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Wang R, Lu JY, Herbert D, Lieberman JA, Meltzer HY, Tiwari AK, Remington G, Kennedy JL, Zai CC. Analysis of schizophrenia-associated genetic markers in the HLA region as risk factors for tardive dyskinesia. Hum Psychopharmacol 2024:e2898. [PMID: 38676936 DOI: 10.1002/hup.2898] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/01/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES The pathology of Tardive Dyskinesia (TD) has yet to be fully understood, but there have been proposed hypotheses for the cause of this condition. Our team previously reported a possible association of TD with the Complement Component C4 gene in the HLA region. In this study, we explored the HLA region further by examining two previously identified schizophrenia-associated HLA-region single-nucleotide polymorphisms (SNPs), namely rs13194504 and rs210133. METHODS The SNPs rs13194504 and rs210133 were tested for association with the occurrence and severity of TD in a sample of 172 schizophrenia patients who were recruited for four studies from three different clinical sites in Canada and USA. RESULTS The rs13194504 AA genotype was associated with decreased severity for TD as measured by Abnormal Involuntary Movement Scale (AIMS) scores (p = 0.047) but not for TD occurrence. SNP rs210133 was not significantly associated with either TD occurrence or AIMS scores. CONCLUSION Our findings suggest that the rs13194504 AA genotype may play a role in TD severity, while SNP rs210133 may not have a major role in the risk or severity of TD.
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Affiliation(s)
- Ruoyu Wang
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Justin Y Lu
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Deanna Herbert
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jeffrey A Lieberman
- Columbia University, New York State Psychiatric Institute, New York City, New York, USA
| | - Herbert Y Meltzer
- Psychiatry and Behavioral Sciences, Pharmacology and Physiology, Chemistry of Life Processes Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Arun K Tiwari
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gary Remington
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James L Kennedy
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clement C Zai
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
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Stone WS, Phillips MR, Yang LH, Kegeles LS, Lieberman JA. Is schizophrenia neurodevelopmental, neurodegenerative or something else: A reply to Murray et al. (2022). Schizophr Res 2023; 261:234-235. [PMID: 37804599 DOI: 10.1016/j.schres.2023.09.037] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/24/2023] [Indexed: 10/09/2023]
Affiliation(s)
- William S Stone
- Harvard Medical School Department of Psychiatry at Beth, Israel Deaconess Medical Center, Boston, MA, USA.
| | - Michael R Phillips
- Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, Shanghai, China; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lawrence H Yang
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA; New York University College of Global Public Health, New York, NY, USA
| | - Lawrence S Kegeles
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
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Yoshida K, Marshe VS, Elsheikh SSM, Maciukiewicz M, Tiwari AK, Brandl EJ, Lieberman JA, Meltzer HY, Kennedy JL, Müller DJ. Polygenic risk scores analyses of psychiatric and metabolic traits with antipsychotic-induced weight gain in schizophrenia: an exploratory study. Pharmacogenomics J 2023; 23:119-126. [PMID: 37106021 DOI: 10.1038/s41397-023-00305-y] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/20/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023]
Abstract
Given the polygenic nature of antipsychotic-induced weight gain (AIWG), we investigated whether polygenic risk scores (PRS) for various psychiatric and metabolic traits were associated with AIWG. We included individuals with schizophrenia (SCZ) of European ancestry from two cohorts (N = 151, age = 40.3 ± 11.8 and N = 138, age = 36.5 ± 10.8). We investigated associations of AIWG defined as binary and continuous variables with PRS calculated from genome-wide association studies of body mass index (BMI), coronary artery disease (CAD), fasting glucose, fasting insulin, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, type 1 and 2 diabetes mellitus, and SCZ, using regression models. We observed nominal associations (uncorrected p < 0.05) between PRSs for BMI, CAD, and LDL-C, type 1 diabetes, and SCZ with AIWG. While results became non-significant after correction for multiple testing, these preliminary results suggest that PRS analyses might contribute to identifying risk factors of AIWG and might help to elucidate mechanisms at play in AIWG.
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Affiliation(s)
- Kazunari Yoshida
- Tanenbaum Centre for Pharmacogenetics, Neurogenetics Section, Molecular Brain Sciences Research Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Victoria S Marshe
- Tanenbaum Centre for Pharmacogenetics, Neurogenetics Section, Molecular Brain Sciences Research Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Samar S M Elsheikh
- Tanenbaum Centre for Pharmacogenetics, Neurogenetics Section, Molecular Brain Sciences Research Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Malgorzata Maciukiewicz
- Tanenbaum Centre for Pharmacogenetics, Neurogenetics Section, Molecular Brain Sciences Research Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Arun K Tiwari
- Tanenbaum Centre for Pharmacogenetics, Neurogenetics Section, Molecular Brain Sciences Research Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eva J Brandl
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Herbert Y Meltzer
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - James L Kennedy
- Tanenbaum Centre for Pharmacogenetics, Neurogenetics Section, Molecular Brain Sciences Research Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel J Müller
- Tanenbaum Centre for Pharmacogenetics, Neurogenetics Section, Molecular Brain Sciences Research Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.
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4
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Kohler CG, Wolf DH, Abi-Dargham A, Anticevic A, Cho YT, Fonteneau C, Gil R, Girgis RR, Gray DL, Grinband J, Javitch JA, Kantrowitz JT, Krystal JH, Lieberman JA, Murray JD, Ranganathan M, Santamauro N, Van Snellenberg JX, Tamayo Z, Gur RC, Gur RE, Calkins ME. Illness Phase as a Key Assessment and Intervention Window for Psychosis. Biol Psychiatry Glob Open Sci 2023; 3:340-350. [PMID: 37519466 PMCID: PMC10382701 DOI: 10.1016/j.bpsgos.2022.05.009] [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] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022] Open
Abstract
The phenotype of schizophrenia, regardless of etiology, represents the most studied psychotic disorder with respect to neurobiology and distinct phases of illness. The early phase of illness represents a unique opportunity to provide effective and individualized interventions that can alter illness trajectories. Developmental age and illness stage, including temporal variation in neurobiology, can be targeted to develop phase-specific clinical assessment, biomarkers, and interventions. We review an earlier model whereby an initial glutamate signaling deficit progresses through different phases of allostatic adaptation, moving from potentially reversible functional abnormalities associated with early psychosis and working memory dysfunction, and ending with difficult-to-reverse structural changes after chronic illness. We integrate this model with evidence of dopaminergic abnormalities, including cortical D1 dysfunction, which develop during adolescence. We discuss how this model and a focus on a potential critical window of intervention in the early stages of schizophrenia impact the approach to research design and clinical care. This impact includes stage-specific considerations for symptom assessment as well as genetic, cognitive, and neurophysiological biomarkers. We examine how phase-specific biomarkers of illness phase and brain development can be incorporated into current strategies for large-scale research and clinical programs implementing coordinated specialty care. We highlight working memory and D1 dysfunction as early treatment targets that can substantially affect functional outcome.
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Affiliation(s)
- Christian G. Kohler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel H. Wolf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anissa Abi-Dargham
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook
| | - Alan Anticevic
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Youngsun T. Cho
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Clara Fonteneau
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Roberto Gil
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook
| | - Ragy R. Girgis
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - David L. Gray
- Cerevel Therapeutics Research and Development, East Cambridge, Massachusetts
| | - Jack Grinband
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Jonathan A. Javitch
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
- Molecular Pharmacology and Therapeutics, Vagelos College of Physicians and Surgeons, Columbia University, New York
- Division of Molecular Therapeutics, New York State Psychiatric Institute, New York
| | - Joshua T. Kantrowitz
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
- New York State Psychiatric Institute, New York
- Nathan Kline Institute, Orangeburg, New York
| | - John H. Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey A. Lieberman
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - John D. Murray
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Mohini Ranganathan
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Nicole Santamauro
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jared X. Van Snellenberg
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook
| | - Zailyn Tamayo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Ruben C. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raquel E. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Monica E. Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Brucato G, Hesson H, Dishy G, Lee K, Pia T, Syed F, Villalobos A, Rogers RT, Corbeil T, Stone MH, Lieberman JA, Appelbaum PS, Girgis RR. An Analysis of Motivating Factors in 1,725 Worldwide Cases of Mass Murder Between 1900-2019. J Forens Psychiatry Psychol 2023; 34:261-274. [PMID: 37600153 PMCID: PMC10435045 DOI: 10.1080/14789949.2023.2208570] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/25/2023] [Indexed: 08/22/2023]
Abstract
Mass murder, particularly mass shootings, constitutes a major, growing public health concern. Specific motivations for these acts are not well understood, often overattributed to severe mental illness. Identifying diverse factors motivating mass murders may facilitate prevention. We examined 1,725 global mass murders from 1900-2019, publicly described in English in print or online. We empirically categorized each into one of ten categories reflecting reported primary motivating factors, which were analyzed across mass murderers generally, as well as between U.S- and non-U.S.-based mass-shooters. Psychosis or disorganization related to mental illness were infrequently motivational factors (166; 9.6%), and were significantly more associated with mass murder committed using methods other than firearms. The vast majority (998, 57.86%) of incidents were impulsive and emotionally-driven, following adverse life circumstances. Most mass murderers prompted by emotional upset were found to be driven by despair or extreme sadness over life events (161, 16.13% within the category); romantic rejection or loss, or severe jealousy (204, 20.44% within the category); some specific non-romantic grudge (212, 21.24% within the category); or explosive, overwhelming rage following a dispute (266, 26.65% within the category). Results suggest that policies seeking to prevent mass murder should focus on criminal history, as well as subacute emotional disturbances not associated with severe mental illness in individuals with poor coping skills who have recently experienced negative life events.
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Affiliation(s)
- Gary Brucato
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Hannah Hesson
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Gabriella Dishy
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Kathryn Lee
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Tyler Pia
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Faizan Syed
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Alexandra Villalobos
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - R. Tyler Rogers
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Thomas Corbeil
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Michael H. Stone
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Jeffrey A. Lieberman
- Columbia University Irving Medical Center, Department of Psychiatry, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Paul S. Appelbaum
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Ragy R. Girgis
- Columbia University Irving Medical Center, Department of Psychiatry, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
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Basavaraju R, France J, Sigmon HC, Girgis RR, Brucato G, Lieberman JA, Small SA, Provenzano FA. Increased parietal and occipital lobe gyrification predicts conversion to syndromal psychosis in a clinical high-risk cohort. Schizophr Res 2023; 255:246-255. [PMID: 37043842 DOI: 10.1016/j.schres.2023.03.027] [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: 07/23/2021] [Revised: 02/15/2023] [Accepted: 03/12/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Local gyrification index (lGI), indicative of the degree of cortical folding is a proxy marker for early cortical neurodevelopmental abnormalities. We studied the difference in lGI between those who do and do not convert to psychosis (non-converters) in a clinical high-risk (CHR) cohort, and whether lGI predicts conversion to psychosis. METHODS Seventy-two CHR participants with attenuated positive symptom syndrome were followed up for two years. The difference in baseline whole-brain lGI was examined on the T1-weighted MRIs between, i)CHR (N = 72) and healthy controls (N = 19), ii)Converters to psychosis (N = 24) and non-converters (N = 48), adjusting for age and sex, on Freesurfer-6.0. The significant cluster obtained in the converters versus non-converters comparison was registered as a region of interest to individual images of all 72 participants and lGI values were extracted from this region. A cox proportional hazards model was applied with these values to study whether lGI predicts conversion to psychosis. RESULTS lGI was not different between CHR and healthy controls. lGI was increased in converters in the right-sided inferior parietal and lateral occipital areas (corrected cluster-wise-p-value = 0.009, cohen's f = 0.42) compared to non-converters, which significantly increased the risk of onset of psychosis (p = 0.029, hazard ratio = 1.471). CONCLUSIONS Increased gyrification in the right-sided inferior parietal and lateral occipital area differentiates converters to psychosis in CHR, significantly increasing the risk of conversion to psychosis. This measure may reflect underlying traits in parts of the brain that develop earliest in-utero (parietal and occipital), conferring a heightened vulnerability to convert to syndromal psychosis subsequently.
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Affiliation(s)
- Rakshathi Basavaraju
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA
| | - Jeanelle France
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA
| | - Hannah C Sigmon
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA
| | - Ragy R Girgis
- Department of Psychiatry, College of Physicians and Surgeons, New York State Psychiatric Institute, Columbia University Medical Center, USA
| | - Gary Brucato
- Department of Psychiatry, College of Physicians and Surgeons, New York State Psychiatric Institute, Columbia University Medical Center, USA
| | - Jeffrey A Lieberman
- Department of Psychiatry, College of Physicians and Surgeons, New York State Psychiatric Institute, Columbia University Medical Center, USA
| | - Scott A Small
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA
| | - Frank A Provenzano
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA.
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Hesson HM, Shea EA, Appelbaum PS, Dishy G, Cohen-Romano C, Kennedy L, Bornico M, Lee K, Pia T, Syed F, Villalobos A, Lieberman JA, Wall MM, Brucato G, Girgis RR. Victimology of Mass Shootings and Mass Murders Not Involving Firearms. Violence Vict 2023; 38:15-24. [PMID: 36717195 DOI: 10.1891/vv-2022-0051] [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] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Most research to date has focused on perpetrators of mass murder incidents. Hence, there is little information on victims. We examined 973 mass murders that occurred in the United States between 1900 and 2019 resulting in 5,273 total fatalities and 4,498 nonfatal injuries for a total of 9,771 victims (on average 10 victims per incident). Approximately 64% of victims of mass murder were White individuals, 13% were Black individuals, 6% were Asian individuals, and 14% were Latinx individuals. Given the higher number of nonfatal injuries per non-firearm mass murder event (11.0 vs. 2.8, p < .001), the total number of victims was only 50% higher for mass shootings (5,855 victims) vs. non-firearm mass murder events (3,916 victims). Among the 421 incidents of mass murder in the United States since 2000, Black, Asian, and Native American individuals were overrepresented among victims of mass shootings compared with their representation in the general U.S. population, and White individuals were underrepresented (all p ≤ .002). Findings of racial/ethnic differences were similar among victims of mass murder committed with means other than firearms for Black, Asian, and White individuals. These findings highlight different areas of victimology within the context of these incidents.
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Affiliation(s)
- Hannah M Hesson
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Eileen A Shea
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Gabriella Dishy
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Carol Cohen-Romano
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Leda Kennedy
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Melissa Bornico
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Kathryn Lee
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Tyler Pia
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Faizan Syed
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Alexandra Villalobos
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Gary Brucato
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Ragy R Girgis
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
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8
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Zoghbi AW, Lieberman JA, Girgis RR. The neurobiology of duration of untreated psychosis: a comprehensive review. Mol Psychiatry 2023; 28:168-190. [PMID: 35931757 PMCID: PMC10979514 DOI: 10.1038/s41380-022-01718-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 01/11/2023]
Abstract
Duration of untreated psychosis (DUP) is defined as the time from the onset of psychotic symptoms until the first treatment. Studies have shown that longer DUP is associated with poorer response rates to antipsychotic medications and impaired cognition, yet the neurobiologic correlates of DUP are poorly understood. Moreover, it has been hypothesized that untreated psychosis may be neurotoxic. Here, we conducted a comprehensive review of studies that have examined the neurobiology of DUP. Specifically, we included studies that evaluated DUP using a range of neurobiologic and imaging techniques and identified 83 articles that met inclusion and exclusion criteria. Overall, 27 out of the total 83 studies (32.5%) reported a significant neurobiological correlate with DUP. These results provide evidence against the notion of psychosis as structurally or functionally neurotoxic on a global scale and suggest that specific regions of the brain, such as temporal regions, may be more vulnerable to the effects of DUP. It is also possible that current methodologies lack the resolution needed to more accurately examine the effects of DUP on the brain, such as effects on synaptic density. Newer methodologies, such as MR scanners with stronger magnets, PET imaging with newer ligands capable of measuring subcellular structures (e.g., the PET ligand [11C]UCB-J) may be better able to capture these limited neuropathologic processes. Lastly, to ensure robust and replicable results, future studies of DUP should be adequately powered and specifically designed to test for the effects of DUP on localized brain structure and function with careful attention paid to potential confounds and methodological issues.
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Affiliation(s)
- Anthony W Zoghbi
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA.
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA.
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA.
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, 10032, USA.
- Office of Mental Health, New York State Psychiatric Institute, New York, NY, 10032, USA.
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Ragy R Girgis
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, 10032, USA.
- Office of Mental Health, New York State Psychiatric Institute, New York, NY, 10032, USA.
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9
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Girgis RR, Rogers RT, Hesson H, Lieberman JA, Appelbaum PS, Brucato G. Mass murders involving firearms and other methods in school, college, and university settings: Findings from the Columbia Mass Murder Database. J Forensic Sci 2023; 68:207-211. [PMID: 36303265 DOI: 10.1111/1556-4029.15161] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 12/31/2022]
Abstract
While mass murders involving academic settings, especially using firearms, are of grave, growing public concern, identifying consistent patterns to aid prevention has proved challenging. Although some characteristics, such as male sex, have been routinely associated with these events, another hypothesized risk factor, severe mental illness, has been less reliably predictive. We isolated cases of mass murder perpetrated at least in part at schools, colleges, and universities from the Columbia Mass Murder Database (CMDD) and categorized them by location (within or outside of the US), and whether firearms were used. Demographic similarities and differences between groups were analyzed statistically wherever possible. We examined 82 incidents of mass murder, by any means, involving academic settings. Nearly half of all incidents (47.6%), and most involving firearms (63.2%), were U.S.-based, whereas those not involving firearms largely occurred elsewhere (88.0%). Consistent with previous reports, perpetrators of mass shootings involving academic settings are primarily Caucasian (66.7%) and male (100%). Severe mental illness (i.e., psychosis) was absent in the majority of perpetrators (firearms: 80.7%; nonfirearms: 68.0%). About half (45.6%) of mass school shootings ended with the perpetrator's suicide. When present, psychotic symptoms are more associated with mass murders in academic settings involving means other than firearms. The question of whether perpetrators of such incidents may perceive their actions as a kind of final act might enhance policy development and/or how law enforcement intervenes.
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Affiliation(s)
- Ragy R Girgis
- Department of Psychiatry, and New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Russell Tyler Rogers
- Department of Psychiatry, and New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Hannah Hesson
- Department of Psychiatry, and New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey A Lieberman
- Department of Psychiatry, and New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Paul S Appelbaum
- Department of Psychiatry, and New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Gary Brucato
- Department of Psychiatry, and New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
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10
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Stone WS, Phillips MR, Yang LH, Kegeles LS, Susser ES, Lieberman JA. Neurodegenerative model of schizophrenia: Growing evidence to support a revisit. Schizophr Res 2022; 243:154-162. [PMID: 35344853 PMCID: PMC9189010 DOI: 10.1016/j.schres.2022.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [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: 02/02/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/21/2022]
Abstract
Multidimensional progressive declines in the absence of standard biomarkers for neurodegeneration are observed commonly in the development of schizophrenia, and are accepted as consistent with neurodevelopmental etiological hypotheses to explain the origins of the disorder. Far less accepted is the possibility that neurodegenerative processes are involved as well, or even that key dimensions of function, such as cognition and aspects of biological integrity, such as white matter function, decline in chronic schizophrenia beyond levels associated with normal aging. We propose that recent research germane to these issues warrants a current look at the question of neurodegeneration. We propose the view that a neurodegenerative hypothesis provides a better explanation of some features of chronic schizophrenia, including accelerated aging, than is provided by neurodevelopmental hypotheses. Moreover, we suggest that neurodevelopmental influences in early life, including those that may extend to later life, do not preclude the development of neurodegenerative processes in later life, including some declines in cognitive and biological integrity. We evaluate these views by integrating recent findings in representative domains such as cognition and white and gray matter integrity with results from studies on accelerated aging, together with functional implications of neurodegeneration for our understanding of chronic schizophrenia.
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Affiliation(s)
- William S. Stone
- Harvard Medical School Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, Massachusetts,Corresponding Author: William S. Stone, Ph.D., Massachusetts Mental Health Center, 75 Fenwood Road, Boston, Massachusetts, USA,
| | - Michael R. Phillips
- Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, Shanghai, China,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Lawrence H. Yang
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York,New York University College of Global Public Health, New York, New York
| | - Lawrence S. Kegeles
- Department of Psychiatry, Columbia University, New York, New York,New York State Psychiatric Institute, New York, New York
| | - Ezra S. Susser
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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11
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First MB, Lieberman JA. How should we diagnose schizophrenia: Don't throw the baby out with the bath water. Schizophr Res 2022; 242:81-83. [PMID: 35241315 DOI: 10.1016/j.schres.2022.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Michael B First
- Columbia University Irving Medical Center, New York, NY, United States of America; New York State Psychiatric Institute, New York, NY, United States of America
| | - Jeffrey A Lieberman
- Columbia University Irving Medical Center, New York, NY, United States of America; New York State Psychiatric Institute, New York, NY, United States of America.
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12
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Affiliation(s)
- Joshua Phelps
- Columbia University Irving Medical Center, New York, New York.,New York State Psychiatric Institute, New York
| | - Ravi N Shah
- Columbia University Irving Medical Center, New York, New York
| | - Jeffrey A Lieberman
- Columbia University Irving Medical Center, New York, New York.,New York State Psychiatric Institute, New York
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13
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Basavaraju R, Guo J, Small SA, Lieberman JA, Girgis RR, Provenzano FA. Hippocampal Glutamate and Positive Symptom Severity in Clinical High Risk for Psychosis. JAMA Psychiatry 2022; 79:178-179. [PMID: 34964821 PMCID: PMC8717208 DOI: 10.1001/jamapsychiatry.2021.3710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 12/31/2022]
Abstract
This study examines the association between increased hippocampal glutamate and higher total positive symptom severity in converters to psychosis.
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Affiliation(s)
- Rakshathi Basavaraju
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, New York, New York
| | - Jia Guo
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York
| | - Scott A. Small
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, New York, New York
| | - Jeffrey A. Lieberman
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York
| | - Ragy R. Girgis
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York
| | - Frank A. Provenzano
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, New York, New York
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14
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Zoghbi AW, Dhindsa RS, Goldberg TE, Mehralizade A, Motelow JE, Wang X, Alkelai A, Harms MB, Lieberman JA, Markx S, Goldstein DB. High-impact rare genetic variants in severe schizophrenia. Proc Natl Acad Sci U S A 2021; 118:e2112560118. [PMID: 34903660 PMCID: PMC8713775 DOI: 10.1073/pnas.2112560118] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 02/04/2023] Open
Abstract
Extreme phenotype sequencing has led to the identification of high-impact rare genetic variants for many complex disorders but has not been applied to studies of severe schizophrenia. We sequenced 112 individuals with severe, extremely treatment-resistant schizophrenia, 218 individuals with typical schizophrenia, and 4,929 controls. We compared the burden of rare, damaging missense and loss-of-function variants between severe, extremely treatment-resistant schizophrenia, typical schizophrenia, and controls across mutation intolerant genes. Individuals with severe, extremely treatment-resistant schizophrenia had a high burden of rare loss-of-function (odds ratio, 1.91; 95% CI, 1.39 to 2.63; P = 7.8 × 10-5) and damaging missense variants in intolerant genes (odds ratio, 2.90; 95% CI, 2.02 to 4.15; P = 3.2 × 10-9). A total of 48.2% of individuals with severe, extremely treatment-resistant schizophrenia carried at least one rare, damaging missense or loss-of-function variant in intolerant genes compared to 29.8% of typical schizophrenia individuals (odds ratio, 2.18; 95% CI, 1.33 to 3.60; P = 1.6 × 10-3) and 25.4% of controls (odds ratio, 2.74; 95% CI, 1.85 to 4.06; P = 2.9 × 10-7). Restricting to genes previously associated with schizophrenia risk strengthened the enrichment with 8.9% of individuals with severe, extremely treatment-resistant schizophrenia carrying a damaging missense or loss-of-function variant compared to 2.3% of typical schizophrenia (odds ratio, 5.48; 95% CI, 1.52 to 19.74; P = 0.02) and 1.6% of controls (odds ratio, 5.82; 95% CI, 3.00 to 11.28; P = 2.6 × 10-8). These results demonstrate the power of extreme phenotype case selection in psychiatric genetics and an approach to augment schizophrenia gene discovery efforts.
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Affiliation(s)
- Anthony W Zoghbi
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030;
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032
- Office of Mental Health, New York State Psychiatric Institute, New York, NY 10032
| | - Ryan S Dhindsa
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032
- Department of Molecular and Human Genetics, Jan and Dan Duncan Neurological Research Institute, Houston, TX 77030
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY 10032
| | - Terry E Goldberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032
- Office of Mental Health, New York State Psychiatric Institute, New York, NY 10032
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY 10032
| | - Aydan Mehralizade
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032
- Office of Mental Health, New York State Psychiatric Institute, New York, NY 10032
| | - Joshua E Motelow
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY 10032
- Department of Pediatrics, Division of Critical Care and Hospital Medicine, Columbia University Irving Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital of New York, New York, NY 10032
| | - Xinchen Wang
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY 10032
- Waypoint Bio, New York, NY 10014
| | - Anna Alkelai
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY 10032
| | - Matthew B Harms
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032
- Center for Motor Neuron Biology and Disease, Columbia University Irving Medical Center, New York, NY 10032
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032
- Office of Mental Health, New York State Psychiatric Institute, New York, NY 10032
| | - Sander Markx
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032;
- Office of Mental Health, New York State Psychiatric Institute, New York, NY 10032
| | - David B Goldstein
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032;
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY 10032
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15
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Girgis RR, Feng X, Brucato G, Sigmon HC, Lieberman JA, Provenzano F. The neurobiology of auditory and visual perceptual abnormalities in a clinical high-risk for psychosis cohort: A pilot morphometric magnetic resonance imaging study. J Psychiatr Res 2021; 142:240-242. [PMID: 34391077 DOI: 10.1016/j.jpsychires.2021.08.009] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/23/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022]
Abstract
Our goal was to examine the neurobiology of auditory and visual perceptual abnormalities in individuals at clinical high-risk for psychosis (CHR) using morphometric magnetic resonance imaging (MRI). We enrolled 72 CHR subjects as delineated by the Structured Interview for Psychosis-Risk Syndromes (SIPS). Greater severity of visual perceptual abnormalities was associated with larger volumes in all regions tested (amygdala, hippocampus, and occipital cortex), while no relationships were observed between auditory perceptual abnormalities and brain volumes. These data support findings that while perceptual abnormalities may share a central set of neurobiological mechanisms, each type may also have distinct pathogeneses.
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Affiliation(s)
- Ragy R Girgis
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA.
| | - Xinyang Feng
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Gary Brucato
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Hannah C Sigmon
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Jeffrey A Lieberman
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Frank Provenzano
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
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16
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Kantrowitz JT, Dong Z, Milak MS, Rashid R, Kegeles LS, Javitt DC, Lieberman JA, John Mann J. Ventromedial prefrontal cortex/anterior cingulate cortex Glx, glutamate, and GABA levels in medication-free major depressive disorder. Transl Psychiatry 2021; 11:419. [PMID: 34354048 PMCID: PMC8342485 DOI: 10.1038/s41398-021-01541-1] [Citation(s) in RCA: 40] [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] [Received: 06/29/2021] [Revised: 07/12/2021] [Accepted: 07/23/2021] [Indexed: 02/07/2023] Open
Abstract
Glutamate (Glu) and gamma-aminobutyric acid (GABA) are implicated in the pathophysiology of major depressive disorder (MDD). GABA levels or GABAergic interneuron numbers are generally low in MDD, potentially disinhibiting Glu release. It is unclear whether Glu release or turnover is increased in depression. Conversely, a meta-analysis of prefrontal proton magnetic resonance spectroscopy (1H MRS) studies in MDD finds low Glx (combination of glutamate and glutamine) in medicated MDD. We hypothesize that elevated Glx or Glu may be a marker of more severe, untreated MDD. We examined ventromedial prefrontal cortex/anterior cingulate cortex (vmPFC/ACC) Glx and glutamate levels using 1H MRS in 34 medication-free, symptomatic, chronically ill MDD patients and 32 healthy volunteers, and GABA levels in a subsample. Elevated Glx and Glu were observed in MDD compared with healthy volunteers, with the highest levels seen in males with MDD. vmPFC/ACC GABA was low in MDD. Higher Glx levels correlated with more severe depression and lower GABA. MDD severity and diagnosis were both linked to higher Glx in vmPFC/ACC. Low GABA in a subset of these patients is consistent with our hypothesized model of low GABA leading to glutamate disinhibition in MDD. This finding and model are consistent with our previously reported findings that the NMDAR-antagonist antidepressant effect is proportional to the reduction of vmPFC/ACC Glx or Glu levels.
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Affiliation(s)
- Joshua T. Kantrowitz
- grid.21729.3f0000000419368729Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA ,grid.250263.00000 0001 2189 4777Nathan Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY USA
| | - Zhengchao Dong
- grid.21729.3f0000000419368729Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA
| | - Matthew S. Milak
- grid.21729.3f0000000419368729Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA
| | - Rain Rashid
- grid.21729.3f0000000419368729Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA
| | - Lawrence S. Kegeles
- grid.21729.3f0000000419368729Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA ,grid.21729.3f0000000419368729Department of Radiology, Columbia University, College of Physicians and Surgeons, New York, NY USA
| | - Daniel C. Javitt
- grid.21729.3f0000000419368729Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA ,grid.250263.00000 0001 2189 4777Nathan Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY USA
| | - Jeffrey A. Lieberman
- grid.21729.3f0000000419368729Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA
| | - J. John Mann
- grid.21729.3f0000000419368729Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA ,grid.21729.3f0000000419368729Department of Radiology, Columbia University, College of Physicians and Surgeons, New York, NY USA
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17
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Girgis RR, Basavaraju R, France J, Wall MM, Brucato G, Lieberman JA, Provenzano FA. An exploratory magnetic resonance imaging study of suicidal ideation in individuals at clinical high-risk for psychosis. Psychiatry Res Neuroimaging 2021; 312:111287. [PMID: 33848727 PMCID: PMC8137659 DOI: 10.1016/j.pscychresns.2021.111287] [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: 08/22/2020] [Revised: 11/18/2020] [Accepted: 04/06/2021] [Indexed: 11/28/2022]
Abstract
Suicide is a major cause of death in psychosis and associated with significant morbidity. Suicidal ideation (SI) is very common in those at clinical high-risk for psychosis (CHR) and predicts later suicide. Despite substantial work on the pathobiology of suicide in schizophrenia, little is known of its neurobiological underpinnings in the CHR or putatively prodromal state. Therefore, in this pilot study, we examined the neurobiology of SI in CHR individuals using structural MRI. Subjects were aged 14-30 and met criteria for the Attenuated Positive Symptom Psychosis-Risk Syndrome (APSS) delineated in the Structured Interview for Psychosis-Risk Syndromes (SIPS). Suicidality was assessed using the Columbia Suicide Severity Rating Scale (C-SSRS). Volumetric MRI scans were obtained on a 3T Phillips scanner. MRI data were available for 69 individuals (19 CHR without SI, 31 CHR with SI and 19 healthy control subjects). CHR individuals with SI had thicker middle temporal and right insular cortices than CHR individuals without SI and healthy control subjects. The location of these findings is consistent with neurobiological findings regarding suicide in syndromal psychosis. These findings underscore the potential for the use of brain imaging biomarkers of suicide risk in CHR individuals.
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Affiliation(s)
- Ragy R Girgis
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A.
| | - Rakshathi Basavaraju
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
| | - Jeanelle France
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
| | - Melanie M Wall
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
| | - Gary Brucato
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
| | - Jeffrey A Lieberman
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
| | - Frank A Provenzano
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
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18
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Affiliation(s)
- Jeffrey A Lieberman
- From the Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute - both in New York
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19
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Lawrence RE, Appelbaum PS, Lieberman JA. A historical review of placebo-controlled, relapse prevention trials in schizophrenia: The loss of clinical equipoise. Schizophr Res 2021; 229:122-131. [PMID: 33234427 DOI: 10.1016/j.schres.2020.11.022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/14/2020] [Accepted: 11/15/2020] [Indexed: 11/19/2022]
Abstract
Recent ethical critiques have proposed that placebo-controlled, relapse prevention trials in schizophrenia are no longer justifiable and are therefore unethical. This review provides an historical perspective on the justifications for these trials and how arguments evolved over several decades. We identified 87 placebo-controlled, relapse prevention trials published over the last seventy years and examined the purpose for each trial. We found that first-generation trials had compelling justifications, yet these arguments changed considerably over time. Second-generation trials offered comparatively weaker-and sometimes no-justifications for their conduct. Without clear and compelling justifications for a given trial, it is not ethical to continue using this study design.
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Affiliation(s)
- Ryan E Lawrence
- Columbia University Medical Center, New York - Presbyterian Hospital, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Jeffrey A Lieberman
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York - Presbyterian Hospital, Columbia University Medical Center, United States of America.
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20
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Abstract
BACKGROUND The muscarinic receptor agonist xanomeline has antipsychotic properties and is devoid of dopamine receptor-blocking activity but causes cholinergic adverse events. Trospium is a peripherally restricted muscarinic receptor antagonist that reduces peripheral cholinergic effects of xanomeline. The efficacy and safety of combined xanomeline and trospium in patients with schizophrenia are unknown. METHODS In this double-blind, phase 2 trial, we randomly assigned patients with schizophrenia in a 1:1 ratio to receive twice-daily xanomeline-trospium (increased to a maximum of 125 mg of xanomeline and 30 mg of trospium per dose) or placebo for 5 weeks. The primary end point was the change from baseline to week 5 in the total score on the Positive and Negative Syndrome Scale (PANSS; range, 30 to 210, with higher scores indicating more severe symptoms of schizophrenia). Secondary end points were the change in the PANSS positive symptom subscore, the score on the Clinical Global Impression-Severity (CGI-S) scale (range, 1 to 7, with higher scores indicating greater severity of illness), the change in the PANSS negative symptom subscore, the change in the PANSS Marder negative symptom subscore, and the percentage of patients with a response according to a CGI-S score of 1 or 2. RESULTS A total of 182 patients were enrolled, with 90 assigned to receive xanomeline-trospium and 92 to receive placebo. The PANSS total score at baseline was 97.7 in the xanomeline-trospium group and 96.6 in the placebo group. The change from baseline to week 5 was -17.4 points with xanomeline-trospium and -5.9 points with placebo (least-squares mean difference, -11.6 points; 95% confidence interval, -16.1 to -7.1; P<0.001). The results for the secondary end points were significantly better in the xanomeline-trospium group than in the placebo group, with the exception of the percentage of patients with a CGI-S response. The most common adverse events in the xanomeline-trospium group were constipation, nausea, dry mouth, dyspepsia, and vomiting. The incidences of somnolence, weight gain, restlessness, and extrapyramidal symptoms were similar in the two groups. CONCLUSIONS In a 5-week trial, xanomeline-trospium resulted in a greater decrease in the PANSS total score than placebo but was associated with cholinergic and anticholinergic adverse events. Larger and longer trials are required to determine the efficacy and safety of xanomeline-trospium in patients with schizophrenia. (Funded by Karuna Therapeutics and the Wellcome Trust; ClinicalTrials.gov number, NCT03697252.).
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Affiliation(s)
- Stephen K Brannan
- From Karuna Therapeutics, Boston (S.K.B., S.S., A.C.M., S.M.P.); Columbia University Vagelos College of Physicians and Surgeons, New York (J.A.L.); and Indiana University School of Medicine, Indianapolis (A.B.)
| | - Sharon Sawchak
- From Karuna Therapeutics, Boston (S.K.B., S.S., A.C.M., S.M.P.); Columbia University Vagelos College of Physicians and Surgeons, New York (J.A.L.); and Indiana University School of Medicine, Indianapolis (A.B.)
| | - Andrew C Miller
- From Karuna Therapeutics, Boston (S.K.B., S.S., A.C.M., S.M.P.); Columbia University Vagelos College of Physicians and Surgeons, New York (J.A.L.); and Indiana University School of Medicine, Indianapolis (A.B.)
| | - Jeffrey A Lieberman
- From Karuna Therapeutics, Boston (S.K.B., S.S., A.C.M., S.M.P.); Columbia University Vagelos College of Physicians and Surgeons, New York (J.A.L.); and Indiana University School of Medicine, Indianapolis (A.B.)
| | - Steven M Paul
- From Karuna Therapeutics, Boston (S.K.B., S.S., A.C.M., S.M.P.); Columbia University Vagelos College of Physicians and Surgeons, New York (J.A.L.); and Indiana University School of Medicine, Indianapolis (A.B.)
| | - Alan Breier
- From Karuna Therapeutics, Boston (S.K.B., S.S., A.C.M., S.M.P.); Columbia University Vagelos College of Physicians and Surgeons, New York (J.A.L.); and Indiana University School of Medicine, Indianapolis (A.B.)
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Brucato G, Appelbaum PS, Hesson H, Shea EA, Dishy G, Lee K, Pia T, Syed F, Villalobos A, Wall MM, Lieberman JA, Girgis RR. Psychotic symptoms in mass shootings v. mass murders not involving firearms: findings from the Columbia mass murder database. Psychol Med 2021; 52:1-9. [PMID: 33595428 DOI: 10.1017/s0033291721000076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/07/2022]
Abstract
BACKGROUND Mass shootings account for a small fraction of annual worldwide murders, yet disproportionately affect society and influence policy. Evidence suggesting a link between mass shootings and severe mental illness (i.e. involving psychosis) is often misrepresented, generating stigma. Thus, the actual prevalence constitutes a key public health concern. METHODS We examined global personal-cause mass murders from 1900 to 2019, amassed by review of 14 785 murders publicly described in English in print or online, and collected information regarding perpetrator, demographics, legal history, drug use and alcohol misuse, and history of symptoms of psychiatric or neurologic illness using standardized methods. We distinguished whether firearms were or were not used, and, if so, the type (non-automatic v. semi- or fully-automatic). RESULTS We identified 1315 mass murders, 65% of which involved firearms. Lifetime psychotic symptoms were noted among 11% of perpetrators, consistent with previous reports, including 18% of mass murderers who did not use firearms and 8% of those who did (χ2 = 28.0, p < 0.01). US-based mass shooters were more likely to have legal histories, use recreational drugs or misuse alcohol, or have histories of non-psychotic psychiatric or neurologic symptoms. US-based mass shooters with symptoms of any psychiatric or neurologic illness more frequently used semi-or fully-automatic firearms. CONCLUSIONS These results suggest that policies aimed at preventing mass shootings by focusing on serious mental illness, characterized by psychotic symptoms, may have limited impact. Policies such as those targeting firearm access, recreational drug use and alcohol misuse, legal history, and non-psychotic psychopathology might yield more substantial results.
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Affiliation(s)
- Gary Brucato
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Hannah Hesson
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Eileen A Shea
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Gabriella Dishy
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Kathryn Lee
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Tyler Pia
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Faizan Syed
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Alexandra Villalobos
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Ragy R Girgis
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
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22
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23
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Brucato G, First MB, Dishy GA, Samuel SS, Xu Q, Wall MM, Small SA, Masucci MD, Lieberman JA, Girgis RR. Recency and intensification of positive symptoms enhance prediction of conversion to syndromal psychosis in clinical high-risk patients. Psychol Med 2021; 51:112-120. [PMID: 31658912 DOI: 10.1017/s0033291719003040] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early detection and intervention strategies in patients at clinical high-risk (CHR) for syndromal psychosis have the potential to contain the morbidity of schizophrenia and similar conditions. However, research criteria that have relied on severity and number of positive symptoms are limited in their specificity and risk high false-positive rates. Our objective was to examine the degree to which measures of recency of onset or intensification of positive symptoms [a.k.a., new or worsening (NOW) symptoms] contribute to predictive capacity. METHODS We recruited 109 help-seeking individuals whose symptoms met criteria for the Progression Subtype of the Attenuated Positive Symptom Psychosis-Risk Syndrome defined by the Structured Interview for Psychosis-Risk Syndromes and followed every three months for two years or onset of syndromal psychosis. RESULTS Forty-one (40.6%) of 101 participants meeting CHR criteria developed a syndromal psychotic disorder [mostly (80.5%) schizophrenia] with half converting within 142 days (interquartile range: 69-410 days). Patients with more NOW symptoms were more likely to convert (converters: 3.63 ± 0.89; non-converters: 2.90 ± 1.27; p = 0.001). Patients with stable attenuated positive symptoms were less likely to convert than those with NOW symptoms. New, but not worsening, symptoms, in isolation, also predicted conversion. CONCLUSIONS Results suggest that the severity and number of attenuated positive symptoms are less predictive of conversion to syndromal psychosis than the timing of their emergence and intensification. These findings also suggest that the earliest phase of psychotic illness involves a rapid, dynamic process, beginning before the syndromal first episode, with potentially substantial implications for CHR research and understanding the neurobiology of psychosis.
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Affiliation(s)
- Gary Brucato
- Department of Psychiatry, The Center of Prevention & Evaluation (COPE), Columbia University College of Physicians & Surgeons, Columbia University Medical Center, New York State Psychiatric Institute, NY, USA
| | - Michael B First
- Columbia University College of Physicians & Surgeons, Columbia University Medical Center, New York State Psychiatric Institute, NY, USA
| | | | | | - Qing Xu
- New York State Psychiatric Institute, NY, USA
| | - Melanie M Wall
- Columbia University College of Physicians & Surgeons, Columbia University Medical Center, New York State Psychiatric Institute, NY, USA
| | - Scott A Small
- Alzheimer's Disease Research Center, Departments of Neurology, Psychiatry, Radiology, Columbia University, NY, USA
| | | | - Jeffrey A Lieberman
- Columbia University, Vagelos College of Physicians and Surgeons, Director, New York State Psychiatric Institute Psychiatrist-in-Chief, New York Presbyterian Hospital-Columbia University Medical Center, NY, USA
| | - Ragy R Girgis
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York> State Psychiatric Institute, NY, USA
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24
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Kegeles LS, Ciarleglio A, León-Ortiz P, Reyes-Madrigal F, Lieberman JA, Brucato G, Girgis RR, de la Fuente-Sandoval C. An imaging-based risk calculator for prediction of conversion to psychosis in clinical high-risk individuals using glutamate 1H MRS. Schizophr Res 2020; 226:70-73. [PMID: 31522867 PMCID: PMC7065933 DOI: 10.1016/j.schres.2019.09.004] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 01/12/2023]
Abstract
Risk calculators for prediction of conversion of Clinical High-Risk (CHR) individuals to syndromal psychosis have recently been developed and have generated considerable clinical use and research interest. Predictor variables in these calculators have been clinical rather than biological, and our goal was to incorporate a neurochemical imaging measure into this framework and assess its impact on prediction. We combined striatal glutamate 1H MRS data with the SIPS symptoms identified by the Columbia Risk Calculator as having the greatest predictive value in order to develop an imaging-based risk calculator for conversion to psychosis. We evaluated the calculator in 19 CHR individuals, 7 (36.84%) of whom converted to syndromal psychosis during the 2-year follow up. The receiver operating characteristic (ROC) curve for the logistic model including only striatal glutamate and visual perceptual abnormalities showed an AUC = 0.869 (95% CI = [0.667, 1.000]) and AUCoa = 0.823, with sensitivity of 0.714, specificity of 0.917, positive predictive value of 0.833, and negative predictive value of 0.846. These results represent modest improvements over each of the individual ROC curves based on either striatal glutamate or visual perceptual abnormalities alone. The preliminary model building and evaluation presented here in a small CHR sample suggests that the approach of incorporating predictive imaging measures into risk classification is not only feasible but offers the potential of enhancing risk assessment.
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Affiliation(s)
- Lawrence S Kegeles
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute (NYSPI), New York, NY, USA
| | - Adam Ciarleglio
- George Washington University, Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, Washington, DC, USA
| | - Pablo León-Ortiz
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Francisco Reyes-Madrigal
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Jeffrey A Lieberman
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute (NYSPI), New York, NY, USA
| | - Gary Brucato
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute (NYSPI), New York, NY, USA
| | - Ragy R Girgis
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute (NYSPI), New York, NY, USA
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25
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Stone WS, Cai B, Liu X, Grivel MMR, Yu G, Xu Y, Ouyang X, Chen H, Deng F, Xue F, Li H, Lieberman JA, Keshavan MS, Susser ES, Yang LH, Phillips MR. Association Between the Duration of Untreated Psychosis and Selective Cognitive Performance in Community-Dwelling Individuals With Chronic Untreated Schizophrenia in Rural China. JAMA Psychiatry 2020; 77:1116-1126. [PMID: 32639517 PMCID: PMC7344798 DOI: 10.1001/jamapsychiatry.2020.1619] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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] [Indexed: 01/10/2023]
Abstract
IMPORTANCE Cognitive deficits constitute core features of schizophrenia, but the trajectories of cognitive difficulties in chronic untreated schizophrenia remain unclear. OBJECTIVE To assess the association of neuropsychological deficits with duration of untreated psychosis in individuals with chronic untreated schizophrenia. DESIGN, SETTING, AND PARTICIPANTS Community-dwelling individuals with chronic untreated schizophrenia (untreated patient group) and individuals without mental illness (control group) were recruited from predominantly rural communities in Ningxia, China between June 20, 2016, and August 6, 2019, and administered the Structured Clinical Interview for DSM-IV, the Mini-Mental State Examination, an 8-test version of the MATRICS Consensus Cognition Battery adapted for use in individuals with low levels of education, and a measure of social cognition. MAIN OUTCOMES AND MEASURES Comparison of cognitive test scores between the two groups and association of cognitive test scores with duration of untreated schizophrenia. RESULTS The patient group included 197 individuals with chronic untreated schizophrenia (101 men [51.3%]; mean [SD] age, 52.1 [11.8] years; median [interquartile range] years of schooling, 3 [0-6] years; median [interquartile range] years of untreated psychosis, 22.9 [14.9-32.8] years). The control group included 220 individuals (118 men [53.6%]; mean [SD] age, 52.1 [11.2] years; median [interquartile range] years of schooling, 4 [0-6] years). The untreated patient group performed significantly worse than the control group on all cognitive measures (adjusted partial Spearman correlation coefficient [Spearman ρ] ranged from -0.35 for the revised Chinese version of the Reading the Mind in the Eyes Test to -0.60 for the Brief Visuospatial Memory Test-Revised; P < .001 for all comparisons). Longer durations of untreated psychosis were associated with lower performance in 3 MATRICS Consensus Cognition Battery measures assessing different aspects of executive functioning (Brief Visuospatial Memory Test-Revised [ρ = -0.20; P = .04]; Brief Assessment of Cognition in Schizophrenia, Symbol Coding subtest [ρ = -0.35; P < .001]; and Neuropsychological Assessment Battery, Mazes subtest [ρ = -0.24; P = .01]). The median duration of untreated psychosis (22.9 years) was associated with estimated score reductions in the 3 measures of 34% (95% CI, 10%-52%), 43% (95% CI, 28%-55%), and 57% (95% CI, 31%-73%), respectively. CONCLUSIONS AND RELEVANCE The findings of this study suggest that long-term untreated schizophrenia was associated with decreases in selective cognitive abilities; both neurodegenerative pathology and neurodevelopmental dysfunction may be factors in cognition in persistent psychosis. Expanding research to include cohorts of patients from underserved rural communities in low- and middle-income countries may provide new insights about the etiological factors, disease course, and management of schizophrenia.
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Affiliation(s)
- William S. Stone
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bing Cai
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai, China
| | - Xinhua Liu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Margaux M.-R. Grivel
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York
| | - Gary Yu
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Yangmu Xu
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Xinyi Ouyang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai, China
| | - Hanhui Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai, China
| | - Fei Deng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai, China
| | - Fang Xue
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai, China
| | - Huijun Li
- Department of Psychology, Florida A&M University, Tallahassee
| | - Jeffrey A. Lieberman
- Department of Psychiatry, Columbia University, New York, New York,New York State Psychiatric Institute, New York
| | - Matcheri S. Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ezra S. Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Lawrence H. Yang
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Michael R. Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai, China,Department of Psychiatry, Columbia University, New York, New York,New York State Psychiatric Institute, New York,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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26
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Kantrowitz JT, Grinband J, Goff DC, Lahti AC, Marder SR, Kegeles LS, Girgis RR, Sobeih T, Wall MM, Choo TH, Green MF, Yang YS, Lee J, Horga G, Krystal JH, Potter WZ, Javitt DC, Lieberman JA. Proof of mechanism and target engagement of glutamatergic drugs for the treatment of schizophrenia: RCTs of pomaglumetad and TS-134 on ketamine-induced psychotic symptoms and pharmacoBOLD in healthy volunteers. Neuropsychopharmacology 2020; 45:1842-1850. [PMID: 32403118 PMCID: PMC7608251 DOI: 10.1038/s41386-020-0706-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 02/14/2020] [Revised: 04/12/2020] [Accepted: 05/06/2020] [Indexed: 12/15/2022]
Abstract
Glutamate neurotransmission is a prioritized target for antipsychotic drug development. Two metabotropic glutamate receptor 2/3 (mGluR2/3) agonists (pomaglumetad [POMA] and TS-134) were assessed in two Phase Ib proof of mechanism studies of comparable designs and using identical clinical assessments and pharmacoBOLD methodology. POMA was examined in a randomized controlled trial under double-blind conditions for 10-days at doses of 80 or 320 mg/d POMA versus placebo (1:1:1 ratio). The TS-134 trial was a randomized, single-blind, 6-day study of 20 or 60 mg/d TS-134 versus placebo (5:5:2 ratio). Primary outcomes were ketamine-induced changes in pharmacoBOLD in the dorsal anterior cingulate cortex (dACC) and symptoms reflected on the Brief Psychiatric Rating Scale (BPRS). Both trials were conducted contemporaneously. 95 healthy volunteers were randomized to POMA and 63 to TS-134. High-dose POMA significantly reduced ketamine-induced BPRS total symptoms within and between-groups (p < 0.01, d = -0.41; p = 0.04, d = -0.44, respectively), but neither POMA dose significantly suppressed ketamine-induced dACC pharmacoBOLD. In contrast, low-dose TS-134 led to moderate to large within and between group reductions in both BPRS positive symptoms (p = 0.02, d = -0.36; p = 0.008, d = -0.82, respectively) and dACC pharmacoBOLD (p = 0.004, d = -0.56; p = 0.079, d = -0.50, respectively) using pooled across-study placebo data. High-dose POMA exerted significant effects on clinical symptoms, but not on target engagement, suggesting a higher dose may yet be needed, while the low dose of TS-134 showed evidence of symptom reduction and target engagement. These results support further investigation of mGluR2/3 and other glutamate-targeted treatments for schizophrenia.
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Affiliation(s)
- Joshua T. Kantrowitz
- grid.21729.3f0000000419368729Columbia University, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA ,grid.250263.00000 0001 2189 4777Nathan Kline Institute, Orangeburg, NY USA
| | - Jack Grinband
- grid.21729.3f0000000419368729Columbia University, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA
| | - Donald C. Goff
- grid.250263.00000 0001 2189 4777Nathan Kline Institute, Orangeburg, NY USA ,grid.240324.30000 0001 2109 4251NYU Langone Medical Center, New York, NY USA
| | - Adrienne C. Lahti
- grid.265892.20000000106344187University of Alabama at Birmingham, Birmingham, AL USA
| | | | - Lawrence S. Kegeles
- grid.21729.3f0000000419368729Columbia University, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA
| | - Ragy R. Girgis
- grid.21729.3f0000000419368729Columbia University, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA
| | - Tarek Sobeih
- grid.250263.00000 0001 2189 4777Nathan Kline Institute, Orangeburg, NY USA
| | - Melanie M. Wall
- grid.21729.3f0000000419368729Columbia University, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA
| | - Tse-Hwei Choo
- grid.21729.3f0000000419368729Columbia University, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA
| | | | - Yvonne S. Yang
- grid.19006.3e0000 0000 9632 6718UCLA, Los Angeles, CA USA
| | - Junghee Lee
- grid.19006.3e0000 0000 9632 6718UCLA, Los Angeles, CA USA
| | - Guillermo Horga
- grid.21729.3f0000000419368729Columbia University, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA
| | - John H. Krystal
- grid.47100.320000000419368710Yale University School of Medicine, New Haven, CT USA
| | - William Z. Potter
- grid.94365.3d0000 0001 2297 5165National Institutes of Health, Bethesda, MD USA
| | - Daniel C. Javitt
- grid.21729.3f0000000419368729Columbia University, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA ,grid.250263.00000 0001 2189 4777Nathan Kline Institute, Orangeburg, NY USA
| | - Jeffrey A. Lieberman
- grid.21729.3f0000000419368729Columbia University, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA
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27
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Lu JY, Tiwari AK, Freeman N, Zai GC, Luca VD, Müller DJ, Tampakeras M, Herbert D, Emmerson H, Cheema SY, King N, Voineskos AN, Potkin SG, Lieberman JA, Meltzer HY, Remington G, Kennedy JL, Zai CC. Liver enzyme CYP2D6 gene and tardive dyskinesia. Pharmacogenomics 2020; 21:1065-1072. [PMID: 32969762 DOI: 10.2217/pgs-2020-0065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Tardive dyskinesia (TD) is an iatrogenic involuntary movement disorder occurring after extended antipsychotic use with unclear pathogenesis. CYP2D6 is a liver enzyme involved in antipsychotic metabolism and a well-studied gene candidate for TD. Materials & methods: We tested predicted CYP2D6 metabolizer phenotype with TD occurrence and severity in our two samples of European chronic schizophrenia patients (total n = 198, of which 82 had TD). Results: TD occurrence were associated with extreme metabolizer phenotype, controlling for age and sex (p = 0.012). In other words, individuals with either increased and no CYP2D6 activity were at higher risk of having TD. Conclusion: Unlike most previous findings, TD occurrence may be associated with both extremes of CYP2D6 metabolic activity rather than solely for poor metabolizers.
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Affiliation(s)
- Justin Y Lu
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5T 1R8, Canada
| | - Arun K Tiwari
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5T 1R8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
| | - Natalie Freeman
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5T 1R8, Canada
| | - Gwyneth C Zai
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5T 1R8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Vincenzo de Luca
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5T 1R8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Daniel J Müller
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5T 1R8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Maria Tampakeras
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5T 1R8, Canada
| | - Deanna Herbert
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5T 1R8, Canada
| | - Heather Emmerson
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5T 1R8, Canada
| | - Sheraz Y Cheema
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5T 1R8, Canada
| | - Nicole King
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5T 1R8, Canada
| | - Aristotle N Voineskos
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5T 1R8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Steven G Potkin
- Department of Psychiatry & Human Behavior, Long Beach Veterans Administration Health Care System, University of California, Irvine, Irvine, CA 92617, USA
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York City, NY 10032, USA
| | - Herbert Y Meltzer
- Psychiatry & Behavioral Sciences, Pharmacology & Physiology, Chemistry of Life Processes Institute, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Gary Remington
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5T 1R8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - James L Kennedy
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5T 1R8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Clement C Zai
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5T 1R8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada.,Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, M5S 1A8, Canada
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28
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Yoshida K, Maciukiewicz M, Zai CC, Gonçalves VF, Brandl EJ, Lieberman JA, Meltzer HY, Tiwari AK, Kennedy JL, Müller DJ. Association between the -2548G/A polymorphism of the leptin gene and antipsychotic-induced weight gain: Analysis of the CATIE sample and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2020; 102:109952. [PMID: 32335267 DOI: 10.1016/j.pnpbp.2020.109952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/06/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antipsychotics, especially most of the second-generation antipsychotics, have a high risk for metabolic syndrome and antipsychotic-induced weight gain (AIWG). A promoter variant of the leptin (LEP) gene, -2548G/A (rs7799039), has been associated with AIWG in several studies. The aim of this study was to evaluate this association in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) sample, followed by meta-analysis. METHODS We investigated the association between rs7799039 and AIWG in a sub-sample of European (N = 164) individuals from the CATIE study. Body mass index (BMI) change and weight gain (presence or absence) was analyzed using ANCOVA and logistic regression, respectively. For the meta-analysis, a literature search was conducted using MEDLINE, Embase, and PsycINFO up to October 2019. The pooled odds ratio was calculated for presence or absence of weight gain (≥7% weight change) using a random effects model. RESULTS We did not detect an association between rs7799039 and BMI change or weight gain (presence or absence) in the CATIE sample. As for the meta-analysis, we included 12 studies. No significant associations between the LEP rs7799039 polymorphism and AIWG were observed under the allelic genetic model (allele A vs. allele G) (OR = 1.10 [0.71, 1.70], p = .68). In the subgroup analyses of first-episode schizophrenia patients, a significant association between the A-allele and weight gain was observed, respectively (OR = 2.32 [1.41, 3.82], p = .0009). CONCLUSIONS The present meta-analysis showed no significant effect of rs7799039 on AIWG. However, this variant may influence AIWG in first-episode schizophrenia patients. Further investigation of a larger and more homogenous sample is required to elucidate the role of the LEP gene in AIWG.
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Affiliation(s)
- Kazunari Yoshida
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Malgorzata Maciukiewicz
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Rheumatology, Center of Experimental Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Clement C Zai
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Vanessa F Gonçalves
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eva J Brandl
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jeffrey A Lieberman
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, The New York State Psychiatric Institute, New York City, NY, USA
| | - Herbert Y Meltzer
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Evanston, IL, USA
| | - Arun K Tiwari
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - James L Kennedy
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Daniel J Müller
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Kantrowitz JT, Javitt DC, Freedman R, Sehatpour P, Kegeles LS, Carlson M, Sobeih T, Wall MM, Choo TH, Vail B, Grinband J, Lieberman JA. Double blind, two dose, randomized, placebo-controlled, cross-over clinical trial of the positive allosteric modulator at the alpha7 nicotinic cholinergic receptor AVL-3288 in schizophrenia patients. Neuropsychopharmacology 2020; 45:1339-1345. [PMID: 32015461 PMCID: PMC7298033 DOI: 10.1038/s41386-020-0628-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/06/2020] [Accepted: 01/26/2020] [Indexed: 11/09/2022]
Abstract
Despite their theoretical rationale, nicotinic alpha-7 acetylcholine (nα7) receptor agonists, have largely failed to demonstrate efficacy in placebo-controlled trials in schizophrenia. AVL-3288 is a nα7 positive allosteric modulator (PAM), which is only active in the presence of the endogenous ligand (acetylcholine), and thus theoretically less likely to cause receptor desensitization. We evaluated the efficacy of AVL-3288 in a Phase 1b, randomized, double-blind, placebo-controlled, triple cross-over study. Twenty-four non-smoking, medicated, outpatients with schizophrenia or schizoaffective disorder and a Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) ≥62 were randomized. Each subject received 5 days of AVL-3288 (10, 30 mg) and placebo across three separate treatment weeks. The primary outcome measure was the RBANS total scale score, with auditory P50 evoked potential suppression the key target engagement biomarker. Secondary outcome measures include task-based fMRI (RISE task), mismatch negativity, the Scale for the Assessment of Negative Symptoms of Schizophrenia (SANS) and the Brief Psychiatric Rating Scale (BPRS). Twenty-four subjects were randomized and treated without any clinically significant treatment emergent adverse effects. Baseline RBANS (82 ± 17) and BPRS (41 ± 13) scores were consistent with moderate impairment. Primary outcomes were negative, with non-significant worsening for both active groups vs. placebo in the P50 and minimal between group changes on the RBANS. In conclusion, the results did not indicate efficacy of the compound, consistent with most prior results for the nα7 target.
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Affiliation(s)
- Joshua T. Kantrowitz
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA ,0000 0001 2189 4777grid.250263.0Nathan Kline Institute, Orangeburg, USA
| | - Daniel C. Javitt
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA ,0000 0001 2189 4777grid.250263.0Nathan Kline Institute, Orangeburg, USA
| | | | - Pejman Sehatpour
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA ,0000 0001 2189 4777grid.250263.0Nathan Kline Institute, Orangeburg, USA
| | - Lawrence S. Kegeles
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA
| | - Marlene Carlson
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA
| | - Tarek Sobeih
- 0000 0001 2189 4777grid.250263.0Nathan Kline Institute, Orangeburg, USA
| | - Melanie M. Wall
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA
| | - Tse-Hwei Choo
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA
| | - Blair Vail
- 0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA
| | - Jack Grinband
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA
| | - Jeffrey A. Lieberman
- 0000000419368729grid.21729.3fColumbia University, New York, USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, USA
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30
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Maes MS, Lu JY, Tiwari AK, Freeman N, de Luca V, Müller DJ, Voineskos AN, Potkin SG, Lieberman JA, Meltzer HY, Remington G, Kennedy JL, Zai CC. Schizophrenia-associated gene dysbindin-1 and tardive dyskinesia. Drug Dev Res 2020; 82:678-684. [PMID: 32394511 DOI: 10.1002/ddr.21681] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/15/2022]
Abstract
Tardive dyskinesia (TD) is a potentially irreversible movement disorder observed following long-term antipsychotic exposure. Its cause is unknown; however, a genetic component has been supported by studies of affected families. Dysbindin-1, encoded by the dystrobrevin-binding protein 1 DTNBP1 gene, has been associated with schizophrenia and is potentially involved in dopamine neurotransmission through its regulation of dopamine release and dopamine D2 receptor recycling, making it a candidate for investigation in TD. We investigated common variants across the DTNBP1 gene in our schizophrenia/patients with schizoaffective disorder of European ancestry. We found a number of DTNBP1 three-marker haplotypes to be associated with TD occurrence and TD severity (p < 0.05). These preliminary findings, if replicated in larger independent samples, would suggest that drugs targeting dysbindin-1 may be an option in the prevention and treatment of TD.
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Affiliation(s)
- Miriam S Maes
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Justin Y Lu
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Arun K Tiwari
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Freeman
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Vincenzo de Luca
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Daniel J Müller
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Aristotle N Voineskos
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Steven G Potkin
- Department of Psychiatry and Human Behavior, Long Beach Veterans Administration Health Care System, University of California, Irvine, California, USA
| | - Jeffrey A Lieberman
- New York State Psychiatric Institute, Columbia University, New York City, New York, USA
| | - Herbert Y Meltzer
- Psychiatry and Behavioral Sciences, Pharmacology and Physiology, Chemistry of Life Processes Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gary Remington
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - James L Kennedy
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Clement C Zai
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Clelland CL, Kantrowitz JT, Choo T, Clelland JD, Lieberman JA. Adjunctive sapropterin dihydrochloride treatment in schizophrenia: A positive proof-of-concept, rater-blind, randomized, multivitamin-controlled study. Schizophr Res 2020; 218:321-323. [PMID: 31973997 DOI: 10.1016/j.schres.2019.12.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Catherine L Clelland
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA; Department of Pathology and Cell Biology, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA.
| | - Joshua T Kantrowitz
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Schizophrenia Research Center, The Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA
| | - Tse Choo
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - James D Clelland
- Clinical Research Department, The Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
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32
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Correll CU, Davis RE, Weingart M, Saillard J, O’Gorman C, Kane JM, Lieberman JA, Tamminga CA, Mates S, Vanover KE. Efficacy and Safety of Lumateperone for Treatment of Schizophrenia: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:349-358. [PMID: 31913424 PMCID: PMC6990963 DOI: 10.1001/jamapsychiatry.2019.4379] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022]
Abstract
Importance Individuals living with schizophrenia are affected by cardiometabolic, endocrine, and motor adverse effects of current antipsychotic medications. Lumateperone is a serotonin, dopamine, and glutamate modulator with the potential to treat schizophrenia with few adverse effects. Objective To examine the efficacy and safety of lumateperone for the short-term treatment of schizophrenia. Design, Setting, and Participants This randomized, double-blind, placebo-controlled, phase 3 clinical trial was conducted from November 13, 2014, to July 20, 2015, with data analyses performed from August 13 to September 15, 2015. Patients with schizophrenia who were aged 18 to 60 years and were experiencing an acute exacerbation of psychosis were enrolled from 12 clinical sites in the United States. Interventions Patients were randomized 1:1:1 (150 patients in each arm) to receive lumateperone tosylate, 60 mg; lumateperone tosylate, 40 mg (equivalent to 42 or 28 mg, respectively, of the active moiety lumateperone); or placebo once daily for 4 weeks. Main Outcomes and Measures The prespecified primary efficacy end point was mean change from baseline to day 28 in the Positive and Negative Syndrome Scale (PANSS) total score vs placebo. The key secondary efficacy measure was the Clinical Global Impression-Severity of Illness (CGI-S) score. The PANSS subscale scores, social function, safety, and tolerability were also assessed. Results The study comprised 450 patients (mean [SD] age, 42.4 [10.2] years; 346 [77.1%] male; mean [SD] baseline PANSS score, 89.8 [10.3]; mean [SD] baseline CGI-S score, 4.8 [0.6]). In the prespecified modified intent-to-treat efficacy analysis (n = 435), 42 mg of lumateperone met the primary and key secondary efficacy objectives, demonstrating a statistically significant improvement vs placebo from baseline to day 28 on the PANSS total score (least-squares mean difference [LSMD], -4.2; 95% CI, -7.8 to -0.6; P = .02; effect size [ES], -0.3) and the CGI-S (LSMD, -0.3; 95% CI, -0.5 to -0.1; P = .003; ES, -0.4). For 28 mg of lumateperone, the LSMD from baseline to day 28 was -2.6 (95% CI, -6.2 to 1.1; P = .16; ES, -0.2) on the PANSS total score and -0.2 (95% CI, -0.5 to 0.0; P = .02; ES, -0.3) on the CGI-S. Both lumateperone doses were well tolerated without clinically significant treatment-emergent motor adverse effects or changes in cardiometabolic or endocrine factors vs placebo. Conclusions and Relevance Lumateperone demonstrated efficacy for improving the symptoms of schizophrenia and had a favorable safety profile. Trial Registration ClinicalTrials.gov identifier: NCT02282761.
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Affiliation(s)
- Christoph U. Correll
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, New York
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Cedric O’Gorman
- Intra-Cellular Therapies Inc, New York, New York
- Now with Axsome Therapeutics Inc, New York, New York
| | - John M. Kane
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, New York
| | - Jeffrey A. Lieberman
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York
| | - Carol A. Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
| | - Sharon Mates
- Intra-Cellular Therapies Inc, New York, New York
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Provenzano FA, Guo J, Wall MM, Feng X, Sigmon HC, Brucato G, First MB, Rothman DL, Girgis RR, Lieberman JA, Small SA. Hippocampal Pathology in Clinical High-Risk Patients and the Onset of Schizophrenia. Biol Psychiatry 2020; 87:234-242. [PMID: 31771861 DOI: 10.1016/j.biopsych.2019.09.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [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: 04/01/2019] [Revised: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND We examined neuroimaging-derived hippocampal biomarkers in subjects at clinical high risk (CHR) for psychosis to further characterize the pathophysiology of early psychosis. We hypothesized that glutamate hyperactivity, reflected by increased metabolic activity derived from functional magnetic resonance imaging in the CA1 hippocampal subregion and from proton magnetic resonance spectroscopy-derived hippocampal levels of glutamate/glutamine, represents early hippocampal dysfunction in CHR subjects and is predictive of conversion to syndromal psychosis. METHODS We enrolled 75 CHR individuals with attenuated positive symptom psychosis-risk syndrome as defined by the Structured Interview for Psychosis-risk Syndromes. We used optimized magnetic resonance imaging techniques to measure 3 validated in vivo pathologies of hippocampal dysfunction-focal cerebral blood volume, focal atrophy, and evidence of elevated glutamate concentrations. All patients were imaged at baseline and were followed for up to 2 years to assess for conversion to psychosis. RESULTS At baseline, compared with control subjects, CHR individuals had high glutamate/glutamine and elevated focal cerebral blood volume on functional magnetic resonance imaging, but only baseline focal hippocampal atrophy predicted progression to syndromal psychosis. CONCLUSIONS These findings provide evidence that CHR patients with attenuated psychotic symptoms have glutamatergic abnormalities, although only CHR patients who develop syndromal psychosis exhibit focal hippocampal atrophy. Furthermore, these results support the growing evidence that hippocampal dysfunction is an early feature of schizophrenia and related psychotic disorders.
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Affiliation(s)
| | - Jia Guo
- Department of Psychiatry, Columbia University, New York, New York
| | - Melanie M Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Xinyang Feng
- Department of Neurology, Columbia University, New York, New York; Department of Biomedical Engineering, Columbia University, New York, New York
| | - Hannah C Sigmon
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Gary Brucato
- Department of Psychiatry, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York
| | | | - Douglas L Rothman
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut; Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Ragy R Girgis
- Department of Psychiatry, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York.
| | - Scott A Small
- Department of Neurology, Columbia University, New York, New York.
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de la Garrigue N, Glasser J, Sehatpour P, Iosifescu DV, Dias E, Carlson M, Shope C, Sobeih T, Choo TH, Wall MM, Kegeles LS, Gangwisch J, Mayer M, Brazis S, De Baun HM, Wolfer S, Bermudez D, Arnold M, Rette D, Meftah AM, Conant M, Lieberman JA, Kantrowitz JT. Grant Report on d-Serine Augmentation of Neuroplasticity-Based Auditory Learning in Schizophrenia †. J Psychiatr Brain Sci 2020; 5:e200018. [PMID: 32856005 PMCID: PMC7448686] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We report on the rationale and design of an ongoing NIMH sponsored R61-R33 project in schizophrenia/schizoaffective disorder. This project studies augmenting the efficacy of auditory neuroplasticity cognitive remediation (AudRem) with d-serine, an N-methyl-d-aspartate-type glutamate receptor (NMDAR) glycine-site agonist. We operationalize improved (smaller) thresholds in pitch (frequency) between successive auditory stimuli after AudRem as improved plasticity, and mismatch negativity (MMN) and auditory θ as measures of functional target engagement of both NMDAR agonism and plasticity. Previous studies showed that AudRem alone produces significant, but small cognitive improvements, while d-serine alone improves symptoms and MMN. However, the strongest results for plasticity outcomes (improved pitch thresholds, auditory MMN and θ) were found when combining d-serine and AudRem. AudRem improvements correlated with reading and other auditory cognitive tasks, suggesting plasticity improvements are predictive of functionally relevant outcomes. While d-serine appears to be efficacious for acute AudRem enhancement, the optimal dose remains an open question, as does the ability of combined d-serine + AudRem to produce sustained improvement. In the ongoing R61, 45 schizophrenia patients will be randomized to receive three placebo-controlled, double-blind d-serine + AudRem sessions across three separate 15 subject dose cohorts (80/100/120 mg/kg). Successful completion of the R61 is defined by ≥moderate effect size changes in target engagement and correlation with function, without safety issues. During the three-year R33, we will assess the sustained effects of d-serine + AudRem. In addition to testing a potentially viable treatment, this project will develop a methodology to assess the efficacy of novel NMDAR modulators, using d-serine as a "gold-standard".
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Affiliation(s)
| | - Juliana Glasser
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Pejman Sehatpour
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA,Nathan Kline Institute, Orangeburg, NY 10962, USA
| | - Dan V. Iosifescu
- Nathan Kline Institute, Orangeburg, NY 10962, USA,NYU Langone Medical Center, New York, NY 10016, USA
| | - Elisa Dias
- Nathan Kline Institute, Orangeburg, NY 10962, USA,NYU Langone Medical Center, New York, NY 10016, USA
| | - Marlene Carlson
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | | | - Tarek Sobeih
- Nathan Kline Institute, Orangeburg, NY 10962, USA
| | - Tse-Hwei Choo
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Melanie M. Wall
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Lawrence S. Kegeles
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - James Gangwisch
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Megan Mayer
- New York State Psychiatric Institute, New York, NY 10032, USA
| | | | | | | | - Dalton Bermudez
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Molly Arnold
- Nathan Kline Institute, Orangeburg, NY 10962, USA
| | | | - Amir M. Meftah
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Melissa Conant
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Jeffrey A. Lieberman
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Joshua T. Kantrowitz
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA,Nathan Kline Institute, Orangeburg, NY 10962, USA,Correspondence: Joshua T. Kantrowitz, ; Tel.: +1-646-774-6738
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Lieberman JA, Fyer A. The smartest person in the room: Donald F. Klein, M.D. (1928-2019). Neuropsychopharmacology 2019; 44:2296-2297. [PMID: 31551481 PMCID: PMC6898686 DOI: 10.1038/s41386-019-0525-2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Jeffrey A. Lieberman
- 0000000419368729grid.21729.3fColumbia University Department of Psychiatry New York State Psychiatric Institute, New York, NY USA
| | - Abby Fyer
- 0000000419368729grid.21729.3fColumbia University Department of Psychiatry New York State Psychiatric Institute, New York, NY USA
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36
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Kraus MS, Gold JM, Barch DM, Walker TM, Chun CA, Buchanan RW, Csernansky JG, Goff DC, Green MF, Jarskog LF, Javitt DC, Kimhy D, Lieberman JA, McEvoy JP, Mesholam-Gately RI, Seidman LJ, Ball MP, Kern RS, McMahon RP, Robinson J, Marder SR, Keefe RSE. The characteristics of cognitive neuroscience tests in a schizophrenia cognition clinical trial: Psychometric properties and correlations with standard measures. Schizophr Res Cogn 2019; 19:100161. [PMID: 31832342 PMCID: PMC6889798 DOI: 10.1016/j.scog.2019.100161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 07/24/2019] [Accepted: 08/25/2019] [Indexed: 11/28/2022]
Abstract
In comparison to batteries of standard neuropsychological tests, cognitive neuroscience tests may offer a more specific assessment of discrete neurobiological processes that may be aberrant in schizophrenia. However, more information regarding psychometric properties and correlations with standard neuropsychological tests and functional measures is warranted to establish their validity as treatment outcome measures. The N-back and AX-Continuous Performance Task (AX-CPT) are two promising cognitive neuroscience tests designed to measure specific components of working memory and contextual processing respectively. In the current study, we report the psychometric properties of multiple outcome measures from these two tests as well as their correlations with standard neuropsychological measures and functional capacity measures. The results suggest that while the AX-CPT and N-back display favorable psychometric properties, they do not exhibit greater sensitivity or specificity with functional measures than standard neurocognitive tests.
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Affiliation(s)
- Michael S Kraus
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Deanna M Barch
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States of America
| | - Trina M Walker
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | | | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - John G Csernansky
- Department of Psychiatry, Northwestern Feinberg School of Medicine, Chicago, IL, United States of America
| | - Donald C Goff
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States of America
| | - Michael F Green
- UCLA Semel Institute for Neuroscience and Human Behavior, United States of America.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America
| | - L Fredrik Jarskog
- North Carolina Psychiatric Research Center, Department of Psychiatry, University of North Carolina at Chapel Hill, United States of America
| | - Daniel C Javitt
- Department of Psychiatry, Nathan Kline Institute for Psychiatric Research, New York University School of Medicine, New York, NY, United States of America
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jeffrey A Lieberman
- Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons, Columbia University, United States of America
| | - Joseph P McEvoy
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - Raquelle I Mesholam-Gately
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Larry J Seidman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States of America.,Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - M Patricia Ball
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Robert S Kern
- UCLA Semel Institute for Neuroscience and Human Behavior, United States of America.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America
| | - Robert P McMahon
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - James Robinson
- Department of Psychiatry, Nathan Kline Institute for Psychiatric Research, New York University School of Medicine, New York, NY, United States of America
| | - Stephen R Marder
- UCLA Semel Institute for Neuroscience and Human Behavior, United States of America.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America
| | - Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
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37
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Bitter I, Lieberman JA, Gaudoux F, Sokoloff P, Groc M, Chavda R, Delsol C, Barthe L, Brunner V, Fabre C, Fagard M, Montagne A, Tonner F. Randomized, double-blind, placebo-controlled study of F17464, a preferential D 3 antagonist, in the treatment of acute exacerbation of schizophrenia. Neuropsychopharmacology 2019; 44:1917-1924. [PMID: 30822774 PMCID: PMC6785149 DOI: 10.1038/s41386-019-0355-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 09/04/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/30/2022]
Abstract
F17464, a highly potent preferential D3 antagonist, is a novel compound in development for schizophrenia treatment. This phase II, double-blind, randomized, placebo-controlled, parallel-group study in five European countries evaluated the efficacy and safety of F17464, 20 mg twice daily, versus placebo over 6 weeks in patients with acute exacerbation of schizophrenia. Change from baseline to Day 43 of the Positive and Negative Syndrome Scale (PANSS) total score was the primary outcome. The data from 134 randomized patients (67 per group) were analyzed (efficacy/safety). Using analysis of covariance (ANCOVA) after last observation carried forward (LOCF) imputation (primary analysis), the PANSS total score reduction was statistically significantly greater for F17464 than placebo treated subjects at endpoint (p = 0.014); using ANCOVA with Multiple Imputation (MI) method, the between-group difference was in favor of F17464 but did not reach statistical significance. Differences in PANSS positive and general psychopathology subscale score, Marder positive factor score, PANSS response, and PANSS resolution criteria were also statistically significant in favor of F17464 (p values < 0.05) using the LOCF method, with similar results as for the primary analysis using the MI method. Treatment-related adverse events (AEs) were reported in 49.3% and 46.3% of patients on F17464 and placebo, respectively. The most common AEs in F17464 group: insomnia, agitation, and increased triglycerides; worsening of schizophrenia/drug ineffective was less frequent in F17464. Interestingly, no weight gain, no extrapyramidal disorder except rare akathisia were observed under F17464. This 6-week trial demonstrated therapeutic efficacy of 40 mg/day F17464 in improving symptoms of acute exacerbation of schizophrenia with a favorable safety profile.
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Affiliation(s)
- Istvan Bitter
- 0000 0001 0942 9821grid.11804.3cDepartment of Psychiatry and Psychotherapy, Semmelweis University, Balassa u.6, Budapest, 1083 Hungary
| | - Jeffrey A. Lieberman
- 0000 0000 8499 1112grid.413734.6New York Presbyterian Hospital – Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032 USA
| | - Florence Gaudoux
- 0000 0001 2188 9169grid.417944.bInstitut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000 France
| | | | - Mélanie Groc
- 0000 0001 2188 9169grid.417944.bInstitut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000 France
| | - Rajeev Chavda
- Galderma, Rue D’Entre-deux-Villes 10, La Tour de Peilz, 1814 Switzerland
| | - Cécile Delsol
- 0000 0001 2188 9169grid.417944.bInstitut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000 France
| | - Laurence Barthe
- 0000 0001 2188 9169grid.417944.bInstitut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000 France
| | | | - Carine Fabre
- 0000 0001 2188 9169grid.417944.bInstitut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000 France
| | - Marine Fagard
- 0000 0001 2188 9169grid.417944.bInstitut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000 France
| | - Agnès Montagne
- 0000 0001 2188 9169grid.417944.bInstitut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000 France
| | - Françoise Tonner
- Institut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000, France.
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Abstract
Scientific progress in understanding human disease can be measured by the effectiveness of its treatment. Antipsychotic drugs have been proven to alleviate acute psychotic symptoms and prevent their recurrence in schizophrenia, but the outcomes of most patients historically have been suboptimal. However, a series of findings in studies of first-episode schizophrenia patients transformed the psychiatric field's thinking about the pathophysiology, course, and potential for disease-modifying effects of treatment. These include the relationship between the duration of untreated psychotic symptoms and outcome; the superior responses of first-episode patients to antipsychotics compared with patients with chronic illness, and the reduction in brain gray matter volume over the course of the illness. Studies of the effectiveness of early detection and intervention models of care have provided encouraging but inconclusive results in limiting the morbidity and modifying the course of illness. Nevertheless, first-episode psychosis studies have established an evidentiary basis for considering a team-based, coordinated specialty approach as the standard of care for treating early psychosis, which has led to their global proliferation. In contrast, while clinical high-risk research has developed an evidence-based care model for decreasing the burden of attenuated symptoms, no treatment has been shown to reduce risk or prevent the transition to syndromal psychosis. Moreover, the current diagnostic criteria for clinical high risk lack adequate specificity for clinical application. What limits our ability to realize the potential of early detection and intervention models of care are the lack of sensitive and specific diagnostic criteria for pre-syndromal schizophrenia, validated biomarkers, and proven therapeutic strategies. Future research requires methodologically rigorous studies in large patient samples, across multiple sites, that ideally are guided by scientifically credible pathophysiological theories for which there is compelling evidence. These caveats notwithstanding, we can reasonably expect future studies to build on the research of the past four decades to advance our knowledge and enable this game-changing model of care to become a reality.
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Affiliation(s)
- Jeffrey A Lieberman
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
| | - Scott A Small
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
| | - Ragy R Girgis
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
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Tiwari AK, Zhang D, Pouget JG, Zai CC, Chowdhury NI, Brandl EJ, Qin L, Freeman N, Lieberman JA, Meltzer HY, Kennedy JL, Müller DJ. Impact of histamine receptors H1 and H3 polymorphisms on antipsychotic-induced weight gain. World J Biol Psychiatry 2019; 19:S97-S105. [PMID: 27855565 DOI: 10.1080/15622975.2016.1262061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/20/2022]
Abstract
OBJECTIVES A positive correlation between antipsychotic-induced weight gain (AIWG) and the antagonist effect of antipsychotic drugs at the histamine H1 receptor (HRH1) as well as the agonist effect at the histamine H3 receptor (HRH3) in the brain has been consistently demonstrated. We investigated the potential impact of single-nucleotide polymorphisms (SNPs) in HRH1 and HRH3 genes on AIWG. METHODS We analysed 40 tagSNPs in HRH1 (n = 34) and HRH3 (n = 6) in schizophrenia/schizoaffective disorder patients (n = 193) primarily treated with clozapine or olanzapine for up to 14 weeks. Linear regression was used to evaluate the association between SNPs and AIWG, with baseline weight and treatment duration as covariates. RESULTS In HRH1, a nominal association of rs7639145 with AIWG was observed in patients of European ancestry treated with either clozapine or olanzapine (P = 0.043; β = 1.658; n = 77). We observed nominal association for two HRH1 SNPs rs346074 (P = 0.002; β = -5.024) and rs13064530 (P = 0.004; β = -5.158) in patients of African ancestry treated with either clozapine or olanzapine (n = 37). However, the above associations are not significant after correcting for multiple testing. In HRH3, we did not observe association in either ancestry. CONCLUSIONS The current study suggests that SNPs in HRH1 and HRH3 may not have a major role in AIWG.
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Affiliation(s)
- Arun K Tiwari
- a Neurogenetics Section, Neuroscience Department , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada.,b Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Danning Zhang
- a Neurogenetics Section, Neuroscience Department , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada
| | - Jennie G Pouget
- a Neurogenetics Section, Neuroscience Department , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada.,b Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Clement C Zai
- a Neurogenetics Section, Neuroscience Department , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada.,b Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Nabilah I Chowdhury
- a Neurogenetics Section, Neuroscience Department , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada
| | - Eva J Brandl
- a Neurogenetics Section, Neuroscience Department , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada.,c Department of Psychiatry and Psychotherapy , Campus Mitte, Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Li Qin
- a Neurogenetics Section, Neuroscience Department , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada
| | - Natalie Freeman
- a Neurogenetics Section, Neuroscience Department , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada
| | - Jeffrey A Lieberman
- d Department of Psychiatry, College of Physicians and Surgeons , Columbia University and the New York State Psychiatric Institute , New York City , NY , USA
| | - Herbert Y Meltzer
- e Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - James L Kennedy
- a Neurogenetics Section, Neuroscience Department , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada.,b Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Daniel J Müller
- a Neurogenetics Section, Neuroscience Department , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada.,b Department of Psychiatry , University of Toronto , Toronto , ON , Canada
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40
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Alkelai A, Greenbaum L, Heinzen EL, Baugh EH, Teitelbaum A, Zhu X, Strous RD, Tatarskyy P, Zai CC, Tiwari AK, Tampakeras M, Freeman N, Müller DJ, Voineskos AN, Lieberman JA, Delaney SL, Meltzer HY, Remington G, Kennedy JL, Pulver AE, Peabody EP, Levy DL, Lerer B. New insights into tardive dyskinesia genetics: Implementation of whole-exome sequencing approach. Prog Neuropsychopharmacol Biol Psychiatry 2019; 94:109659. [PMID: 31153890 DOI: 10.1016/j.pnpbp.2019.109659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 04/02/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 02/07/2023]
Abstract
Tardive dyskinesia (TD) is an adverse movement disorder induced by chronic treatment with antipsychotics drugs. The contribution of common genetic variants to TD susceptibility has been investigated in recent years, but with limited success. The aim of the current study was to investigate the potential contribution of rare variants to TD vulnerability. In order to identify TD risk genes, we performed whole-exome sequencing (WES) and gene-based collapsing analysis focusing on rare (allele frequency < 1%) and putatively deleterious variants (qualifying variants). 82 Jewish schizophrenia patients chronically treated with antipsychotics were included and classified as having severe TD or lack of any abnormal movements based on a rigorous definition of the TD phenotype. First, we performed a case-control, exome-wide collapsing analysis comparing 39 schizophrenia patients with severe TD to 3118 unrelated population controls. Then, we checked the potential top candidate genes among 43 patients without any TD manifestations. All the genes that were found to harbor one or more qualifying variants in patients without any TD features were excluded from the final list of candidate genes. Only one gene, regulating synaptic membrane exocytosis 2 (RIMS2), showed significant enrichment of qualifying variants in TD patients compared with unrelated population controls after correcting for multiple testing (Fisher's exact test p = 5.32E-08, logistic regression p = 2.50E-08). Enrichment was caused by a single variant (rs567070433) due to a frameshift in an alternative transcript of RIMS2. None of the TD negative patients had qualifying variants in this gene. In a validation cohort of 140 schizophrenia patients assessed for TD, the variant was also not detected in any individual. Some potentially suggestive TD genes were detected in the TD cohort and warrant follow-up in future studies. No significant enrichment in previously reported TD candidate genes was identified. To the best of our knowledge, this is the first WES study of TD, demonstrating the potential role of rare loss-of-function variant enrichment in this pharmacogenetic phenotype.
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Affiliation(s)
- Anna Alkelai
- Institute for Genomic Medicine, Columbia University Medical Center, New York, USA.
| | - Lior Greenbaum
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erin L Heinzen
- Institute for Genomic Medicine, Columbia University Medical Center, New York, USA
| | - Evan H Baugh
- Institute for Genomic Medicine, Columbia University Medical Center, New York, USA
| | - Alexander Teitelbaum
- Jerusalem Mental Health Center, Kfar Shaul Psychiatric Hospital, Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Xiaolin Zhu
- Institute for Genomic Medicine, Columbia University Medical Center, New York, USA
| | - Rael D Strous
- Maayenei Hayeshua Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pavel Tatarskyy
- Biological Psychiatry Laboratory, Department of Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Clement C Zai
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Arun K Tiwari
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Maria Tampakeras
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Natalie Freeman
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Daniel J Müller
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Aristotle N Voineskos
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Jeffrey A Lieberman
- Columbia University, New York State Psychiatric Institute, New York City, NY, USA
| | - Shannon L Delaney
- Columbia University, New York State Psychiatric Institute, New York City, NY, USA
| | - Herbert Y Meltzer
- Psychiatry and Behavioral Sciences, Pharmacology and Physiology, Chemistry of Life Processes Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gary Remington
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - James L Kennedy
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Ann E Pulver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emma P Peabody
- Psychology Research Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Deborah L Levy
- Psychology Research Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Bernard Lerer
- Biological Psychiatry Laboratory, Department of Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Affiliation(s)
- Ryan E Lawrence
- Department of Psychiatry, New York-Presbyterian Hospital, New York.,Department of Psychiatry, Columbia University Medical Center, New York, New York
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Medical Center, New York, New York.,New York State Psychiatric Institute, New York
| | - Jeffrey A Lieberman
- Department of Psychiatry, New York-Presbyterian Hospital, New York.,Department of Psychiatry, Columbia University Medical Center, New York, New York.,New York State Psychiatric Institute, New York
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42
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Feng X, Provenzano F, Appelbaum PS, Masucci MD, Brucato G, Lieberman JA, Girgis RR. Amygdalar volume and violent ideation in a sample at clinical high-risk for psychosis. Psychiatry Res Neuroimaging 2019; 287:60-62. [PMID: 30991249 PMCID: PMC6524143 DOI: 10.1016/j.pscychresns.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/16/2019] [Revised: 04/05/2019] [Accepted: 04/07/2019] [Indexed: 01/04/2023]
Abstract
We previously demonstrated that violent ideation predicts both violent acts and eventual progression to syndromal psychosis in individuals at clinical high-risk for psychosis (CHR). We performed amygdalar surface morphometry analysis on MRI scans from 70 CHR individuals, 21 of whom had violent ideation, 49 of whom did not. CHR individuals with violent ideation have abnormal and asymmetric amygdalar volumes. These data suggest some commonalities in the genesis of violence and aggression among clinical populations, as well as that there may be specific neurobiological links between violence and psychosis.
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Affiliation(s)
- Xinyang Feng
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute (NYSPI), 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Frank Provenzano
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute (NYSPI), 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Paul S Appelbaum
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute (NYSPI), 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Michael D Masucci
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute (NYSPI), 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Gary Brucato
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute (NYSPI), 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Jeffrey A Lieberman
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute (NYSPI), 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Ragy R Girgis
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute (NYSPI), 1051 Riverside Drive, Unit 31, New York, NY 10032, USA.
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43
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Ciarleglio AJ, Brucato G, Masucci MD, Altschuler R, Colibazzi T, Corcoran CM, Crump FM, Horga G, Lehembre-Shiah E, Leong W, Schobel SA, Wall MM, Yang LH, Lieberman JA, Girgis RR. A predictive model for conversion to psychosis in clinical high-risk patients. Psychol Med 2019; 49:1128-1137. [PMID: 29950184 PMCID: PMC6374204 DOI: 10.1017/s003329171800171x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 01/05/2023]
Abstract
BACKGROUND The authors developed a practical and clinically useful model to predict the risk of psychosis that utilizes clinical characteristics empirically demonstrated to be strong predictors of conversion to psychosis in clinical high-risk (CHR) individuals. The model is based upon the Structured Interview for Psychosis Risk Syndromes (SIPS) and accompanying clinical interview, and yields scores indicating one's risk of conversion. METHODS Baseline data, including demographic and clinical characteristics measured by the SIPS, were obtained on 199 CHR individuals seeking evaluation in the early detection and intervention for mental disorders program at the New York State Psychiatric Institute at Columbia University Medical Center. Each patient was followed for up to 2 years or until they developed a syndromal DSM-4 disorder. A LASSO logistic fitting procedure was used to construct a model for conversion specifically to a psychotic disorder. RESULTS At 2 years, 64 patients (32.2%) converted to a psychotic disorder. The top five variables with relatively large standardized effect sizes included SIPS subscales of visual perceptual abnormalities, dysphoric mood, unusual thought content, disorganized communication, and violent ideation. The concordance index (c-index) was 0.73, indicating a moderately strong ability to discriminate between converters and non-converters. CONCLUSIONS The prediction model performed well in classifying converters and non-converters and revealed SIPS measures that are relatively strong predictors of conversion, comparable with the risk calculator published by NAPLS (c-index = 0.71), but requiring only a structured clinical interview. Future work will seek to externally validate the model and enhance its performance with the incorporation of relevant biomarkers.
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Affiliation(s)
- Adam J. Ciarleglio
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Research Foundation for Mental Hygiene, New York, NY, USA
| | - Gary Brucato
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Research Foundation for Mental Hygiene, New York, NY, USA
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Michael D. Masucci
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Research Foundation for Mental Hygiene, New York, NY, USA
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Rebecca Altschuler
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Tiziano Colibazzi
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Research Foundation for Mental Hygiene, New York, NY, USA
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | | | - Francesca M. Crump
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Guillermo Horga
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Research Foundation for Mental Hygiene, New York, NY, USA
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Eugénie Lehembre-Shiah
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Wei Leong
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | | | - Melanie M. Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Research Foundation for Mental Hygiene, New York, NY, USA
| | - Lawrence H. Yang
- College of Global Public Health, New York University, New York, NY, USA
| | - Jeffrey A. Lieberman
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Research Foundation for Mental Hygiene, New York, NY, USA
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Ragy R. Girgis
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Research Foundation for Mental Hygiene, New York, NY, USA
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
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44
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Levin FR, Lieberman JA, Pardes H. Herbert D. Kleber. Neuropsychopharmacology 2019; 44:1007. [PMID: 30718705 PMCID: PMC6461778 DOI: 10.1038/s41386-019-0318-7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Frances R. Levin
- 0000 0000 8499 1112grid.413734.6Division of Substance Abuse, New York State Psychiatric Institute, New York, USA ,0000000419368729grid.21729.3fDepartment of Psychiatry, Columbia University College of Physicians and Surgeons, New York, USA
| | - Jeffrey A. Lieberman
- 0000000419368729grid.21729.3fDepartment of Psychiatry, Columbia University College of Physicians and Surgeons, New York, USA
| | - Herbert Pardes
- 0000 0000 8499 1112grid.413734.6NewYork-Presbyterian Hospital, New York, USA
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45
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Zai CC, Tiwari AK, Chowdhury NI, Yilmaz Z, de Luca V, Müller DJ, Potkin SG, Lieberman JA, Meltzer HY, Voineskos AN, Remington G, Kennedy JL. Genetic study of neuregulin 1 and receptor tyrosine-protein kinase erbB-4 in tardive dyskinesia. World J Biol Psychiatry 2019; 20:91-95. [PMID: 28394697 DOI: 10.1080/15622975.2017.1301681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/19/2022]
Abstract
OBJECTIVES Tardive dyskinesia (TD) is a movement disorder that may develop as a side effect of antipsychotic medication. The aetiology underlying TD is unclear, but a number of mechanisms have been proposed. METHODS We investigated single-nucleotide polymorphisms (SNPs) in the genes coding for neuregulin-1 and erbB-4 receptor in our sample of 153 European schizophrenia patients for possible association with TD. RESULTS We found the ERBB4 rs839523 CC genotype to be associated with risk for TD occurrence and increased severity as measured by the Abnormal Involuntary Movement Scale (AIMS) (P = .003). CONCLUSIONS This study supports a role for the neuregulin signalling pathway in TD, although independent replications are warranted.
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Affiliation(s)
- Clement C Zai
- a Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada.,b Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,c Laboratory Medicine and Pathophysiology , University of Toronto , ON , Canada
| | - Arun K Tiwari
- a Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada.,b Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Nabilah I Chowdhury
- a Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada
| | - Zeynep Yilmaz
- a Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada.,d Center of Excellence for Eating Disorders at the University of North Carolina at Chapel Hill , NC , USA
| | - Vincenzo de Luca
- a Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada.,b Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,e Institute of Medical Science , University of Toronto , Toronto , ON , Canada
| | - Daniel J Müller
- a Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada.,b Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,e Institute of Medical Science , University of Toronto , Toronto , ON , Canada
| | - Steven G Potkin
- f Department of Psychiatry and Human Behavior , University of California , Irvine, Irvine , CA , USA
| | - Jeffrey A Lieberman
- g Department of Psychiatry , Columbia University College of Physicians and Surgeons , NY , USA
| | - Herbert Y Meltzer
- h Psychiatry and Behavioral Sciences, Pharmacology and Physiology, Chemistry of Life Processes Institute , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Aristotle N Voineskos
- a Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada.,b Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,e Institute of Medical Science , University of Toronto , Toronto , ON , Canada
| | - Gary Remington
- b Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,e Institute of Medical Science , University of Toronto , Toronto , ON , Canada
| | - James L Kennedy
- a Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto , ON , Canada.,b Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,e Institute of Medical Science , University of Toronto , Toronto , ON , Canada
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46
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Lu JY, Tiwari AK, Zai GC, Rastogi A, Shaikh SA, Müller DJ, Voineskos AN, Potkin SG, Lieberman JA, Meltzer HY, Remington G, Wong AH, Kennedy JL, Zai CC. Association study of Disrupted-In-Schizophrenia-1 gene variants and tardive dyskinesia. Neurosci Lett 2018; 686:17-22. [DOI: 10.1016/j.neulet.2018.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/26/2018] [Accepted: 08/08/2018] [Indexed: 01/19/2023]
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47
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Zai CC, Lee FH, Tiwari AK, Lu JY, de Luca V, Maes MS, Herbert D, Shahmirian A, Cheema SY, Zai GC, Atukuri A, Sherman M, Shaikh SA, Tampakeras M, Freeman N, King N, Müller DJ, Greenbaum L, Lerer B, Voineskos AN, Potkin SG, Lieberman JA, Meltzer HY, Remington G, Kennedy JL. Investigation of the HSPG2 Gene in Tardive Dyskinesia - New Data and Meta-Analysis. Front Pharmacol 2018; 9:974. [PMID: 30283332 PMCID: PMC6157325 DOI: 10.3389/fphar.2018.00974] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/08/2018] [Indexed: 01/26/2023] Open
Abstract
Tardive dyskinesia (TD) is a movement disorder that may occur after extended use of antipsychotic medications. The etiopathophysiology is unclear; however, genetic factors play an important role. The Perlecan (HSPG2) gene was found to be significantly associated with TD in Japanese schizophrenia patients, and this association was subsequently replicated by an independent research group. To add to the evidence for this gene in TD, we conducted a meta-analysis specific to the relationship of HSPG2 rs2445142 with TD occurrence, while also adding our unpublished genotype data. Overall, we found a significant association of the G allele with TD occurrence (p = 0.0001); however, much of the effect appeared to originate from the discovery dataset. Nonetheless, most study samples exhibit the same trend of association with TD for the G allele. Our findings encourage further genetic and molecular studies of HSPG2 in TD.
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Affiliation(s)
- Clement C Zai
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Frankie H Lee
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Arun K Tiwari
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Justin Y Lu
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Vincenzo de Luca
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Miriam S Maes
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Deanna Herbert
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anashe Shahmirian
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sheraz Y Cheema
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gwyneth C Zai
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Anupama Atukuri
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Michael Sherman
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sajid A Shaikh
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Maria Tampakeras
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Natalie Freeman
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nicole King
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel J Müller
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Lior Greenbaum
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel.,The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bernard Lerer
- Biological Psychiatry Laboratory and Hadassah BrainLabs, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Aristotle N Voineskos
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Steven G Potkin
- Department of Psychiatry and Human Behavior, Long Beach Veterans Administration Health Care System, University of California, Irvine, Irvine, CA, United States
| | - Jeffrey A Lieberman
- Columbia University, New York State Psychiatric Institute, New York City, NY, United States
| | - Herbert Y Meltzer
- Psychiatry and Behavioral Sciences, Pharmacology and Physiology, Chemistry of Life Processes Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Gary Remington
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - James L Kennedy
- Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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48
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Lieberman JA, Girgis RR, Brucato G, Moore H, Provenzano F, Kegeles L, Javitt D, Kantrowitz J, Wall MM, Corcoran CM, Schobel SA, Small SA. Hippocampal dysfunction in the pathophysiology of schizophrenia: a selective review and hypothesis for early detection and intervention. Mol Psychiatry 2018; 23:1764-1772. [PMID: 29311665 PMCID: PMC6037569 DOI: 10.1038/mp.2017.249] [Citation(s) in RCA: 217] [Impact Index Per Article: 36.2] [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: 06/29/2017] [Revised: 09/18/2017] [Accepted: 09/27/2017] [Indexed: 02/07/2023]
Abstract
Scientists have long sought to characterize the pathophysiologic basis of schizophrenia and develop biomarkers that could identify the illness. Extensive postmortem and in vivo neuroimaging research has described the early involvement of the hippocampus in the pathophysiology of schizophrenia. In this context, we have developed a hypothesis that describes the evolution of schizophrenia-from the premorbid through the prodromal stages to syndromal psychosis-and posits dysregulation of glutamate neurotransmission beginning in the CA1 region of the hippocampus as inducing attenuated psychotic symptoms and initiating the transition to syndromal psychosis. As the illness progresses, this pathological process expands to other regions of the hippocampal circuit and projection fields in other anatomic areas including the frontal cortex, and induces an atrophic process in which hippocampal neuropil is reduced and interneurons are lost. This paper will describe the studies of our group and other investigators supporting this pathophysiological hypothesis, as well as its implications for early detection and therapeutic intervention.
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Affiliation(s)
- JA Lieberman
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - RR Girgis
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - G Brucato
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - H Moore
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - F Provenzano
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - L Kegeles
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - D Javitt
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - J Kantrowitz
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - MM Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - CM Corcoran
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - SA Schobel
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - SA Small
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,Department of Radiology, College of Physicians & Surgeons, Columbia University, New York, NY, USA
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49
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Lieberman JA, Ehrhardt AA, Simpson HB, Arbuckle MR, Fyer AJ, Essock SM. Eliminating the Glass Ceiling in Academic Psychiatry. Acad Psychiatry 2018; 42:523-528. [PMID: 29110268 PMCID: PMC6096872 DOI: 10.1007/s40596-017-0810-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/06/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Jeffrey A Lieberman
- Columbia University, New York, NY, USA.
- New York State Psychiatric Institute, New York, NY, USA.
| | - Anke A Ehrhardt
- Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - H Blair Simpson
- Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Melissa R Arbuckle
- Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Abby J Fyer
- Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Susan M Essock
- Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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50
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Affiliation(s)
- Jeffrey A Lieberman
- From the Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and the New York State Psychiatric Institute - both in New York
| | - Michael B First
- From the Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and the New York State Psychiatric Institute - both in New York
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