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Luykx JJ, van Duijn E, Geerdinck B, Burgers E, Kremer HPH, Veenhuizen R. [The value of re-evaluation and thorough family history taking for the diagnostic work-up of chorea]. Tijdschr Psychiatr 2024; 66:51-54. [PMID: 38380489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
The differential diagnosis of chorea encompasses a broad range of disorders. In psychiatry, tardive dyskinesia may be difficult to discern from other causes, particularly when the family history is negative. A 59-year-old man with an unclear medical history had been using risperidone for over a decade when we first saw him. He presented with severe dyskinesia in all extremities. The family history for neuropsychiatric disorders was negative. We interpreted the movement disorder as tardive dyskinesia, but later he turned out to suffer from Huntington’s disease. To improve diagnostic accuracy, we should have more frequently re-evaluated the differential diagnosis and our family history should have been more thorough. We outline the diagnostic considerations in patients presenting with chorea. Finally, we highlight the value of diagnostic re-evaluation and thorough family history taking to optimize diagnostic accuracy in neuropsychiatry.
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de Boer N, Vermeulen J, Lin B, van Os J, ten Have M, de Graaf R, van Dorsselaer S, Bak M, Rutten B, Batalla A, Guloksuz S, Luykx JJ. Longitudinal associations between alcohol use, smoking, genetic risk scoring and symptoms of depression in the general population: a prospective 6-year cohort study. Psychol Med 2023; 53:1409-1417. [PMID: 35023464 PMCID: PMC10009403 DOI: 10.1017/s0033291721002968] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/28/2021] [Accepted: 07/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Alcohol consumption, smoking and mood disorders are leading contributors to the global burden of disease and are highly comorbid. Yet, their interrelationships have remained elusive. The aim of this study was to examine the multi-cross-sectional and longitudinal associations between (change in) smoking and alcohol use and (change in) number of depressive symptoms. METHODS In this prospective, longitudinal study, 6646 adults from the general population were included with follow-up measurements after 3 and 6 years. Linear mixed-effects models were used to test multi-cross-sectional and longitudinal associations, with smoking behaviour, alcohol use and genetic risk scores for smoking and alcohol use as independent variables and depressive symptoms as dependent variables. RESULTS In the multi-cross-sectional analysis, smoking status and number of cigarettes per day were positively associated with depressive symptoms (p < 0.001). Moderate drinking was associated with less symptoms of depression compared to non-use (p = 0.011). Longitudinally, decreases in the numbers of cigarettes per day and alcoholic drinks per week as well as alcohol cessation were associated with a reduction of depressive symptoms (p = 0.001-0.028). Results of genetic risk score analyses aligned with these findings. CONCLUSIONS While cross-sectionally smoking and moderate alcohol use show opposing associations with depressive symptoms, decreases in smoking behaviour as well as alcohol consumption are associated with improvements in depressive symptoms over time. Although we cannot infer causality, these results open avenues to further investigate interventions targeting smoking and alcohol behaviours in people suffering from depressive symptoms.
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Affiliation(s)
- N. de Boer
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J. Vermeulen
- Department of Psychiatry, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - B. Lin
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J. van Os
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M. ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - R. de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - S. van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - M. Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- FACT, Mondriaan Mental Health, Maastricht, The Netherlands
| | - B. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A. Batalla
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - S. Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - J. J. Luykx
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- GGNet Mental Health, Apeldoorn, The Netherlands
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Okhuijsen-Pfeifer C, van der Horst MZ, Luykx JJ. [Towards personalized treatment with clozapine]. Tijdschr Psychiatr 2023; 65:107-112. [PMID: 36912056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Clozapine is the most effective treatment for people with treatment-resistant schizophrenia. However, it is prescribed less often than guidelines indicate. AIM To personalize clozapine treatment, we investigated the efficacy of clozapine as first- or second-line treatment and investigated whether there are factors that were associated with efficacy and side effects. METHOD We collected a unique cohort of over 800 clozapine users diagnosed with a schizophrenia spectrum disorder. We meta-analyzed factors that were associated with response during clozapine treatment. Additionally, we conducted genetic association analyses to investigate the relations between side effects and symptom severity during clozapinetreatment. RESULTS From our meta-analyses, we found that clozapine was more effective when used as a first- or second-line treatment. Furthermore, we found that younger age, less negative symptoms and the paranoid subtype of schizophreniawere associated with a better clozapine response. Several specific locations on genes (loci) were associated with clozapine-induced agranulocytosis and neutropenia, while polygenic risk scores were associated with symptom severity. CONCLUSION We found that clozapine could be effective earlier in treatment and identified factors that could aid the prediction of< response to clozapine treatment in the future. These finding could contribute to the start of a personalized clozapine treatment.
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Catthoor K, Luykx JJ, De Hert M, Niemegeers P, Peeters H, Krudop W, Van Den Broeck K, Detraux J. [Sustainability in Flemish and Dutch mental health care]. Tijdschr Psychiatr 2023; 65:329-333. [PMID: 37434571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
BACKGROUND The Flemish and Dutch (mental) health sectors cause greenhouse gas emissions and therefore will have to make an effort to reduce their climate impact. AIM To assess whether differences can be found in the climate policies of Flemish and Dutch mental health institutions. METHOD Descriptive research based on a sustainability questionnaire, in which concrete actions, objectives and ambitions in the field of sustainability were questioned at Flemish and Dutch mental health institutions. RESULTS 59% and 38% of respectively the Flemish and Dutch institutions fully agreed that sustainability is a very important theme (with a main focus on sustainable energy transition and recycling in both regions). Statistically significant differences between both regions were only found with regard to fostering more sustainable commuting (stronger in Flanders; p < 0.0001). The climate impact of medicines and food, as well as investments in sustainable projects, received little attention. CONCLUSION Although a substantial part of Flemish and Dutch mental health institutions consider sustainability (very) important, a systemic ‘transformation’ will be necessary to make them climate neutral.
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Zinkstok JR, van der Horst MZ, Wouters RPH, Aalfs CM, Luykx JJ. [Genetic risk of mental illness: what do we know and how do we communicate this?]. Tijdschr Psychiatr 2022; 64:266-272. [PMID: 35735035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Insights from psychiatric genetics research and large international psychiatric genetics consortia are promising but still remain outside the realm of clinical practice. <br> AIM: To provide an overview of developments in the field of psychiatric genetics; and to offer guidance for health professionals how to assess and manage clinical implications of these developments.<br> METHOD: In this review, we address: recent developments in psychiatric genetics, with a focus on polygenic risk scores (PRS); ethical dilemmas associated with clinical application of PRS; and basic principles of genetic counseling for psychiatric disorders.<br> RESULTS: PRS are not yet ready for implementation in clinical practice because of limited predictive value and poor generalizability. In addition, it is still unclear how genetic risk and PRS can be communicated clearly to patients and families.<br> CONCLUSION: Advances in psychiatric genetics and increased availability of genetic risk scores may lead to questions from patients and families coping with psychiatric illness. These questions may be best addressed using psychiatric genetic counseling techniques. We recommend that psychiatrists have some basic knowledge of psychiatric genetics and know how to refer their patients to a clinical geneticist. Implementing a psychiatric genetics theme in training and education may be helpful.<br>.
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Van Assche E, Van de Woestyne K, van Elburg AA, Birkenhäger TK, Luykx JJ, Zinkstok JR. [Psychiatrie en genetica: de lange weg van laboratorium naar spreekkamer]. Tijdschr Psychiatr 2022; 64:245-247. [PMID: 35735032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Van Assche E, Luykx JJ. [Relating the history of genetics to the field of psychiatric genetics: the discovery, reading and writing of DNA]. Tijdschr Psychiatr 2022; 64:256-259. [PMID: 35735033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The importance of genetics in psychiatry has been a topic of ongoing debate. The futile search for candidate genes underlying psychiatric disorders in the decades before 2007 resulted in overall disappointment. Since then, however, researchers and clinicians have witnessed the discovery of a plethora of common and rare genetic variants associated with psychiatric disorders.<br> AIM: To relate the history of general genetics to the history of psychiatric genetics, underlining how.<br> METHOD: Literature research.<br> RESULTS: The anatomical and physiological phases of this history have shaped the field of psychiatric genetics. We describe pivotal discoveries that have facilitated the uncovering, reading and writing of DNA. We then discuss several milestone discoveries in the field of psychiatric genetics. We end with an outlook on where the field of psychiatric genetics may be heading in the decades to come, arguing that a ‘clinical phase’ of psychiatric genetics may be ahead of us.<br> CONCLUSION: The research with a focus on polygenic risk scores (PRS) could be translated into clinical practice in the coming years and we expect more attention to the question of how genetic variants cause psychiatric disorders. We look to future developments with some optimism.<br>.
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Luykx JJ, Lungu M, Cornestean-Roman DM, Philip S, Őri D. [Frontline reporting: international mental health care perspectives on the invasion of Ukraine]. Tijdschr Psychiatr 2022; 64:190-192. [PMID: 35506969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Luykx JJ, Tijdink JK, Krudop WA. [Wat kunnen ggz-professionals doen om duurzaamheid te stimuleren?]. Tijdschr Psychiatr 2022; 64:340-343. [PMID: 35748142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Rutten BPF, Guloksuz S, Boks M, van Os J, Luykx JJ, van Winkel R. [Interplay between genetic background and environmental factors in psychiatry: current situation and future prospects]. Tijdschr Psychiatr 2022; 64:317-322. [PMID: 35735044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The hypothesis that etiopathogeneses of psychiatric disorders are determined by interplay between genetic background and environmental factors, as well their interactions can increasingly be put to direct scientific test, based on a wave of methodological, technological and knowledge developments.<br> AIM: To provide insight into and to provide perspective on some important scientific developments and facilitate challenges in this area.<br> METHOD: Narrative overview of the scientific literature and formulation of a concept and future perspective.<br> RESULTS: The overview points to concrete progress in the fields of genetic epidemiology, environmental analyses, gene-environment interactions and epigenetics in psychiatry. For example, recent studies have provided evidence for the existence of interactions and correlations between genetic and environmental factors, interdependence of risk-influencing effects of environmental factors, and translational neurobiological studies have identified biological processes that influence the impact of (or the response to) environmental influences on individuals mediate. These important steps to translate epidemiological research into testable biological hypotheses are facilitated by new techniques and the availability of large and relevant clinical and biological datasets.<br> CONCLUSION: Scientific progress on the interplay between genetic background and environmental factors enriches the conceptual framework of the etiopathogenesis of mental disorders and provides a future perspective in which we are likely to receive answers to a number of clinically relevant questions in the coming decade.<br>.
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van der Horst MZ, Aalfs CM, Vorstman JAS, Luykx JJ, Zinkstok JR. [Guidelines on genetic testing in psychiatry: an overview]. Tijdschr Psychiatr 2022; 64:278-285. [PMID: 35735037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND In recent years, technological advances have led to the identification of numerous genetic variations that are associated with psychiatric symptoms. Establishing a genetic cause may provide patients and family members with an explanation for the problems and in specific cases allows targeted treatment of psychiatric and somatic (co)morbidity. At present, patients with psychiatric disorders are rarely referred for genetic testing. AIM To provide an overview of literature and (inter)national guidelines in the field of genetic testing for patients with psychiatric disorder, and to present guidance on indications for genetic testing in clinical practice. METHOD A systematic search was conducted in PubMed and Embase focusing on articles with recommendations on genetic testing in psychiatric disorders. In addition, national and international guidelines on genetic testing in psychiatry were studied. The main findings were summarized in an infographic. RESULTS Based on the current literature and (inter)national guidelines, patients with (comorbid) intellectual disability should always be referred to a clinical geneticist. Psychiatrists should consider genetic testing in patients with other psychiatric disorders if there are ‘red flags’ such as a positive family history, congenital abnormalities, developmental delay, dysmorphic features, movement disorders or cognitive decline. Psychiatrists may request genetic testing themselves or refer patients to clinical geneticists. CONCLUSION Psychiatric disorders may be underpinned by a genetic anomaly, particularly in patients presenting with psychiatric as well as somatic symptomatology. Psychiatrists should recognize symptoms and warning signs indicative of an underlying genetic abnormality, and know when to refer their patients for genetic testing.
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Luykx JJ. [Prescribing antipsychotics rationally: the real world as a vital resource to tailor treatment]. Tijdschr Psychiatr 2022; 64:133-136. [PMID: 35420140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Abstract
Major depressive disorder (MDD) is a common, debilitating, phenotypically heterogeneous disorder with heritability ranges from 30% to 50%. Compared to other psychiatric disorders, its high prevalence, moderate heritability, and strong polygenicity have posed major challenges for gene-mapping in MDD. Studies of common genetic variation in MDD, driven by large international collaborations such as the Psychiatric Genomics Consortium, have confirmed the highly polygenic nature of the disorder and implicated over 100 genetic risk loci to date. Rare copy number variants associated with MDD risk were also recently identified. The goal of this review is to present a broad picture of our current understanding of the epidemiology, genetic epidemiology, molecular genetics, and gene-environment interplay in MDD. Insights into the impact of genetic factors on the aetiology of this complex disorder hold great promise for improving clinical care.
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Affiliation(s)
- K M Kendall
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - E Van Assche
- Department of Psychiatry, University of Muenster, Muenster, Germany
| | - T F M Andlauer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - K W Choi
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA02114, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA02114, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA02115, USA
| | - J J Luykx
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Outpatient Second Opinion Clinic, GGNet Mental Health, Warnsveld, The Netherlands
| | - E C Schulte
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Y Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Huisman R, Okhuijsen-Pfeifer C, Mulder EYH, Jongkind A, Cohen D, Bogers JPAM, van der Horst MZ, Luykx JJ. [Validation of the Dutch Glasgow Anti- psychotic Side-Effect Scale for Clozapine]. Tijdschr Psychiatr 2021; 63:270-275. [PMID: 33913142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND To monitor the unique side effect pattern of clozapine, the Glasgow Antipsychotic Side-effect Scale for Clozapine (GASS-C) was developed in English and validated. This questionnaire was previously translated to Dutch, and revised, but not yet validated. AIM The current study concerns the validation of the second revision of the GASS-C-NL-R2 for the Dutch language. METHOD Two Spearman correlation tests were conducted to compare GASS-C-NL-R2 with the Dutch version of the Liverpool University Neuroleptic Side-Effect Rating Scale (LUNSERS) at two time p´oints. There was one week between these two time points. The test-retest reliability was determined using a Spearman correlation test and Cronbach's alpha on the GASS-C-NL-R2 between the two time points. In addition, a factor analysis was performed. RESULTS Spearman's correlation coefficient between the GASS-C-NL-R2 and the LUNSERS was 0.830 (p < 0.001, n = 72) at the first time point and 0.684 (p < 0.001, n = 50) at the second time point. GASS-C-NL-R2 also had a strong test-retest reliability: Spearman's correlation coefficient was 0.680 (p < 0.001; n = 46), and Cronbach's alpha was 0.847, n = 78. Factor analysis showed that all questions were relevant. CONCLUSION The current study shows that GASS-C-NL-R2 is a valid and reliable questionnaire to monitor side effects related to clozapine with a relatively high prevalence. Future studies should focus on the practical utility of GASS-C-NL-R2 with a larger sample size.
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van der Horst MZ, van Houwelingen F, Luykx JJ. Isolated nausea and vomiting as the cardinal presenting symptoms of clozapine-induced myocarditis: a case report. BMC Psychiatry 2020; 20:568. [PMID: 33246443 PMCID: PMC7694895 DOI: 10.1186/s12888-020-02955-9] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/15/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Clozapine is an atypical antipsychotic proven to be superior in the treatment of treatment-resistant schizophrenia. Myocarditis is a rare, but well-known complication of treatment with clozapine. Only few cases have been reported in which nausea and vomiting were prominent symptoms. This is the first described report in which nausea and vomiting were the only presenting symptoms of clozapine-induced myocarditis. CASE PRESENTATION We report a case of a 58-year-old woman, suffering from schizoaffective disorder, who is being treated with clozapine. Two weeks after initiation of clozapine, she developed nausea and vomiting, in absence of any other clinical symptoms. Laboratory examination and magnetic resonance imaging confirmed the diagnosis of clozapine-induced myocarditis. Clozapine was discontinued and the patient recovered fully. CONCLUSIONS This case emphasizes the importance of recognizing myocarditis as a cause of isolated nausea and vomiting in patients treated with clozapine. Early recognition improves clinical outcome and reduces mortality.
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Affiliation(s)
- M. Z. van der Horst
- grid.5477.10000000120346234Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ,grid.5477.10000000120346234Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ,Outpatient Second Opinion Clinic, GGNet Mental Health, Warnsveld, The Netherlands
| | - F. van Houwelingen
- grid.5477.10000000120346234Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ,grid.5477.10000000120346234Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J. J. Luykx
- grid.5477.10000000120346234Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ,grid.5477.10000000120346234Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ,Outpatient Second Opinion Clinic, GGNet Mental Health, Warnsveld, The Netherlands
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Pries L, Klingenberg B, Menne‐Lothmann C, Decoster J, van Winkel R, Collip D, Delespaul P, De Hert M, Derom C, Thiery E, Jacobs N, Wichers M, Cinar O, Lin BD, Luykx JJ, Rutten BPF, van Os J, Guloksuz S. Polygenic liability for schizophrenia and childhood adversity influences daily-life emotion dysregulation and psychosis proneness. Acta Psychiatr Scand 2020; 141:465-475. [PMID: 32027017 PMCID: PMC7318228 DOI: 10.1111/acps.13158] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 10/22/2019] [Revised: 01/23/2020] [Accepted: 02/02/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To test whether polygenic risk score for schizophrenia (PRS-S) interacts with childhood adversity and daily-life stressors to influence momentary mental state domains (negative affect, positive affect, and subtle psychosis expression) and stress-sensitivity measures. METHODS The data were retrieved from a general population twin cohort including 593 adolescents and young adults. Childhood adversity was assessed using the Childhood Trauma Questionnaire. Daily-life stressors and momentary mental state domains were measured using ecological momentary assessment. PRS-S was trained on the latest Psychiatric Genetics Consortium schizophrenia meta-analysis. The analyses were conducted using multilevel mixed-effects tobit regression models. RESULTS Both childhood adversity and daily-life stressors were associated with increased negative affect, decreased positive affect, and increased subtle psychosis expression, while PRS-S was only associated with increased positive affect. No gene-environment correlation was detected. There is novel evidence for interaction effects between PRS-S and childhood adversity to influence momentary mental states [negative affect (b = 0.07, P = 0.013), positive affect (b = -0.05, P = 0.043), and subtle psychosis expression (b = 0.11, P = 0.007)] and stress-sensitivity measures. CONCLUSION Exposure to childhood adversities, particularly in individuals with high PRS-S, is pleiotropically associated with emotion dysregulation and psychosis proneness.
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Affiliation(s)
- L.‐K. Pries
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - B. Klingenberg
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - C. Menne‐Lothmann
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - J. Decoster
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Department of NeurosciencesUniversity Psychiatric Centre KU LeuvenKU LeuvenLeuvenBelgium,Brothers of CharityUniversity Psychiatric Centre Sint‐Kamillus BierbeekBierbeekBelgium
| | - R. van Winkel
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Department of NeurosciencesUniversity Psychiatric Centre KU LeuvenKU LeuvenLeuvenBelgium
| | - D. Collip
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - P. Delespaul
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - M. De Hert
- Department of NeurosciencesUniversity Psychiatric Centre KU LeuvenKU LeuvenLeuvenBelgium,Antwerp Health Law and Ethics Chair – AHLECUniversity AntwerpAntwerpBelgium
| | - C. Derom
- Centre of Human GeneticsUniversity Hospitals LeuvenKU LeuvenLeuvenBelgium,Department of Obstetrics and GynecologyGhent University HospitalsGhent UniversityGhentBelgium
| | - E. Thiery
- Department of NeurologyGhent University HospitalGhent UniversityGhentBelgium
| | - N. Jacobs
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Faculty of Psychology and Educational SciencesOpen University of the NetherlandsHeerlenThe Netherlands
| | - M. Wichers
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Department of PsychiatryInterdisciplinary Center Psychopathology and Emotion Regulation (ICPE)University of GroningenUniversity Medical Center GroningenThe Netherlands
| | - O. Cinar
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - B. D. Lin
- Department of Translational NeuroscienceUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - J. J. Luykx
- Department of Translational NeuroscienceUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,Department of PsychiatryUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,GGNet Mental HealthApeldoornThe Netherlands
| | - B. P. F. Rutten
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - J. van Os
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Department of PsychiatryUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,Department of Psychosis StudiesInstitute of PsychiatryKing's Health PartnersKing's College LondonLondonUK
| | - S. Guloksuz
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Department of PsychiatryYale School of MedicineNew HavenCTUSA
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Okhuijsen-Pfeifer C, Sterk AY, Horn IM, Terstappen J, Kahn RS, Luykx JJ. Demographic and clinical features as predictors of clozapine response in patients with schizophrenia spectrum disorders: A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 111:246-252. [PMID: 31982601 DOI: 10.1016/j.neubiorev.2020.01.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 11/04/2019] [Revised: 12/19/2019] [Accepted: 01/18/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Clozapine (CLZ) is prescribed to (relatively) treatment-resistant patients with schizophrenia spectrum disorders. Currently, it is unknown what factors predict response to CLZ. Therefore, we performed meta-analyses to identify predictors of CLZ response, hence aiming to facilitate timely and efficient prescribing of CLZ. METHODS A systematic search was performed in 'Pubmed' and 'Embase' until 1 January 2019. Articles were eligible if they provided data on predictors of CLZ response measured demographic and clinical factors at baseline or biochemical factors at follow-up in schizophrenia spectrum disorder patients. RESULTS A total of 34 articles, total number of participants = 9386; N unique = 2094, were eligible. Factors significantly associated with better CLZ response were: lower age, lower PANSS negative score and paranoid schizophrenia subtype. CONCLUSION The results of our meta-analyses suggest that three baseline demographic and clinical features are associated with better clozapine response, i.e. relatively young age, few negative symptoms and paranoid schizophrenia subtype. These variables may be taken into account by clinicians who consider treating a specific patient with CLZ.
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Affiliation(s)
- C Okhuijsen-Pfeifer
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
| | - A Y Sterk
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - I M Horn
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - J Terstappen
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - R S Kahn
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, 10029, New York City, New York, United States
| | - J J Luykx
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands; GGNet Mental Health, Deventerstraat 459, 7323 PT, Apeldoorn, The Netherlands; Department of Translational Neuroscience, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
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Beurmanjer H, Luykx JJ, De Wilde B, van Rompaey K, Buwalda VJA, De Jong CAJ, Dijkstra BAG, Schellekens AFA. Tapering with Pharmaceutical GHB or Benzodiazepines for Detoxification in GHB-Dependent Patients: A Matched-Subject Observational Study of Treatment-as-Usual in Belgium and The Netherlands. CNS Drugs 2020; 34:651-659. [PMID: 32319006 PMCID: PMC7275016 DOI: 10.1007/s40263-020-00730-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Indexed: 11/29/2022]
Abstract
BACKGROUND The gamma-hydroxybutyric acid (GHB) withdrawal syndrome often has a fulminant course, with a rapid onset and swift progression of severe complications. In clinical practice, two pharmacological regimens are commonly used to counteract withdrawal symptoms during GHB detoxification: tapering with benzodiazepines (BZDs) or tapering with pharmaceutical GHB. In Belgium, standard treatment is tapering with BZDs, while in the Netherlands, pharmaceutical GHB is the preferred treatment method. Though BZDs are cheaper and readily available, case studies suggest GHB tapering results in less severe withdrawal and fewer complications. OBJECTIVES This study aimed to compare two treatments-as-usual in tapering methods on withdrawal, craving and adverse events during detoxification in GHB-dependent patients. METHODS In this multicentre non-randomised indirect comparison of two treatments-as-usual, patients with GHB dependence received BZD tapering (Belgian sample: n = 42) or GHB tapering (Dutch sample: n = 42, matched historical sample). Withdrawal was assessed using the Subjective and Objective Withdrawal Scales, craving was assessed with a Visual Analogue Scale and adverse events were systematically recorded. Differences in withdrawal and craving were analysed using a linear mixed-model analysis, with 'days in admission' and 'detoxification method' as fixed factors. Differences in adverse events were analysed using a Chi-square analysis. RESULTS Withdrawal decreased over time in both groups. Withdrawal severity was higher in patients receiving BZD tapering (subjective mean = 36.50, standard deviation = 21.08; objective mean = 8.05, standard deviation = 4.68) than in patients receiving pharmaceutical GHB tapering (subjective mean = 15.90; standard deviation = 13.83; objective mean = 3.72; standard deviation = 2.56). No differences in craving were found. Adverse events were more common in the BZD than the GHB group, especially delirium (20 vs 2.5%, respectively). CONCLUSIONS These results support earlier work that BZD tapering might not always sufficiently dampen withdrawal in GHB-dependent patients. However, it needs to be taken into account that both treatments were assessed in separate countries. Based on the current findings, tapering with pharmaceutical GHB could be considered for patients with GHB dependence during detoxification, as it has potentially less severe withdrawal and fewer complications than BZD tapering.
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Affiliation(s)
- Harmen Beurmanjer
- Novadic-Kentron Addictioncare, Hogedwarsstraat 3, 5261, AE, Vught, The Netherlands. .,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands.
| | - J. J. Luykx
- Ziekenhuis Netwerk Antwerpen (ZNA), Borgerhout, Belgium
| | - B. De Wilde
- Ziekenhuis Netwerk Antwerpen (ZNA), Borgerhout, Belgium ,University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - V. J. A. Buwalda
- Novadic-Kentron Addictioncare, Hogedwarsstraat 3, 5261 AE Vught, The Netherlands
| | - C. A. J. De Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - B. A. G. Dijkstra
- Novadic-Kentron Addictioncare, Hogedwarsstraat 3, 5261 AE Vught, The Netherlands ,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - A. F. A. Schellekens
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands ,Department of Psychiatry, RadboudUmc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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Schijven D, Zinkstok JR, Luykx JJ. [From genetic findings to clinical practice in psychiatry: how genetics may enable Precision Psychiatry]. Tijdschr Psychiatr 2020; 62:776-783. [PMID: 32910449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Most psychiatric disorders are characterized by a complex genetic background where many common variants are involved. Nowadays, we are able to 'read' these variants, test for their association with phenotypes in genome-wide association studies (GWAS), and perform further downstream analyses. However, the impact of such findings on clinical psychiatry has remained largely unclear.<br/> AIM: To provide new insight into the degree of genetic overlap between psychiatric disorders and neurological disorders. And to investigate how genetic findings may impact clinical practice in psychiatry.<br/> METHOD: Bioinformatics and statistical methods were applied to perform analyses in large genetic datasets. In particular, we focused on: pathway analyses in schizophrenia; a multivariate GWAS of stress and trauma phenotypes; and genetic overlap analyses between amyotrophic lateral sclerosis (ALS) and schizophrenia. Finally, we assessed for which psychiatric disorders genetic findings are most likely to impact clinical practice in the near future.<br/> RESULTS: First, we found enrichment of common genetic variants associated with schizophrenia in synaptic signalling pathways relating to dopaminergic, acetylcholinergic and glutamatergic neurons. Second, we found that ALS and schizophrenia partly share common genetic risk. And third, we outline the clinical relevance of genetic cross-disorder studies in psychiatry, and posit that these studies have meaning for diagnostics, prognostics and treatment prediction in psychiatry.<br/> CONCLUSION: The summarized and previous genetic studies into psychiatric disorders will hopefully soon enable precision psychiatry, as genetics is a powerful tool to elucidate individualized risk profiles of patients and their responses to psychotropic medication. Genetic counselling allows clinicians to carefully balance the wide range of considerations in those patients and relatives with questions related to genetic underpinnings of disease and treatment response.
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Luykx JJ, Tijdink JK, van Veen SMP, Naarding P, Risselada A, Vinkers CH. [Attention to psychiatry and pharmacotherapy during the COVID-19 pandemic]. Tijdschr Psychiatr 2020; 62:427-432. [PMID: 32902836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Pandit R, Cianci D, ter Hark SE, Winter‐van Rossum I, Ebdrup BH, Broberg BV, Garcia‐Portilla MP, Bobes J, Vinkers CH, Kahn RS, Guloksuz S, Huitema ADR, Luykx JJ. Phenotypic factors associated with amisulpride-induced weight gain in first-episode psychosis patients (from the OPTiMiSE cohort). Acta Psychiatr Scand 2019; 140:283-290. [PMID: 31323113 PMCID: PMC6771865 DOI: 10.1111/acps.13074] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Antipsychotic-induced weight gain (AiWG) is a debilitating adverse effect of most antipsychotics. First-episode psychosis patients are particularly vulnerable to the detrimental consequences of AiWG. Amisulpride has good efficacy and tolerability. We here aimed to identify the phenotypic factors associated with amisulpride-induced weight gain in first-episode psychosis patients. METHOD Data were collected from the Optimization of Treatment and Management of Schizophrenia in Europe trial. Multivariable regression models with various phenotypic variables (N = 305) were performed with absolute AiWG and clinically relevant AiWG (≥7% AiWG) as outcomes. RESULTS Four weeks of amisulpride treatment increased body weight from 69.7 to 72.4 kg (P < 0.001). In the regression model of absolute AiWG, unemployment (β = 0.94, P = 0.016), younger age (β = -0.07, P = 0.031) and absence of current comorbid major depression disorder (β = -1.61, P = 0.034) were positively associated with absolute AiWG. In the regression model of clinically relevant AiWG, unemployment (OR = 2.83, P = 0.001), schizophreniform disorder (OR = 2.00, P = 0.025) and low baseline weight (OR = 0.97, P = 0.032) increased the likelihood of clinically relevant AiWG. CONCLUSIONS Clinicians prescribing amisulpride should consider the relatively high susceptibility to AiWG in unemployed first-episode patients with psychosis, in particular young subjects with a diagnosis of schizophreniform disorder. We advise to carefully monitor these patients and, when needed, implement weight-reducing strategies.
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Affiliation(s)
- R. Pandit
- Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - D. Cianci
- Department of Biostatistics and Research SupportJulius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUniversity of UtrechtUtrechtthe Netherlands
| | - S. E. ter Hark
- Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - I. Winter‐van Rossum
- Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - B. H. Ebdrup
- Centre for Neuropsychiatric Schizophrenia ResearchCNSR & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINSMental Health Centre GlostrupCopenhagen University HospitalGlostrupDenmark,Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - B. V. Broberg
- Centre for Neuropsychiatric Schizophrenia ResearchCNSR & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINSMental Health Centre GlostrupCopenhagen University HospitalGlostrupDenmark
| | - M. P. Garcia‐Portilla
- Department of Psychiatry and CIBERSAMUniversity of OviedoOviedoSpain,Instituto de Investigación Biosanitaria del Principado de Asturias (ISPA)OviedoSpain
| | - J. Bobes
- Department of Psychiatry and CIBERSAMUniversity of OviedoOviedoSpain,Instituto de Investigación Biosanitaria del Principado de Asturias (ISPA)OviedoSpain
| | - C. H. Vinkers
- Department of PsychiatryAmsterdam UMC (location VUmc)Amsterdamthe Netherlands,Department of Anatomy and NeurosciencesAmsterdam UMC (location VUmc)Amsterdamthe Netherlands
| | - R. S. Kahn
- Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PsychiatryIcahn School of MedicineMount SinaiNew YorkUSA
| | - S. Guloksuz
- Department of Psychiatry and NeuropsychologySchool for Mental HealthNeuroscience Maastricht University Medical CenterMaastrichtthe Netherlands,Department of PsychiatryYale School of MedicineNew HavenCTUSA
| | - A. D. R. Huitema
- Department of Pharmacy PharmacologyThe Netherlands Cancer InstituteAmsterdamthe Netherlands,Department of Clinical PharmacyUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - J. J. Luykx
- Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,GGNet Mental HealthApeldoornthe Netherlands
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Luykx JJ, Jacobs G, Vinkers CH. [Reaction on 'Hypomania induced by intranasal corticosteroid fluticasone spray']. Tijdschr Psychiatr 2019; 61:362-364. [PMID: 31243754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Okhuijsen‐Pfeifer C, Huijsman EAH, Hasan A, Sommer IEC, Leucht S, Kahn RS, Luykx JJ. Clozapine as a first- or second-line treatment in schizophrenia: a systematic review and meta-analysis. Acta Psychiatr Scand 2018; 138:281-288. [PMID: 30218445 PMCID: PMC6175356 DOI: 10.1111/acps.12954] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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] [Accepted: 08/06/2018] [Indexed: 12/02/2022]
Abstract
OBJECTIVE No consensus exists on whether clozapine should be prescribed in early stages of psychosis. This systematic review and meta-analysis therefore focus on the use of clozapine as first-line or second-line treatment in non-treatment-resistant patients. METHODS Articles were eligible if they investigated clozapine compared to another antipsychotic as a first- or second-line treatment in non-treatment-resistant schizophrenia spectrum disorders (SCZ) patients and provided data on treatment response. We performed random-effects meta-analyses. RESULTS Fifteen articles were eligible for the systematic review (N = 314 subjects on clozapine and N = 800 on other antipsychotics). Our meta-analysis comparing clozapine to a miscellaneous group of antipsychotics revealed a significant benefit of clozapine (Hedges' g = 0.220, P = 0.026, 95% CI = 0.026-0.414), with no evidence of heterogeneity. In addition, a sensitivity analysis revealed a significant benefit of clozapine over risperidone (Hedges' g = 0.274, P = 0.030, 95% CI = 0.027-0.521). CONCLUSION The few eligible trials on this topic suggest that clozapine may be more effective than other antipsychotics when used as first- or second-line treatment. Only large clinical trials may comprehensively probe disease stage-dependent superiority of clozapine and investigate overall tolerability.
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Affiliation(s)
- C. Okhuijsen‐Pfeifer
- Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - E. A. H. Huijsman
- Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - A. Hasan
- Department of Psychiatry and PsychotherapyKlinikum der UniversitätMunichGermany
| | - I. E. C. Sommer
- Department of Neuroscience and Department of PsychiatryUniversitair Medisch Centrum GroningenGroningenThe Netherlands
| | - S. Leucht
- Department of Psychiatry and PsychotherapyTechnische Universität MünchenMunichGermany
| | - R. S. Kahn
- Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - J. J. Luykx
- Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,Department of PsychiatryZNA HospitalsAntwerpBelgium,Department of PsychiatrySymforaMeander HospitalAmersfoortThe Netherlands
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Luykx JJ, Huygh J, Daems J, Schoonheydt K. [Pancreatitis and thrombotic thrombocytopenic purpura caused by quetiapine-induced hypertriglyceridemia]. Tijdschr Psychiatr 2018; 60:552-556. [PMID: 30132585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
An important cause of hypertriglyceridemia in psychiatric patients is the administration of antipsychotics. Mildly elevated levels of triglycerides are seen most often, occurring shortly after treatment inception. Whether hypertriglyceridemia may be caused by alcohol use has not been fully elucidated. We describe the case of a 38-year-old woman suffering from schizophrenia who had been prescribed quetiapine for five years and consumed two glasses of alcohol daily. Upon presentation with stomach pain, lab results showed alarming triglyceride levels (8348 mg/dl). She rapidly developed both a severe pancreatitis and thrombotic thrombocytopenic purpura (ttp). We discuss how this most severe case of pancreatitis and ttp in a patient on an antipsychotic described in the literature to date should encourage prevention and early management of hypertriglyceridemia in psychiatric patients.
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25
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Luykx JJ, Tijdink JK, Tempelaar W, Vinkers CH, de Witte L. [In- and out-of-hospital emergency psychiatry: what is the best approach?]. Ned Tijdschr Geneeskd 2018; 162:D2387. [PMID: 29451111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A range of clinical syndromes may present with psychiatric symptoms, both in and out of hospital settings. In such situations agitation, suicidality, communication difficulties and legal aspects often play a role, making diagnosis and treatment a challenge. Based on several case studies, we illustrate how the recently-published Dutch open access source 'Acute Psychiatry' (www.acutepsychiatrie.com) can be of help in acute psychiatric presentations both within and outside psychiatric hospitals.
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Affiliation(s)
- J J Luykx
- UMC Utrecht, Hersencentrum Rudolf Magnus, afd. Psychiatrie, Utrecht
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26
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Luykx JJ, Olde Loohuis LM, Neeleman M, Strengman E, Bakker SC, Lentjes E, Borgdorff P, van Dongen EPA, Bruins P, Kahn RS, Horvath S, de Jong S, Ophoff RA. Peripheral blood gene expression profiles linked to monoamine metabolite levels in cerebrospinal fluid. Transl Psychiatry 2016; 6:e983. [PMID: 27959337 PMCID: PMC5290339 DOI: 10.1038/tp.2016.245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 07/07/2016] [Accepted: 10/15/2016] [Indexed: 01/07/2023] Open
Abstract
The blood-brain barrier separates circulating blood from the central nervous system (CNS). The scope of this barrier is not fully understood which limits our ability to relate biological measurements from peripheral to central phenotypes. For example, it is unknown to what extent gene expression levels in peripheral blood are reflective of CNS metabolism. In this study, we examine links between central monoamine metabolite levels and whole-blood gene expression to better understand the connection between peripheral systems and the CNS. To that end, we correlated the prime monoamine metabolites in cerebrospinal fluid (CSF) with whole-genome gene expression microarray data from blood (N=240 human subjects). We additionally applied gene-enrichment analysis and weighted gene co-expression network analyses (WGCNA) to identify modules of co-expressed genes in blood that may be involved with monoamine metabolite levels in CSF. Transcript levels of two genes were significantly associated with CSF serotonin metabolite levels after Bonferroni correction for multiple testing: THAP7 (P=2.8 × 10-8, β=0.08) and DDX6 (P=2.9 × 10-7, β=0.07). Differentially expressed genes were significantly enriched for genes expressed in the brain tissue (P=6.0 × 10-52). WGCNA revealed significant correlations between serotonin metabolism and hub genes with known functions in serotonin metabolism, for example, HTR2A and COMT. We conclude that gene expression levels in whole blood are associated with monoamine metabolite levels in the human CSF. Our results, including the strong enrichment of brain-expressed genes, illustrate that gene expression profiles in peripheral blood can be relevant for quantitative metabolic phenotypes in the CNS.
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Affiliation(s)
- J J Luykx
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,Department of Translational Neuroscience Human Neurogenetics Unit, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,Department of Psychiatry, ZNA Hospitals, Antwerp, Belgium
| | - L M Olde Loohuis
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - M Neeleman
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Strengman
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S C Bakker
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Lentjes
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Borgdorff
- Department of Anesthesiology, Intensive Care and Pain Management, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - E P A van Dongen
- Department of Anesthesiology, Intensive Care and Pain Management, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Bruins
- Department of Anesthesiology, Intensive Care and Pain Management, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Horvath
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA,Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - S de Jong
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - R A Ophoff
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA,Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA,Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095 USA. E-mail:
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Luykx JJ, Boks MPM, Terwindt APR, Bakker S, Kahn RS, Ophoff RA. The involvement of GSK3beta in bipolar disorder: integrating evidence from multiple types of genetic studies. Eur Neuropsychopharmacol 2010; 20:357-68. [PMID: 20226637 DOI: 10.1016/j.euroneuro.2010.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [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: 10/04/2009] [Revised: 01/17/2010] [Accepted: 02/13/2010] [Indexed: 11/27/2022]
Abstract
We aimed to get a comprehensive insight into the genetic evidence supporting the role of GSK3beta in bipolar disorder (BD). Using broad searches in NCBI's PubMed and the Genetic Association Database we looked for association, whole-genome linkage, genome-wide association, gene expression, pharmocogenomic, epigenetic, cytogenetic, and mouse model studies performed for BD until July 2009. Per gene, we rated the degree of converging evidence across these types of genetic studies. The genes most consistently associated with BD in the genetic studies we reviewed were GSK3beta , GRK3, 5-HTTLPR, GRIN3, COMT, and GLUR3. GSK3beta stood out as it was implicated in at least five types of genetic studies. Although our results are limited by design differences of included studies and possibly by publication bias, GSK3beta is a plausible candidate gene for BD from a pharmacological and a genetic perspective. Future studies investigating the effects of GSK3beta manipulation in BD seem warranted.
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Affiliation(s)
- J J Luykx
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, B01.206, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
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