostic significance of DSM-5-APS was assessed with percent overall agreement, prevalence bias adjusted kappa, Bowker's test, Stuart-Maxwell test, residual analysis; the prognostic significance with Cox regression, Kaplan-Meier failure function, time-dependent area under the curve (AUC) and net benefits analysis. The impact of specific revisions of the DSM-5-APS was further tested. RESULT In 203 help-seeking individuals undergoing UHR assessment, the agreement between the DSM-5-APS and the CAARMS 12/2006 was only moderate (kappa 0.59). Among 142 nonpsychotic cases, those meeting DSM-5-APS criteria had a 5-fold probability (HR = 5.379) of developing psychosis compared to those not meeting DSM-5-APS criteria, with a 21-month cumulative risk of psychosis of 28.17% vs 6.49%, respectively. The DSM-5-APS prognostic accuracy was acceptable (AUC 0.76 at 24 months) and similar to the CAARMS 12/2006. The DSM-5-APS designation may be clinically useful to guide the provision of indicated interventions within a 7%-35% (2-year) range of psychosis risk. The removal of the criterion E or C of the DSM-5-APS may improve its prognostic performance and transdiagnostic value. CONCLUSIONS The DSM-5-APS designation may be clinically useful in individuals accessing clinical services for psychosis prevention.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK,OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK,To whom correspondence should be addressed; Department of Psychosis Studies, King’s College London, Institute of Psychiatry Psychology and Neuroscience, London SE5 8AF, UK; tel: +44-0-20-7848-0900, fax: +44-0-20-7848-0976, e-mail:
| | - Andrea De Micheli
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK,OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Marco Cappucciati
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK,OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Grazia Rutigliano
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK,OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Cathy Davies
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Valentina Ramella-Cravaro
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK,OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Dominic Oliver
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Ilaria Bonoldi
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK,OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Matteo Rocchetti
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK,OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Lauren Gavaghan
- OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Rashmi Patel
- OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK,Department of Psychosis Studies, King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Philip McGuire
- OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK,Department of Psychosis Studies, King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
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Abstract
TAAR1 is widely expressed across the mammalian brain, particularly in limbic and monoaminergic areas, allegedly involved in mood, attention, memory, fear, and addiction. However, the subcellular distribution of TAAR1 is still unclear, since TAAR1 signal is largely intracellular. In vitro, TAAR1 is activated with nanomolar to micromolar affinity by some endogenous amines, particularly p-tyramine, beta-phenylethylamine, and 3-iodothyronamine (T1AM), the latter representing a novel branch of thyroid hormone signaling. In addition, TAAR1 responds to a number of psychoactive drugs, i.e., amphetamines, ergoline derivatives, bromocriptine and lisuride. Trace amines have been identified as neurotransmitters in invertebrates, and they are considered as potential neuromodulators. In particular, beta-phenylethylamine and p-tyramine have been reported to modify the release and/or the response to dopamine, norepinephrine, acetylcholine and GABA, while evidence of cross-talk between TAAR1 and other aminergic receptors has been provided. Systemic or intracerebroventricular injection of exogenous T1AM produced prolearning and antiamnestic effects, reduced pain threshold, decreased non-REM sleep, and modulated the firing rate of adrenergic neurons in locus coeruleus. However each of these substances may have additional molecular targets, and it is unclear whether their endogenous levels are sufficient to produce significant TAAR1 activation in vivo. TAAR1 knock out mice show a worse performance in anxiety and working memory tests, and they are more prone to develop ethanol addiction. They also show increased locomotor response to amphetamine, and decreased stereotypical responses induced by apomorphine. Notably, human genes for TAARs cluster on chromosome 6 at q23, within a region whose mutations have been reported to confer susceptibility to schizophrenia and bipolar disorder. For human TAAR1, around 200 non-synonymous and 400 synonymous single nucleotide polymorphisms have been identified, but their functional consequences have not been extensively investigated yet. In conclusion, the bulk of evidence points to a significant physiological role of TAAR1 in the modulation of central nervous system function and a potential pharmacological role of TAAR1 agonists in neurology and/or psychiatry. However, the specific effects of TAAR1 stimulation are still controversial, and many crucial issues require further investigation.
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Affiliation(s)
- Grazia Rutigliano
- Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Pisa, Italy.,Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Alice Accorroni
- Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Pisa, Italy.,Institute of Clinical Physiology, National Research Council, Pisa, Italy
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Abstract
Thyroid hormones (THs) have a major role in regulating cardiac function. Their classical mechanism of action is genomic. Recent findings have broadened our knowledge about the (patho)physiology of cardiac regulation by THs, to include non-genomic actions of THs and their metabolites (THM). This review provides an overview of classical and non-classical cardiac effects controlled by: i) iodothyronines (thyroxine, T4; 3,5,3'-triiodothyronine,T3; 3, 5-diiodothyronine, T2); ii) thyronamines (thyronamine, T0AM; 3-iodothyronamine, T1AM); and iii) iodothyroacetic acids (3, 5, 3', 5'-tetraiodothyroacetic acid, tetrac; 3, 5, 3'-triiodothyroacetic acid, triac; 3-iodothyroacetic acid, TA1). Whereas iodothyronines enhance both diastolic and systolic function and heart rate, thyronamines were observed to have negative inotropic and chronotropic effects and might function as a brake with respect to THs, although their physiological role is unclear. Moreover, thyronamines showed a cardioprotective effect at physiological concentrations. The cardiac effects of iodothyroacetic acids seem to be limited and need to be elucidated.
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Affiliation(s)
- Grazia Rutigliano
- Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy; National Research Council (CNR), Institute of Clinical Physiology (IFC), Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - Riccardo Zucchi
- Department of Pathology, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
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Demjaha A, Weinstein S, Stahl D, Day F, Valmaggia L, Rutigliano G, De Micheli A, Fusar-Poli P, McGuire P. Formal thought disorder in people at ultra-high risk of psychosis. BJPsych Open 2017; 3:165-170. [PMID: 28713586 PMCID: PMC5509964 DOI: 10.1192/bjpo.bp.116.004408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 06/12/2017] [Accepted: 06/19/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Formal thought disorder is a cardinal feature of psychosis. However, the extent to which formal thought disorder is evident in ultra-high-risk individuals and whether it is linked to the progression to psychosis remains unclear. AIMS Examine the severity of formal thought disorder in ultra-high-risk participants and its association with future psychosis. METHOD The Thought and Language Index (TLI) was used to assess 24 ultra-high-risk participants, 16 people with first-episode psychosis and 13 healthy controls. Ultra-high-risk individuals were followed up for a mean duration of 7 years (s.d.=1.5) to determine the relationship between formal thought disorder at baseline and transition to psychosis. RESULTS TLI scores were significantly greater in the ultra-high-risk group compared with the healthy control group (effect size (ES)=1.2), but lower than in people with first-episode psychosis (ES=0.8). Total and negative TLI scores were higher in ultra-high-risk individuals who developed psychosis, but this was not significant. Combining negative TLI scores with attenuated psychotic symptoms and basic symptoms predicted transition to psychosis (P=0.04; ES=1.04). CONCLUSIONS TLI is beneficial in evaluating formal thought disorder in ultra-high-risk participants, and complements existing instruments for the evaluation of psychopathology in this group. DECLARATION OF INTERESTS None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Arsime Demjaha
- , PhD, Department of Psychosis Studies, Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sara Weinstein
- , PhD, Boeing Vancouver Labs, Vancuver, British Columbia, Canada
| | - Daniel Stahl
- , PhD, Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Fern Day
- , PhD, Department of Psychosis Studies, Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Lucia Valmaggia
- , PhD, Department of Psychosis Studies, Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Grazia Rutigliano
- , MD, Department of Psychosis Studies, Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea De Micheli
- , MD, Department of Psychosis Studies, Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- , PhD, Department of Psychosis Studies, Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Philip McGuire
- , PhD, Department of Psychosis Studies, Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Fusar-Poli P, Rutigliano G, Stahl D, Davies C, Bonoldi I, Reilly T, McGuire P. Development and Validation of a Clinically Based Risk Calculator for the Transdiagnostic Prediction of Psychosis. JAMA Psychiatry 2017; 74:493-500. [PMID: 28355424 PMCID: PMC5470394 DOI: 10.1001/jamapsychiatry.2017.0284] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/08/2017] [Indexed: 12/23/2022]
Abstract
Importance The overall effect of At Risk Mental State (ARMS) services for the detection of individuals who will develop psychosis in secondary mental health care is undetermined. Objective To measure the proportion of individuals with a first episode of psychosis detected by ARMS services in secondary mental health services, and to develop and externally validate a practical web-based individualized risk calculator tool for the transdiagnostic prediction of psychosis in secondary mental health care. Design, Setting, and Participants Clinical register-based cohort study. Patients were drawn from electronic, real-world, real-time clinical records relating to 2008 to 2015 routine secondary mental health care in the South London and the Maudsley National Health Service Foundation Trust. The study included all patients receiving a first index diagnosis of nonorganic and nonpsychotic mental disorder within the South London and the Maudsley National Health Service Foundation Trust in the period between January 1, 2008, and December 31, 2015. Data analysis began on September 1, 2016. Main Outcomes and Measures Risk of development of nonorganic International Statistical Classification of Diseases and Related Health Problems, Tenth Revision psychotic disorders. Results A total of 91 199 patients receiving a first index diagnosis of nonorganic and nonpsychotic mental disorder within South London and the Maudsley National Health Service Foundation Trust were included in the derivation (n = 33 820) or external validation (n = 54 716) data sets. The mean age was 32.97 years, 50.88% were men, and 61.05% were white race/ethnicity. The mean follow-up was 1588 days. The overall 6-year risk of psychosis in secondary mental health care was 3.02 (95% CI, 2.88-3.15), which is higher than the 6-year risk in the local general population (0.62). Compared with the ARMS designation, all of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses showed a lower risk of psychosis, with the exception of bipolar mood disorders (similar risk) and brief psychotic episodes (higher risk). The ARMS designation accounted only for a small proportion of transitions to psychosis (n = 52 of 1001; 5.19% in the derivation data set), indicating the need for transdiagnostic prediction of psychosis in secondary mental health care. A prognostic risk stratification model based on preselected variables, including index diagnosis, age, sex, age by sex, and race/ethnicity, was developed and externally validated, showing good performance and potential clinical usefulness. Conclusions and Relevance This online individualized risk calculator can be of clinical usefulness for the transdiagnostic prediction of psychosis in secondary mental health care. The risk calculator can help to identify those patients at risk of developing psychosis who require an ARMS assessment and specialized care. The use of this calculator may eventually facilitate the implementation of an individualized provision of preventive focused interventions and improve outcomes of first episode psychosis.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
- Outreach and Support in South London Service, South London and the Maudsley National Health Service Foundation Trust, London, England
- National Institute for Health Research Biomedical Research Centre for Mental Health, IoPPN, King’s College London, London, England
| | - Grazia Rutigliano
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Daniel Stahl
- National Institute for Health Research Biomedical Research Centre for Mental Health, IoPPN, King’s College London, London, England
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, England
| | - Cathy Davies
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Ilaria Bonoldi
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
- Outreach and Support in South London Service, South London and the Maudsley National Health Service Foundation Trust, London, England
| | - Thomas Reilly
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, England
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Schmidt A, Cappucciati M, Radua J, Rutigliano G, Rocchetti M, Dell’Osso L, Politi P, Borgwardt S, Reilly T, Valmaggia L, McGuire P, Fusar-Poli P. Improving Prognostic Accuracy in Subjects at Clinical High Risk for Psychosis: Systematic Review of Predictive Models and Meta-analytical Sequential Testing Simulation. Schizophr Bull 2017; 43:375-388. [PMID: 27535081 PMCID: PMC5605272 DOI: 10.1093/schbul/sbw098] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Discriminating subjects at clinical high risk (CHR) for psychosis who will develop psychosis from those who will not is a prerequisite for preventive treatments. However, it is not yet possible to make any personalized prediction of psychosis onset relying only on the initial clinical baseline assessment. Here, we first present a systematic review of prognostic accuracy parameters of predictive modeling studies using clinical, biological, neurocognitive, environmental, and combinations of predictors. In a second step, we performed statistical simulations to test different probabilistic sequential 3-stage testing strategies aimed at improving prognostic accuracy on top of the clinical baseline assessment. The systematic review revealed that the best environmental predictive model yielded a modest positive predictive value (PPV) (63%). Conversely, the best predictive models in other domains (clinical, biological, neurocognitive, and combined models) yielded PPVs of above 82%. Using only data from validated models, 3-stage simulations showed that the highest PPV was achieved by sequentially using a combined (clinical + electroencephalography), then structural magnetic resonance imaging and then a blood markers model. Specifically, PPV was estimated to be 98% (number needed to treat, NNT = 2) for an individual with 3 positive sequential tests, 71%-82% (NNT = 3) with 2 positive tests, 12%-21% (NNT = 11-18) with 1 positive test, and 1% (NNT = 219) for an individual with no positive tests. This work suggests that sequentially testing CHR subjects with predictive models across multiple domains may substantially improve psychosis prediction following the initial CHR assessment. Multistage sequential testing may allow individual risk stratification of CHR individuals and optimize the prediction of psychosis.
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Affiliation(s)
- André Schmidt
- Department of Psychosis Studies PO63, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Marco Cappucciati
- Department of Psychosis Studies PO63, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Joaquim Radua
- Department of Psychosis Studies PO63, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,FIDMAG Germanes Hospitalàries, CIBERSAM, Barcelona, Spain;,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Grazia Rutigliano
- Department of Psychosis Studies PO63, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Matteo Rocchetti
- Department of Psychosis Studies PO63, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Stefan Borgwardt
- Department of Psychosis Studies PO63, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Thomas Reilly
- Department of Psychosis Studies PO63, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Lucia Valmaggia
- Department of Psychosis Studies PO63, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies PO63, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,OASIS Team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Paolo Fusar-Poli
- Department of Psychosis Studies PO63, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,OASIS Team, South London and the Maudsley NHS Foundation Trust, London, UK
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Fusar-Poli P, Cappucciati M, De Micheli A, Rutigliano G, Bonoldi I, Tognin S, Ramella-Cravaro V, Castagnini A, McGuire P. Diagnostic and Prognostic Significance of Brief Limited Intermittent Psychotic Symptoms (BLIPS) in Individuals at Ultra High Risk. Schizophr Bull 2017; 43:48-56. [PMID: 28053130 PMCID: PMC5216865 DOI: 10.1093/schbul/sbw151] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Brief Limited Intermittent Psychotic Symptoms (BLIPS) are key inclusion criteria to define individuals at ultra high risk for psychosis (UHR). Their diagnostic and prognostic significance is unclear. OBJECTIVES To address the baseline diagnostic relationship between BLIPS and the ICD-10 categories and examine the longitudinal prognostic impact of clinical and sociodemographic factors. METHODS Prospective long-term study in UHR individuals meeting BLIPS criteria. Sociodemographic and clinical data, including ICD-10 diagnoses, were automatically drawn from electronic health records and analyzed using Kaplan-Meier failure function (1-survival), Cox regression models, bootstrapping methods, and Receiver Operating Characteristics (ROC) curve. RESULTS Eighty BLIPS were included. At baseline, two-thirds (68%) of BLIPS met the diagnostic criteria for ICD-10 Acute and Transient Psychotic Disorder (ATPD), most featuring schizophrenic symptoms. The remaining individuals met ICD-10 diagnostic criteria for unspecified nonorganic psychosis (15%), mental and behavioral disorders due to use of cannabinoids (11%), and mania with psychotic symptoms (6%). The overall 5-year risk of psychosis was 0.54. Recurrent episodes of BLIPS were relatively rare (11%) but associated with a higher risk of psychosis (hazard ratio [HR] 3.98) than mono-episodic BLIPS at the univariate analysis. Multivariate analysis revealed that seriously disorganizing or dangerous features increased greatly (HR = 4.39) the risk of psychosis (0.89 at 5-year). Bootstrapping confirmed the robustness of this predictor (area under the ROC = 0.74). CONCLUSIONS BLIPS are most likely to fulfill the ATPD criteria, mainly acute schizophrenic subtypes. About half of BLIPS cases develops a psychotic disorder during follow-up. Recurrent BLIPS are relatively rare but tend to develop into psychosis. BLIPS with seriously disorganizing or dangerous features have an extreme high risk of psychosis.
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Affiliation(s)
- Paolo Fusar-Poli
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; .,OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Marco Cappucciati
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Andrea De Micheli
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Grazia Rutigliano
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ilaria Bonoldi
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Stefania Tognin
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Valentina Ramella-Cravaro
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Department of Neurofarba, University of Florence, Florence, Italy
| | - Augusto Castagnini
- Postgraduate School of Child Neuropsychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | - Philip McGuire
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Fusar-Poli P, Rutigliano G, Stahl D, Schmidt A, Ramella-Cravaro V, Hitesh S, McGuire P. Deconstructing Pretest Risk Enrichment to Optimize Prediction of Psychosis in Individuals at Clinical High Risk. JAMA Psychiatry 2016; 73:1260-1267. [PMID: 27784037 DOI: 10.1001/jamapsychiatry.2016.2707] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Pretest risk estimation is routinely used in clinical medicine to inform further diagnostic testing in individuals with suspected diseases. To our knowledge, the overall characteristics and specific determinants of pretest risk of psychosis onset in individuals undergoing clinical high risk (CHR) assessment are unknown. OBJECTIVES To investigate the characteristics and determinants of pretest risk of psychosis onset in individuals undergoing CHR assessment and to develop and externally validate a pretest risk stratification model. DESIGN, SETTING, AND PARTICIPANTS Clinical register-based cohort study. Individuals were drawn from electronic, real-world, real-time clinical records relating to routine mental health care of CHR services in South London and the Maudsley National Health Service Trust in London, United Kingdom. The study included nonpsychotic individuals referred on suspicion of psychosis risk and assessed by the Outreach and Support in South London CHR service from 2002 to 2015. Model development and validation was performed with machine-learning methods based on Least Absolute Shrinkage and Selection Operator for Cox proportional hazards model. MAIN OUTCOMES AND MEASURES Pretest risk of psychosis onset in individuals undergoing CHR assessment. Predictors included age, sex, age × sex interaction, race/ethnicity, socioeconomic status, marital status, referral source, and referral year. RESULTS A total of 710 nonpsychotic individuals undergoing CHR assessment were included. The mean age was 23 years. Three hundred ninety-nine individuals were men (56%), their race/ethnicity was heterogenous, and they were referred from a variety of sources. The cumulative 6-year pretest risk of psychosis was 14.55% (95% CI, 11.71% to 17.99%), confirming substantial pretest risk enrichment during the recruitment of individuals undergoing CHR assessment. Race/ethnicity and source of referral were associated with pretest risk enrichment. The predictive model based on these factors was externally validated, showing moderately good discrimination and sufficient calibration. It was used to stratify individuals undergoing CHR assessment into 4 classes of pretest risk (6-year): low, 3.39% (95% CI, 0.96% to 11.56%); moderately low, 11.58% (95% CI, 8.10% to 16.40%); moderately high, 23.69% (95% CI, 16.58% to 33.20%); and high, 53.65% (95% CI, 36.78% to 72.46%). CONCLUSIONS AND RELEVANCE Significant risk enrichment occurs before individuals are assessed for a suspected CHR state. Race/ethnicity and source of referral are associated with pretest risk enrichment in individuals undergoing CHR assessment. A stratification model can identify individuals at differential pretest risk of psychosis. Identification of these subgroups may inform outreach campaigns and subsequent testing and eventually optimize psychosis prediction.
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Affiliation(s)
- Paolo Fusar-Poli
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom2Outreach and Support in South London service, South London and the Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Grazia Rutigliano
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom3Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Daniel Stahl
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
| | - André Schmidt
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
| | - Valentina Ramella-Cravaro
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom4Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Shetty Hitesh
- South London and the Maudsley National Health Service Foundation Trust, Biomedical Research Centre Nucleus, London, United Kingdom
| | - Philip McGuire
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
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Fusar-Poli P, Cappucciati M, Rutigliano G, Heslin M, Stahl D, Brittenden Z, Caverzasi E, McGuire P, Carpenter WT. Diagnostic Stability of ICD/DSM First Episode Psychosis Diagnoses: Meta-analysis. Schizophr Bull 2016; 42:1395-1406. [PMID: 26980142 PMCID: PMC5049518 DOI: 10.1093/schbul/sbw020] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Validity of current International Classification of Disease/Diagnostic and Statistical Manual of Mental Disorders (ICD/DSM) first episode psychosis diagnoses is essential in clinical practice, research, training and public health. METHOD We provide a meta-analytical estimate of prospective diagnostic stability and instability in ICD-10 or DSM-IV first episode diagnoses of functional psychoses. Independent extraction by multiple observers. Random effect meta-analysis conducted with the "metaprop," "metaninf," "metafunnel," "metabias," and "metareg" packages of STATA13.1. Moderators were tested with meta-regression analyses. Heterogeneity was assessed with the I 2 index. Sensitivity analyses tested robustness of results. Publication biases were assessed with funnel plots and Egger's test. FINDINGS 42 studies and 45 samples were included, for a total of 14 484 first episode patients and an average follow-up of 4.5 years. Prospective diagnostic stability ranked: schizophrenia 0.90 (95% CI 0.85-0.95), affective spectrum psychoses 0.84 (95% CI 0.79-0.89), schizoaffective disorder 0.72 (95% CI 0.61-0.73), substance-induced psychotic disorder 0.66 (95% CI 0.51-0.81), delusional disorder 0.59 (95% CI 0.47-0.71), acute and transient psychotic disorder/brief psychotic disorder 0.56 (95% CI 0.62-0.60), psychosis not otherwise specified 0.36 (95% CI 0.27-0.45, schizophreniform disorder 0.29 (95% CI 0.22-0.38). Diagnostic stability within schizophrenia spectrum psychoses was 0.93 (95% CI 0.89-0.97); changes to affective spectrum psychoses were 0.05 (95% CI 0.01-0.08). About 0.10 (95% CI 0.05-0.15) of affective spectrum psychoses changed to schizophrenia spectrum psychosis. Across the other psychotic diagnoses there was high diagnostic instability, mostly to schizophrenia. INTERPRETATION There is meta-analytical evidence for high prospective diagnostic stability in schizophrenia spectrum and affective spectrum psychoses, with no significant ICD/DSM differences. These results may inform the development of new treatment guidelines for early psychosis and impact drug licensing from regulatory agencies.
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Affiliation(s)
- Paolo Fusar-Poli
- Institute of Psychiatry Psychology Neuroscience, King’s College London, London, UK;,OASIS Clinic, SLaM NHS Foundation Trust, London, UK;,*To whom correspondence should be addressed; Department of Psychosis Studies, Institute of Psychiatry, PO63, De Crespigny Park, SE58AF London, UK; tel: 20-7848-0900, fax: 207-848-0976, e-mail:
| | - Marco Cappucciati
- Institute of Psychiatry Psychology Neuroscience, King’s College London, London, UK;,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Grazia Rutigliano
- Institute of Psychiatry Psychology Neuroscience, King’s College London, London, UK;,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Margaret Heslin
- Institute of Psychiatry Psychology Neuroscience, King’s College London, London, UK
| | - Daniel Stahl
- Institute of Psychiatry Psychology Neuroscience, King’s College London, London, UK
| | - Zera Brittenden
- Institute of Psychiatry Psychology Neuroscience, King’s College London, London, UK
| | - Edgardo Caverzasi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Philip McGuire
- Institute of Psychiatry Psychology Neuroscience, King’s College London, London, UK
| | - William T. Carpenter
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, and VA Capitol Network (VISN 5) MIRECC, Baltimore, MD
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Rutigliano G, Valmaggia L, Landi P, Frascarelli M, Cappucciati M, Sear V, Rocchetti M, De Micheli A, Jones C, Palombini E, McGuire P, Fusar-Poli P. Persistence or recurrence of non-psychotic comorbid mental disorders associated with 6-year poor functional outcomes in patients at ultra high risk for psychosis. J Affect Disord 2016; 203:101-110. [PMID: 27285723 DOI: 10.1016/j.jad.2016.05.053] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 04/11/2016] [Accepted: 05/22/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patients at ultra-high risk for psychosis (UHR) are a highly heterogeneous group in terms of clinical and functional outcomes. Several non-psychotic mental disorders co-occur together with the UHR state. Little is known about the impact of non-psychotic comorbid mental disorders on clinical and functional outcomes of UHR patients. METHODS The sample included 154 UHR help-seeking patients (identified with the CAARMS, comprehensive assessment of the at-risk mental state), evaluated at baseline on the Ham-D, Ham-A (Hamilton depression/anxiety rating scale), and PANSS (positive and negative syndrome scale). 74 patients completed the 6-year follow-up assessment (mean=6.19, SD=1.87). Comorbid disorders at follow-up were assessed with the SCID I and II. Global functioning was rated on the global assessment of functioning (GAF) scale. RESULTS In the present sample, 6-year risk of psychosis transition was 28.4%. Among non-transitioned UHR patients, 28.3% reported attenuated psychotic symptoms (APS) and 45.3% remained functionally impaired at follow-up (GAF<60). 56.8% patients were affected by at least one comorbid disorder at follow-up. Among UHR patients who presented with some comorbid disorder at baseline, 61.5% had persistent or recurrent course. Incident comorbid disorders emerged in 45.4% of baseline UHR patients. The persistence or recurrence of non-psychotic comorbid mental disorders was associated with poorer global functional outcomes at follow-up. LIMITATIONS A substantial proportion of the initial sample was not available for follow-up interviews and some groups in the analyses had small sample size. Predictors of longitudinal outcomes were not explored. CONCLUSIONS Among UHR patients, persistence or recurrence of non-psychotic comorbid mental disorders, mostly affective disorders, is associated with 6-year poor functional outcomes.
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Affiliation(s)
- Grazia Rutigliano
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lucia Valmaggia
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | - Paola Landi
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marianna Frascarelli
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Marco Cappucciati
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Victoria Sear
- OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | - Matteo Rocchetti
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Andrea De Micheli
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ceri Jones
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Erika Palombini
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Philip McGuire
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | - Paolo Fusar-Poli
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.
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Rutigliano G, Rocchetti M, Paloyelis Y, Gilleen J, Sardella A, Cappucciati M, Palombini E, Dell'Osso L, Caverzasi E, Politi P, McGuire P, Fusar-Poli P. Peripheral oxytocin and vasopressin: Biomarkers of psychiatric disorders? A comprehensive systematic review and preliminary meta-analysis. Psychiatry Res 2016; 241:207-20. [PMID: 27183106 DOI: 10.1016/j.psychres.2016.04.117] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 11/29/2022]
Abstract
A large array of studies have investigated peripheral oxytocin (OT) and vasopressin (ADH) as potential biomarkers of psychiatric disorders, with highly conflicting and heterogenous findings. We searched Web of KnowledgeSM and Scopus® for English original articles investigating OT and/or ADH levels in different biological fluids (plasma/serum, saliva, urine and cerebrospinal fluid) across several psychiatric disorders. Sixty-four studies were included. We conducted 19 preliminary meta-analyses addressing OT alterations in plasma/serum, saliva, urine and cerebrospinal fluid of 7 psychiatric disorders and ADH alterations in plasma/serum, saliva, urine and cerebrospinal fluid of 6 psychiatric disorders compared to controls. Hedge's g was used as effect size measure, together with heterogeneity analyses, test of publication biases and quality control. None of them (except serum OT in anorexia nervosa) revealed significant differences. There is no convincing evidence that peripheral ADH or OT might be reliable biomarkers in psychiatric disorders. However, the lack of significant results was associated with high methodological heterogeneity, low quality of the studies, small sample size, and scarce reliability of the methods used in previous studies, which need to be validated and standardized.
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Affiliation(s)
- Grazia Rutigliano
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK; Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67-56126 Pisa, Italy
| | - Matteo Rocchetti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Yannis Paloyelis
- Neuroimaging Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO89, De Crespigny Park, SE58AF London, UK
| | - James Gilleen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK; Department of Psychology, University of Roehampton, UK
| | - Alberto Sardella
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK
| | - Marco Cappucciati
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Erika Palombini
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67-56126 Pisa, Italy
| | - Edgardo Caverzasi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK; OASIS clinic, SLaM NHS Foundation Trust, 190 Kennington Lane, SE11 5DL London, UK.
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Abstract
Self-disorders (SDs) (from the German Ichstörungen) are alterations of the first-person perspective, long associated with schizophrenia, particularly in early phases. Although psychopathological features of SDs continue to be studied, their neurobiological underpinnings are unknown. This makes it difficult to integrate SDs into contemporary models of psychosis. The present review aims to address this issue, starting from an historical excursus revealing an interconnection between neuroscientific models and the origin of the psychopathological concept of SDs. Subsequently, the more recent neurobiological models related to SDs are discussed, particularly with respect to the onset of schizophrenia.
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Affiliation(s)
- A. Mishara
- Department of Clinical Psychology, Chicago School of Professional Psychology, Southern California Campus, Los Angeles, CA;,Joint first authors
| | - I. Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College of London, London, UK;,OASIS service, South London and the Maudsley NHS Foundation Trust, London, UK;,Department of Brain and Behavioural Sciences, University of Pavia, Italy;,*To whom correspondence should be addressed; Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College of London, PO Box 63, 16 De Crespigny Park, London SE5 8AF, UK; tel: 020-7848-0801; fax: 020-7848-0976; e-mail:
| | - P. Allen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College of London, London, UK;,Department of Psychology, University of Roehampton, Whitgelands College, London, UK
| | - G. Rutigliano
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College of London, London, UK;,Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - J. Perez
- CAMEO Early Intervention Services, Fulbourn Hospital, Fulbourn, Cambridge, UK;,Department of Psychiatry, Cambridge University, Cambridge, UK
| | - P. Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College of London, London, UK;,OASIS service, South London and the Maudsley NHS Foundation Trust, London, UK;,Department of Brain and Behavioural Sciences, University of Pavia, Italy;,Joint last authors
| | - P. McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College of London, London, UK;,Joint last authors
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Fusar-Poli P, Schultze-Lutter F, Cappucciati M, Rutigliano G, Bonoldi I, Stahl D, Borgwardt S, Riecher-Rössler A, Addington J, Perkins DO, Woods SW, McGlashan T, Lee J, Klosterkötter J, Yung AR, McGuire P. The Dark Side of the Moon: Meta-analytical Impact of Recruitment Strategies on Risk Enrichment in the Clinical High Risk State for Psychosis. Schizophr Bull 2016; 42:732-43. [PMID: 26591006 PMCID: PMC4838090 DOI: 10.1093/schbul/sbv162] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The individual risk of developing psychosis after being tested for clinical high-risk (CHR) criteria (posttest risk of psychosis) depends on the underlying risk of the disease of the population from which the person is selected (pretest risk of psychosis), and thus on recruitment strategies. Yet, the impact of recruitment strategies on pretest risk of psychosis is unknown. METHODS Meta-analysis of the pretest risk of psychosis in help-seeking patients selected to undergo CHR assessment: total transitions to psychosis over the pool of patients assessed for potential risk and deemed at risk (CHR+) or not at risk (CHR-). Recruitment strategies (number of outreach activities per study, main target of outreach campaign, and proportion of self-referrals) were the moderators examined in meta-regressions. RESULTS 11 independent studies met the inclusion criteria, for a total of 2519 (CHR+: n = 1359; CHR-: n = 1160) help-seeking patients undergoing CHR assessment (mean follow-up: 38 months). The overall meta-analytical pretest risk for psychosis in help-seeking patients was 15%, with high heterogeneity (95% CI: 9%-24%, I (2) = 96, P < .001). Recruitment strategies were heterogeneous and opportunistic. Heterogeneity was largely explained by intensive (n = 11, β = -.166, Q = 9.441, P = .002) outreach campaigns primarily targeting the general public (n = 11, β = -1.15, Q = 21.35, P < .001) along with higher proportions of self-referrals (n = 10, β = -.029, Q = 4.262, P = .039), which diluted pretest risk for psychosis in patients undergoing CHR assessment. CONCLUSIONS There is meta-analytical evidence for overall risk enrichment (pretest risk for psychosis at 38 monhts = 15%) in help-seeking samples selected for CHR assessment as compared to the general population (pretest risk of psychosis at 38 monhts=0.1%). Intensive outreach campaigns predominantly targeting the general population and a higher proportion of self-referrals diluted the pretest risk for psychosis.
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Affiliation(s)
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, Department of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Marco Cappucciati
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Grazia Rutigliano
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry Psychology and Neuroscience, King's College London, London UK
| | - Stephan Borgwardt
- Department of Psychiatry (UPK), University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Anita Riecher-Rössler
- Department of Psychiatry (UPK), University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT
| | | | - Jimmy Lee
- Department of General Psychiatry, Institute of Mental Health, Singapore, Singapore
| | | | - Alison R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Philip McGuire
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
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50
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Fusar-Poli P, Cappucciati M, Bonoldi I, Hui LMC, Rutigliano G, Stahl DR, Borgwardt S, Politi P, Mishara AL, Lawrie SM, Carpenter WT, McGuire PK. Prognosis of Brief Psychotic Episodes: A Meta-analysis. JAMA Psychiatry 2016; 73:211-20. [PMID: 26764163 DOI: 10.1001/jamapsychiatry.2015.2313] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The prognostic significance of competing constructs and operationalizations for brief psychotic episodes (acute and transient psychotic disorder [ATPD], brief psychotic disorder [BPD], brief intermittent psychotic symptoms [BIPS], and brief limited intermittent psychotic symptoms [BLIPS]) is unknown. OBJECTIVE To provide a meta-analytical prognosis of the risk of psychotic recurrence in patients with remitted first-episode ATPD, BPD, BIPS, and BLIPS and in a benchmark group of patients with remitted first-episode schizophrenia (FES). We hypothesized a differential risk: FES > ATPD > BPD > BIPS > BLIPS. DATA SOURCES The Web of Knowledge and Scopus databases were searched up to May 18, 2015; the articles identified were reviewed as well as citations of previous publications and results of a manual search of the reference lists of retrieved articles. STUDY SELECTION We included original articles that reported the risk of psychotic recurrence at follow-up for patients in remission from first-episode ATPD, BPD, BLIPS, BIPS, and FES. DATA EXTRACTION AND SYNTHESIS Independent extraction by multiple observers. Random-effects meta-analysis was performed, and moderators were tested with meta-regression analyses, Bonferroni corrected. Heterogeneity was assessed with the I2 index. Sensitivity analyses tested the robustness of the results. Publication bias was assessed with funnel plots and the Egger test. MAIN OUTCOMES AND MEASURES Proportion of patients with baseline ATPD, BPD, BLIPS, and BIPS who had any psychotic recurrence at 6, 12, 24, and 36 or more months of follow-up. RESULTS Eighty-two independent studies comprising up to 11,133 patients were included. There was no prognostic difference in risk of psychotic recurrence between ATPD, BPD, BLIPS, and BIPS at any follow-up (P > .03). In the long-term analysis, risk of psychotic recurrence (reported as mean [95% CI]) was significantly higher in the FES group (0.78 [0.58-0.93] at 24 months and 0.84 [0.70-0.94] at ≥ 36 months; P < .02 and P < .001, respectively) compared with the other 4 groups (0.39 [0.32-0.47] at 24 months and 0.51 [0.41-0.61] at ≥ 36 months). There were no publication biases. Sex and exposure to antipsychotic medication modulated the meta-analytical estimates (.002 < P < .03). CONCLUSIONS AND RELEVANCE There are no prognostic differences in risk of psychotic recurrence between ATPD, BPD, BLIPS, and BIPS constructs of brief psychotic episodes. Conversely, there is consistent meta-analytical evidence for better long-term prognosis of brief psychotic episodes compared with remitted first-episode schizophrenia. These findings should influence the diagnostic practice and clinical services in the management of early psychosis.
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Affiliation(s)
- Paolo Fusar-Poli
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, England2OASIS Service, South London and the Maudsley National Health Service Foundation Trust, London, England3Department of Brain and Behavioral Sciences, University
| | - Marco Cappucciati
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, England3Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ilaria Bonoldi
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, England3Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - L M Christy Hui
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Grazia Rutigliano
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, England
| | - Daniel R Stahl
- Department of Biostatistics, King's College London, Institute of Psychiatry, London, England
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Aaron L Mishara
- Department of Clinical Psychology, Chicago School of Professional Psychology, Southern California Campus, Los Angeles, California
| | - Stephen M Lawrie
- Division of Psychiatry, University of Edinburgh, Edinburgh, Scotland
| | - William T Carpenter
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore10Veterans Affairs Capitol Health Care Network, Mental Illness Research, Education, and Clinical Center, Veterans Integrated Service Network, Baltimore, Maryland
| | - Philip K McGuire
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, England
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