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Jones AA, Cho LL, Gicas KM, Procyshyn RM, Vila-Rodriguez F, Stubbs JL, Leonova O, Buchanan T, Thornton AE, Lang DJ, MacEwan GW, Panenka WJ, Barr AM, Field TS, Honer WG. Multilayer depressive symptom networks in adults with bodily pain living in precarious housing or homelessness. Eur Arch Psychiatry Clin Neurosci 2024; 274:643-653. [PMID: 37610500 DOI: 10.1007/s00406-023-01664-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023]
Abstract
Housing insecurity is associated with co-occurring depression and pain interfering with daily activities. Network analysis of depressive symptoms along with associated risk or protective exposures may identify potential targets for intervention in patients with co-occurring bodily pain. In a community-based sample of adults (n = 408) living in precarious housing or homelessness in Vancouver, Canada, depressive symptoms were measured by the Beck Depression Inventory; bodily pain and impact were assessed with the 36-item Short Form Health Survey. Network and bootstrap permutation analyses were used to compare depressive symptoms endorsed by Low versus Moderate-to-Severe (Mod + Pain) groups. Multilayer networks estimated the effects of risk and protective factors. The overall sample was comprised of 78% men, mean age 40.7 years, with 53% opioid use disorder and 14% major depressive disorder. The Mod + Pain group was characterized by multiple types of pain, more persistent pain, more severe depressive symptoms and a higher rate of suicidal ideation. Global network connectivity did not differ between the two pain groups. Suicidal ideation was a network hub only in the Mod + Pain group, with high centrality and a direct association with exposure to lifetime trauma. Antidepressant medications had limited impact on suicidal ideation. Guilt and increased feelings of failure represented symptoms from two other communities of network nodes, and completed the shortest pathway from trauma exposure through suicidal ideation, to the non-prescribed opioid exposure node. Interventions targeting these risk factors and symptoms could affect the progression of depression among precariously housed patients.
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Affiliation(s)
- Andrea A Jones
- Division of Neurology, Department of Medicine, University of British Columbia, 8219-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | - Lianne L Cho
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesia, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Thalia S Field
- Division of Neurology, Department of Medicine, University of British Columbia, 8219-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Blumberg MJ, Petersson AM, Jones PW, Jones AA, Panenka WJ, Leonova O, Vila-Rodriguez F, Lang DJ, Barr AM, MacEwan GW, Buchanan T, Honer WG, Gicas KM. Differential sensitivity of intraindividual variability dispersion and global cognition in the prediction of functional outcomes and mortality in precariously housed and homeless adults. Clin Neuropsychol 2024:1-24. [PMID: 38444068 DOI: 10.1080/13854046.2024.2325167] [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] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To examine cognitive intraindividual variability (IIV) dispersion as a predictor of everyday functioning and mortality in persons who are homeless or precariously housed. METHOD Participants were 407 community-dwelling adults, followed for up to 13 years. Neurocognition was assessed at baseline and IIV dispersion was derived using a battery of standardized tests. Functional outcomes (social, physical) were obtained at baseline and last follow-up. Mortality was confirmed with Coroner's reports and hospital records (N = 103 deaths). Linear regressions were used to predict current social and physical functioning from IIV dispersion. Repeated measures Analysis of Covariance were used to predict long-term change in functioning. Cox regression models examined the relation between IIV dispersion and mortality. Covariates included global cognition (i.e. mean-level performance), age, education, and physical comorbidities. RESULTS Higher IIV dispersion predicted poorer current physical functioning (B = -0.46 p = .010), while higher global cognition predicted better current (B = 0.21, p = .015) and change in social functioning over a period of up to 13 years (F = 4.23, p = .040). Global cognition, but not IIV dispersion, predicted mortality in individuals under 55 years old (HR = 0.50, p = .013). CONCLUSIONS Our findings suggest that indices of neurocognitive functioning (i.e. IIV dispersion and global cognition) may be differentially related to discrete dimensions of functional outcomes in an at-risk population. IIV dispersion may be a complimentary marker of emergent physical health dysfunction in precariously housed adults and may be best used in conjunction with traditional neuropsychological indices.
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Affiliation(s)
| | - Anna M Petersson
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Paul W Jones
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Canada
- Department of Psychology, University of the Fraser Valley, Abbotsford, Canada
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Kim DD, Procyshyn RM, Jones AA, Gicas KM, Jones PW, Petersson AM, Lee LHN, McLellan-Carich R, Cho LL, Panenka WJ, Leonova O, Lang DJ, Thornton AE, Honer WG, Barr AM. Relationship between drug-induced movement disorders and psychosis in adults living in precarious housing or homelessness. J Psychiatr Res 2024; 170:290-296. [PMID: 38185074 DOI: 10.1016/j.jpsychires.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/07/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
BACKGROUND Studies have reported positive associations between drug-induced movement disorders (DIMDs) and symptoms of psychosis in patients with schizophrenia. However, it is not clear which subtypes of symptoms are related to each other, and whether one symptom precedes another. The current report assessed both concurrent and temporal associations between DIMDs and symptoms of psychosis in a community-based sample of homeless individuals. METHODS Participants were recruited in Vancouver, Canada. Severity of DIMDs and psychosis was rated annually, allowing for the analysis of concurrent associations between DIMDs and Positive and Negative Syndrome Scale (PANSS) five factors. A brief version of the PANSS was rated monthly using five psychotic symptoms, allowing for the analysis of their temporal associations with DIMDs. Mixed-effects linear and logistic regression models were used to assess the associations. RESULTS 401 participants were included, mean age of 40.7 years (SD = 11.2) and 77.4% male. DIMDs and symptoms of psychosis were differentially associated with each other, in which the presence of parkinsonism was associated with greater negative symptoms, dyskinesia with disorganized symptoms, and akathisia with excited symptoms. The presence of DIMDs of any type was not associated with depressive symptoms. Regarding temporal associations, preceding delusions and unusual thought content were associated with parkinsonism, whereas dyskinesia was associated with subsequent conceptual disorganization. CONCLUSIONS The current study found significant associations between DIMDs and symptoms of psychosis in individuals living in precarious housing or homelessness. Moreover, there were temporal associations between parkinsonism and psychotic symptoms (delusions or unusual thought content), and the presence of dyskinesia was temporally associated with higher odds of clinically relevant conceptual disorganization.
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Affiliation(s)
- David D Kim
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Ric M Procyshyn
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Andrea A Jones
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Kristina M Gicas
- Department of Psychology, University of the Fraser Valley, Abbotsford, BC, Canada
| | - Paul W Jones
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Anna M Petersson
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Lik Hang N Lee
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel McLellan-Carich
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Lianne L Cho
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William J Panenka
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Olga Leonova
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Donna J Lang
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - William G Honer
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada.
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Tang VM, Zawertailo L, Selby P, Zangen A, Mehta D, George TP, Le Foll B, Gicas KM, Sloan ME, Veldhuizen S. Identifying clinical predictors of response to repetitive transcranial magnetic stimulation for smoking cessation: Secondary analysis of a multicenter RCT. Brain Stimul 2024; 17:137-139. [PMID: 38309649 DOI: 10.1016/j.brs.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Affiliation(s)
- Victor M Tang
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute for Medical Science, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Laurie Zawertailo
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute for Medical Science, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Abraham Zangen
- Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Zlotowski Centre for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dhvani Mehta
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute for Medical Science, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Tony P George
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute for Medical Science, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute for Medical Science, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Kristina M Gicas
- Department of Psychology, University of the Fraser Valley, Abbotsford, British Columbia, Canada
| | - Matthew E Sloan
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute for Medical Science, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Scott Veldhuizen
- Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Bruno D, Gicas KM, Jauregi‐Zinkunegi A, Mueller KD, Lamar M. Delayed primacy recall performance predicts post mortem Alzheimer's disease pathology from unimpaired ante mortem cognitive baseline. Alzheimers Dement (Amst) 2024; 16:e12524. [PMID: 38239330 PMCID: PMC10795090 DOI: 10.1002/dad2.12524] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/31/2023] [Accepted: 12/19/2023] [Indexed: 01/22/2024]
Abstract
We propose a novel method to assess delayed primacy in the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) memory test. We then examine whether this measure predicts post mortem Alzheimer's disease (AD) neuropathology in individuals who were clinically unimpaired at baseline. A total of 1096 individuals were selected from the Rush Alzheimer's Disease Center database registry. All participants were clinically unimpaired at baseline, and had subsequently undergone brain autopsy. Average age at baseline was 78.8 (6.92). A Bayesian regression analysis was carried out with global pathology as an outcome; demographic, clinical, and apolipoprotein E (APOE) data as covariates; and cognitive predictors, including delayed primacy. Global AD pathology was best predicted by delayed primacy. Secondary analyses showed that delayed primacy was mostly associated with neuritic plaques, whereas total delayed recall was associated with neurofibrillary tangles. Sex differential associations were observed. We conclude that CERAD-derived delayed primacy is a useful metric for early detection and diagnosis of AD in unimpaired individuals. Highlights We propose a novel method to analyse serial position in the CERAD memory test.We analyse data from 1096 individuals who were cognitively unimpaired at baseline.Delayed primacy predicts post mortem pathology better than traditional metrics.
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Affiliation(s)
- Davide Bruno
- School of PsychologyLiverpool John Moores UniversityLiverpoolUK
| | | | | | - Kimberly D. Mueller
- Wisconsin Alzheimer's InstituteSchool of Medicine and Public HealthUniversity of Wisconsin – MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin – MadisonMadisonWisconsinUSA
- Department of Communication Sciences and DisordersUniversity of Wisconsin – MadisonMadisonWisconsinUSA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center and the Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
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Gicas KM, Benitah K, Thornton AE, Petersson AM, Jones PW, Stubbs JL, Jones AA, Panenka WJ, Lang DJ, Leonova O, Vila-Rodriguez F, Barr AM, Buchanan T, Su W, Vertinsky AT, Rauscher A, MacEwan GW, Honer WG. Using serial position effects to investigate memory dysfunction in homeless and precariously housed persons. Clin Neuropsychol 2023; 37:1710-1727. [PMID: 36790121 DOI: 10.1080/13854046.2023.2178513] [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] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/05/2023] [Indexed: 02/16/2023]
Abstract
Background: Homeless and precariously housed persons exhibit significant memory impairment, but the component processes underlying memory dysfunction have not been explored. We examined the serial position profile (i.e., primacy and recency effects) of verbal memory and its neuroanatomical correlates to identify the nature of memory difficulties in a large cohort of homeless and precariously housed adults. Method: The sample included 227 community-dwelling homeless and precariously housed adults. Serial position scores (primacy, middle, recency) were computed using the Hopkins Verbal Learning Test-Revised. Paired sample t-tests were used to compare percent recall from each word list region. Age-adjusted correlations assessed associations between serial position scores and other cognitive domains (attention, processing speed, executive functioning). Regression analyses were conducted to examine regional brain volumes of interest (hippocampus, entorhinal cortex, dorsolateral prefrontal cortex [DLPFC]) and their differential associations with serial position scores. Results: The serial position profile was characterized by a diminished recency effect in relation to the primacy effect. Serial position scores positively correlated with sustained attention and cognitive control. Larger hippocampal volume was associated with better primacy item recall. DLPFC volume was not associated with serial position recall after adjustment for false discovery rate. There were no associations between regional brain volumes and recency item recall. Conclusion: Our results suggest that commonly reported memory difficulties in homeless and precariously housed adults are likely secondary to a core deficit in executive control due to compromised frontal lobe functioning. These findings have implications for cognitive rehabilitation in this complex and vulnerable group.
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Affiliation(s)
| | - Katie Benitah
- Department of Psychology, York University, Toronto, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Anna M Petersson
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Paul W Jones
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Andrea A Jones
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Alexander Rauscher
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, Canada
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Gicas KM, Honer WG, Petyuk VA, Wilson RS, Boyle PA, Leurgans SE, Schneider JA, De Jager PL, Bennett DA. Primacy and recency effects in verbal memory are differentially associated with post-mortem frontal cortex p-tau 217 and 202 levels in a mixed sample of community-dwelling older adults. J Clin Exp Neuropsychol 2023; 45:770-785. [PMID: 37440260 PMCID: PMC10787031 DOI: 10.1080/13803395.2023.2232583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Serial position effects in verbal memory are associated with in vivo fluid biomarkers and neuropathological outcomes in Alzheimer's disease (AD). To extend the biomarker literature, associations between serial position scores and postmortem levels of brain phosphorylated tau (p-tau) were examined, in the context of Braak stage of neurofibrillary tangle progression. METHOD Participants were 1091 community-dwelling adults (Mage = 80.2, 68.9% female) from the Rush University Religious Orders Study and Memory and Aging Project who were non-demented at enrollment and followed for a mean of 9.2 years until death. The CERAD Word List Memory test administered at baseline and within 1 year of death was used to calculate serial position (primacy, recency) and total recall scores. Proteomic analyses quantified p-tau 217 and 202 from dorsolateral prefrontal cortex samples. Linear regressions assessed associations between cognitive scores and p-tau with Braak stage as a moderator. RESULTS Cognitive status proximal to death indicated 34.7% were unimpaired, 26.2% met criteria for MCI, and 39.0% for dementia. Better baseline primacy recall, but not recency recall, was associated with lower p-tau 217 levels across Braak stages. Delayed recall showed a similar pattern as primacy. There was no main effect of immediate recall, but an interaction with Braak stages indicated a negative association with p-tau 217 level only in Braak V-VI. Within 1 year of death, there were no main effects for cognitive scores; however, recency, immediate and delayed recall scores interacted with Braak stage showing better recall was associated with lower p-tau 217 only in Braak V-VI. No associations were observed with p-tau 202. CONCLUSIONS Primacy recall measured in non-demented adults may be sensitive to emergent tau phosphorylation that occurs in the earliest stages of AD. Serial position scores may complement the routinely used delayed recall score and p-tau biomarkers to detect preclinical AD.
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Affiliation(s)
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Vladislav A Petyuk
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Robert S Wilson
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Patricia A Boyle
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Sue E Leurgans
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Julie A Schneider
- Department of Pathology, Rush University Medical Center, Chicago, IL, United States
| | - Philip L De Jager
- Center for Translational and Computational Neuroimmunology, Columbia University Medical Center
| | - David A Bennett
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
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8
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Cho LL, Jones AA, Gao C, Leonova O, Vila-Rodriguez F, Buchanan T, Lang DJ, MacEwan GW, Procyshyn RM, Panenka WJ, Barr AM, Thornton AE, Gicas KM, Honer WG, Barbic SP. Rasch analysis of the beck depression inventory in a homeless and precariously housed sample. Psychiatry Res 2023; 326:115331. [PMID: 37437487 DOI: 10.1016/j.psychres.2023.115331] [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: 01/26/2023] [Revised: 07/01/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023]
Abstract
The approach to analysis of and interpretation of findings from the Beck Depression Inventory (BDI), a self-report questionnaire, depends on sample characteristics. To extend work using conventional BDI scoring, the BDI's suitability in assessing symptom severity in a homeless and precariously housed sample was examined using Rasch analysis. Participants (n=478) recruited from an impoverished neighbourhood in Vancouver, Canada, completed the BDI. Rasch analysis using the partial credit model was done, and the structural validity, unidimensionality, and reliability of the BDI were studied. A receiver operating characteristic curve determined a Rasch cut-off score consistent with clinical depression, and Rasch scores were correlated with raw scores. Good fit to the Rasch model was observed after rescoring all items and removing Item 19 (Weight Loss), and unidimensionality and reliability were satisfactory. Item 9 (Suicidal Wishes) represented the most severe symptom. Rasch-based scores detected clinical depression with moderate sensitivity and specificity, and were positively correlated with conventional scores. The BDI in a community-based sample of homeless and precariously housed adults satisfied Rasch model expectations in a 20-item format, and is suitable for assessing symptom severity. Future research on depression in similar samples may reveal more information on using specific symptoms to determine clinical significance.
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Affiliation(s)
- Lianne L Cho
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chloe Gao
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325 - 2211 Wesbrook Mall, Vancouver, British Columbia, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna J Lang
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - William J Panenka
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada; Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada; Department of Anesthesia, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Skye P Barbic
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325 - 2211 Wesbrook Mall, Vancouver, British Columbia, Canada.
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9
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Bruno D, Gicas KM, Jauregi Zinkunegi A, Mueller KD, Lamar M. Delayed primacy recall performance predicts post mortem Alzheimer's disease pathology from unimpaired ante mortem cognitive baseline. bioRxiv 2023:2023.06.26.546225. [PMID: 37425732 PMCID: PMC10327046 DOI: 10.1101/2023.06.26.546225] [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] [Indexed: 07/11/2023]
Abstract
INTRODUCTION We propose a novel method to assess delayed primacy in the CERAD memory test. We then examine whether this measure predicts post mortem Alzheimer's disease (AD) neuropathology in individuals who were clinically unimpaired at baseline. METHODS A total of 1096 individuals were selected from the Rush Alzheimer's Disease Center database registry. All participants were clinically unimpaired at baseline, and had subsequently undergone brain autopsy. Average age at baseline was 78.8 (6.92). A Bayesian regression analysis was carried out with global pathology as outcome; demographic, clinical and APOE data as covariates; and cognitive predictors, including delayed primacy. RESULTS Global AD pathology was best predicted by delayed primacy. Secondary analyses showed that delayed primacy was mostly associated with neuritic plaques, whereas total delayed recall was associated with neurofibrillary tangles. DISCUSSION We conclude that CERAD-derived delayed primacy is a useful metric for early detection and diagnosis of AD in unimpaired individuals.
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Affiliation(s)
- Davide Bruno
- School of Psychology, Liverpool John Moores University, UK
| | | | | | - Kimberly D. Mueller
- Wisconsin Alzheimer’s Institute, School of Medicine and Public Health, University of Wisconsin – Madison, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin – Madison, Madison, WI, USA
- Department of Communication Sciences and Disorders, University of Wisconsin – Madison, Madison, WI, USA
| | - Melissa Lamar
- Rush Alzheimer’s Disease Center and the Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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10
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Lee LHN, Procyshyn RM, White RF, Gicas KM, Honer WG, Barr AM. Developing prediction models for symptom severity around the time of discharge from a tertiary-care program for treatment-resistant psychosis. Front Psychiatry 2023; 14:1181740. [PMID: 37350999 PMCID: PMC10282838 DOI: 10.3389/fpsyt.2023.1181740] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023] Open
Abstract
Antipsychotics are the only therapeutic class indicated in the symptomatic management of psychotic disorders. However, individuals diagnosed with schizophrenia or schizoaffective disorder may not always benefit from these first-line agents. This refractoriness to conventional treatment can be difficult to address in most clinical settings. Therefore, a referral to a tertiary-care program that is better able to deliver specialized care in excess of the needs of most individuals may be necessary. The average outcome following a period of treatment at these programs tends to be one of improvement. Nonetheless, accurate prognostication of individual-level responses may be useful in identifying those who are unlikely to improve despite receiving specialized care. Thus, the main objective of this study was to predict symptom severity around the time of discharge from the Refractory Psychosis Program in British Columbia, Canada using only clinicodemographic information and prescription drug data available at the time of admission. To this end, a different boosted beta regression model was trained to predict the total score on each of the five factors of the Positive and Negative Syndrome Scale (PANSS) using a data set composed of 320 hospital admissions. Internal validation of these prediction models was then accomplished by nested cross-validation. Insofar as it is possible to make comparisons of model performance across different outcomes, the correlation between predictions and observations tended to be higher for the negative and disorganized factors than the positive, excited, and depressed factors on internal validation. Past scores had the greatest effect on the prediction of future scores across all 5 factors. The results of this study serve as a proof of concept for the prediction of symptom severity using this specific approach.
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Affiliation(s)
- Lik Hang N. Lee
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ric M. Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Randall F. White
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Alasdair M. Barr
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
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11
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Gicas KM, Blumberg MJ, Terao CM, Mejia-Lancheros C, Nisenbaum R, Hwang SW, Stergiopoulos V. Examination of bidirectional associations between neurocognitive functioning and housing stability in homeless adults: A longitudinal subgroup analysis of the at Home/Chez Soi study. Neuropsychology 2023; 37:157-165. [PMID: 36442002 DOI: 10.1037/neu0000885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Homeless adults represent a marginalized group with numerous psychiatric and physical illness risk factors for poor functional outcomes. This study investigated bidirectional associations between housing stability and neurocognitive functioning in homeless adults using a longitudinal study design. METHOD Participants were homeless adults with serious mental illness from the At Home/Chez Soi study Toronto site who participated in a randomized control trial of Housing First. Participants underwent a comprehensive structured baseline interview and clinical evaluation. Up to four brief cognitive evaluations were completed over a period of up to 6 years. Housing status was ascertained every 3 months during the study period. RESULTS The analysis included 283 participants with at least one follow-up evaluation (Mage = 41 years, 70% men). In an adjusted time-lagged mixed-effects logistic regression model, higher verbal learning and memory performance (OR = 1.71, 95% CI [1.16, 2.52], p = .007), but not cognitive flexibility and processing speed, was associated with an increased likelihood of being stably housed in the subsequent 3 months. In a test of reverse associations, mixed-effects linear models did not reveal associations between housing stability in the preceding 3 months and neurocognitive functioning in either domain. CONCLUSIONS These results suggest verbal learning and memory functioning is a key contributor to housing stability among homeless adults with serious mental illness. This work has important implications for health services that support individuals transitioning into stable housing and for the attainment of long-term functional independence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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12
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Stubbs JL, Jones AA, Wolfman D, Chan RCY, Vila-Rodriguez F, Vertinsky AT, Heran MK, Su W, Lang DJ, Field TS, Gicas KM, Woodward ML, Thornton AE, Barr AM, Leonova O, MacEwan W, Rauscher A, Honer WG, Panenka WJ. Differential age-associated brain atrophy and white matter changes among homeless and precariously housed individuals compared with the general population. BMJ Neurol Open 2023; 5:e000349. [PMID: 36660541 PMCID: PMC9843194 DOI: 10.1136/bmjno-2022-000349] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
Background Homeless or precariously housed individuals live with poor health and experience premature mortality compared with the general population, yet little is known about age-related brain changes among these individuals. We evaluated whether MRI measures of brain structure are differentially associated with age and selected risk factors among individuals who are homeless or precariously housed compared with a general population sample. Methods We compared T1-weighted and diffusion tensor imaging measures of brain macrostructure and white matter microstructure in a well-characterised sample of 312 precariously housed participants with a publicly available dataset of 382 participants recruited from the general population. We used piecewise and multiple linear regression to examine differential associations between MRI measures and between the samples, and to explore associations with risk factors in the precariously housed sample. Results Compared with the general population sample, older age in the precariously housed sample was associated with more whole-brain atrophy (β=-0.20, p=0.0029), lower whole-brain fractional anisotropy (β=-0.32, p<0.0001) and higher whole-brain mean diffusivity (β=0.69, p<0.0001). Several MRI measures had non-linear associations with age, with further adverse changes after age 35-40 in the precariously housed sample. History of traumatic brain injury, stimulant dependence and heroin dependence was associated with more atrophy or alterations in white matter diffusivity in the precariously housed sample. Conclusions Older age is associated with adverse MRI measures of brain structure among homeless and precariously housed individuals compared with the general population. Education, improvements in care provision and policy may help to reduce the health disparities experienced by these individuals.
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Affiliation(s)
- Jacob L Stubbs
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Andrea A Jones
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Wolfman
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Ryan C Y Chan
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver, BC, Canada
| | | | - Manraj K Heran
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Su
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Donna J Lang
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | | | - Melissa L Woodward
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Allen E Thornton
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada,Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Olga Leonova
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada
| | - William MacEwan
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Rauscher
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - William J Panenka
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada,British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, BC, Canada
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13
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Gicas KM, Mejia-Lancheros C, Nisenbaum R, Wang R, Hwang SW, Stergiopoulos V. Cognitive determinants of community functioning and quality of life in homeless adults with mental illness: 6-year follow-up from the At Home/Chez Soi Study Toronto site. Psychol Med 2023; 53:362-370. [PMID: 33926584 DOI: 10.1017/s0033291721001550] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND High rates of physical and mental health comorbidities are associated with functional impairment among persons who are homeless. Cognitive dysfunction is common, but how it contributes to various functional outcomes in this population has not been well investigated. This study examines how cognition covaries with community functioning and subjective quality of life over a 6-year period while accounting for the effects of risk and protective factors. METHODS Participants were 349 homeless adults (mean age = 39.8) recruited from the Toronto site of the At Home/Chez Soi study, a large Canadian randomized control trial of Housing First. Participants completed up to four clinical evaluations over 6 years. Factor scores were created to index verbal learning and memory (vLM) and processing speed-cognitive flexibility (PSCF). The primary outcomes were community functioning and subjective quality of life. Risk factors included lifetime homelessness, mental health diagnoses, medical comorbidity, and childhood adversity. Linear mixed-effects models were conducted to examine cognition-functional outcome associations over time, with resilience as a moderator. RESULTS Better vLM (b = 0.787, p = 0.010) and PSCF (b = 1.66, p < 0.001) were associated with better community functioning, but not with quality of life. Resilience conferred a protective effect on subjective quality of life (b = 1.45, p = 0.011) but did not moderate outcomes. CONCLUSIONS Our findings suggest a need to consider the unique determinants of community functioning and quality of life among homeless adults. Cognition should be prioritized as a key intervention target within existing service delivery models to optimize long-term functional outcomes.
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Affiliation(s)
- K M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - C Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - R Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - R Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - S W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - V Stergiopoulos
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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14
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Jones AA, Gicas KM, Mostafavi S, Woodward ML, Leonova O, Vila-Rodriguez F, Procyshyn RM, Cheng A, Buchanan T, Lang DJ, MacEwan GW, Panenka WJ, Barr AM, Thornton AE, Honer WG. Dynamic networks of psychotic symptoms in adults living in precarious housing or homelessness. Psychol Med 2022; 52:2559-2569. [PMID: 33455593 DOI: 10.1017/s0033291720004444] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND People living in precarious housing or homelessness have higher than expected rates of psychotic disorders, persistent psychotic symptoms, and premature mortality. Psychotic symptoms can be modeled as a complex dynamic system, allowing assessment of roles for risk factors in symptom development, persistence, and contribution to premature mortality. METHOD The severity of delusions, conceptual disorganization, hallucinations, suspiciousness, and unusual thought content was rated monthly over 5 years in a community sample of precariously housed/homeless adults (n = 375) in Vancouver, Canada. Multilevel vector auto-regression analysis was used to construct temporal, contemporaneous, and between-person symptom networks. Network measures were compared between participants with (n = 219) or without (n = 156) history of psychotic disorder using bootstrap and permutation analyses. Relationships between network connectivity and risk factors including homelessness, trauma, and substance dependence were estimated by multiple linear regression. The contribution of network measures to premature mortality was estimated by Cox proportional hazard models. RESULTS Delusions and unusual thought content were central symptoms in the multilevel network. Each psychotic symptom was positively reinforcing over time, an effect most pronounced in participants with a history of psychotic disorder. Global connectivity was similar between those with and without such a history. Greater connectivity between symptoms was associated with methamphetamine dependence and past trauma exposure. Auto-regressive connectivity was associated with premature mortality in participants under age 55. CONCLUSIONS Past and current experiences contribute to the severity and dynamic relationships between psychotic symptoms. Interrupting the self-perpetuating severity of psychotic symptoms in a vulnerable group of people could contribute to reducing premature mortality.
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Affiliation(s)
- Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kristina M Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Sara Mostafavi
- Department of Statistics, University of British Columbia, Vancouver, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Melissa L Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Cheng
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- Department of Anesthesia, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Cheng AYT, Stubbs JL, Barr AM, Gicas KM, Su W, Thornton AE, Lang DJ, Hamzah Y, Leonova O, MacEwan WG, Rauscher A, Honer WG, Panenka WJ. Risk factors for hippocampal cavities in a marginally housed population. Hippocampus 2022; 32:567-576. [PMID: 35702814 DOI: 10.1002/hipo.23450] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 05/01/2022] [Accepted: 05/11/2022] [Indexed: 12/25/2022]
Abstract
Cavities in the hippocampus are morphological variants of uncertain significance. Aberrant neurodevelopment along with vascular and inflammatory etiologies have been proposed. We sought to characterize these cavities and their potential risk factors in a marginally housed population, with high rates of viral infection, addiction, and mental illness. (1) The volume of hippocampal cavities (HCavs) is greater in this highly multimorbid population compared to the general population. (2) Conventional vascular risk factors such as greater age and systolic blood pressure are associated with higher HCav volume. (3) Nonprescribed substance-related risk factors such as stimulant use or dependence, and smoking are associated with increased HCav volume independent of vascular risk factors. This is a retrospective analysis of an ongoing prospective study. We analyzed baseline data, including medical history, physical exam, psychiatric diagnosis, and MRI from a total of 375 participants. Hippocampal cavities were defined as spaces isointense to CSF on T1 MRI sequences, bounded on all sides by hippocampal tissue, with a volume of at least 1 mm3 . Risk factors were evaluated using negative binomial multiple regression. Stimulant use was reported by 87.3% of participants, with stimulant dependence diagnosed in 83.3% of participants. Prevalence of cavities was 71.6%, with a mean total bilateral HCav volume of 13.89 mm3 . On average, a 1 mmHg greater systolic blood pressure was associated with a 2.17% greater total HCav volume (95% CI = [0.57%, 3.79%], p = .0076), while each cigarette smoked per day trended toward a 2.69% greater total HCav volume (95% CI = [-0.87%, 5.54%], p = .058). A diagnosis of stimulant dependence was associated with a 95.6% greater total HCav volume (95% CI = [5.39%, 263.19%], p = .0335). Hypertension and diagnosis of stimulant dependence were associated with a greater total volume of HCav.
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Affiliation(s)
- Alex Y T Cheng
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Allen E Thornton
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Donna J Lang
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yasmin Hamzah
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,British Columbia Neuropsychiatry Program, Vancouver, British Columbia, Canada
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16
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Stubbs JL, Thornton AE, Gicas KM, O'Connor TA, Livingston EM, Lu HY, Mehta AK, Lang DJ, Vertinsky AT, Field TS, Heran MK, Leonova O, Sahota CS, Buchanan T, Barr AM, MacEwan GW, Rauscher A, Honer WG, Panenka WJ. Characterizing Traumatic Brain Injury and Its Association with Losing Stable Housing in a Community-based Sample. Can J Psychiatry 2022; 67:207-215. [PMID: 33719613 PMCID: PMC8935598 DOI: 10.1177/07067437211000665] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is increasingly recognized as a common and impactful health determinant in homeless and precariously housed populations. We sought to describe the history of TBI in a precariously housed sample and evaluate how TBI was associated with the initial loss and lifetime duration of homelessness and precarious housing. METHOD We characterized the prevalence, mechanisms, and sex difference of lifetime TBI in a precariously housed sample. We also examined the impact of TBI severity and timing on becoming and staying homeless or precariously housed; 285 precariously housed participants completed the Brain Injury Screening Questionnaire in addition to other health assessments. RESULTS A history of TBI was reported in 82.1% of the sample, with 64.6% reporting > 1 TBI, and 21.4% reporting a moderate or severe TBI. Assault was the most common mechanism of injury overall, and females reported significantly more traumatic brain injuries due to physical abuse than males (adjusted OR = 1.26, 95% CI = 1.14 to 1.39, P < 0.0001). The first moderate or severe TBI was significantly closer to the first experience of homelessness (b = 2.79, P = 0.003) and precarious housing (b = 2.69, P < 0.0001) than was the first mild TBI. In participants who received their first TBI prior to becoming homeless or precariously housed, traumatic brain injuries more proximal to the initial loss of stable housing were associated with a longer lifetime duration of homelessness (RR = 1.04, 95% CI = 1.02 to 1.06, P < 0.0001) and precarious housing (RR = 1.03, 95% CI = 1.01 to 1.04, P < 0.0001). CONCLUSIONS These findings demonstrate the high prevalence of TBI in this vulnerable population, and that aspects of TBI severity and timing are associated with the loss and lifetime duration of stable housing.
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Affiliation(s)
- Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Allen E Thornton
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kristina M Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, York University, Toronto, Ontario, Canada
| | - Tiffany A O'Connor
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Emily M Livingston
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Henri Y Lu
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Amiti K Mehta
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Donna J Lang
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra T Vertinsky
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manraj K Heran
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charanveer S Sahota
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Gicas KM, Parmar PK, Fabiano GF, Mashhadi F. Substance-induced psychosis and cognitive functioning: A systematic review. Psychiatry Res 2022; 308:114361. [PMID: 34979380 DOI: 10.1016/j.psychres.2021.114361] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/15/2022]
Abstract
Longitudinal studies of substance-induced psychosis (SIP) suggest that approximately 11-46% of persons will progress to schizophrenia with differential risk of progression depending on the type of substance used. The findings suggest SIP may be a distinct variant of a psychotic disorder, yet SIP is understudied and the disease expression is not well characterized, particularly the cognitive phenotype. There is some evidence for cognitive dysfunction in SIP, but a synthesis of this literature has not been undertaken. We systematically reviewed all empirical research (up to December 31, 2020) that examined cognition in SIP using clinical neuropsychological measures. The cognitive outcomes are summarized by type of SIP (methamphetamine, other stimulants, alcohol, cannabis, undifferentiated). There was evidence for global and domain-specific cognitive dysfunction in SIP compared to controls and non-psychotic persons who use substances. Impairments were of similar magnitude compared to persons with schizophrenia. Delineation of a specific cognitive profile in SIP was precluded by lack of literature with comparable study designs and outcomes. Variation in visual-based cognition may be a distinct feature of SIP, but this requires further investigation. More rigorously controlled studies of cognition in SIP are needed to inform differential diagnosis and identify the unique clinical needs of this population.
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O'Connor TA, Panenka WJ, Livingston EM, Stubbs JL, Askew J, Sahota CS, Feldman SJ, Buchanan T, Xu L, Hu XJ, Lang DJ, Woodward ML, Thornton WL, Gicas KM, Vertinsky AT, Heran MK, Su W, MacEwan GW, Barr AM, Honer WG, Thornton AE. Traumatic brain injury in precariously housed persons: Incidence and risks. EClinicalMedicine 2022; 44:101277. [PMID: 35252825 PMCID: PMC8888336 DOI: 10.1016/j.eclinm.2022.101277] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/19/2021] [Accepted: 01/10/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Homeless and precarious housed persons are particularly prone to traumatic brain injuries (TBIs), but existent incidence rates are hampered by poor case acquisition. We rigorously documented TBIs in precariously housed persons transitioning in and out of homelessness. METHODS Between December 2016 and May 2018, 326 precariously housed participants enrolled in a longitudinal study in Vancouver, Canada were assessed monthly for TBI occurrences after education on sequelae. Over one participant-year, 2433 TBI screenings were acquired for 326 person-years and variables associated with odds of incident TBI were evaluated. FINDINGS One hundred participants acquired 175 TBIs, yielding an observed incidence proportion of 30·7% and event proportion of 53·7%. Of the injured, 61% reported one TBI and 39% reported multiple injuries. Acute intoxication was present for more than half of the TBI events assessed. Additionally, 9·7% of TBI events occurred in the context of a drug overdose. Common injury mechanisms were falls (45·1%), assaults (25·1%), and hitting one's head on an object (13·1%). In this community-based but non-randomly recruited sample, exploratory analyses identified factors associated with odds of an incident TBI over one year of follow-up, including: schizophrenia disorders (odds ratio (OR) = 0·43, 95% confidence interval (CI) 0·19, 0·94), role functioning (OR = 0·69, 95% CI 0·52, 0·91), opioid dependence (OR = 2·17, 95% CI 1·27, 3·72) and those reporting past TBIs (OR = 1·99, 95% CI 1·13, 3·52). INTERPRETATION Given the ubiquity of TBIs revealed in this precariously housed sample, we identify an underappreciated and urgent healthcare priority. Several factors modified the odds of incident TBI, which can facilitate investigations into targeted prevention efforts. FUNDING Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, William and Ada Isabelle Steel Research Fund, Simon Fraser University Vice-President Research Undergraduate Student Research Award and Simon Fraser University Psychology Department Research Grant.
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Affiliation(s)
- Tiffany A. O'Connor
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute
| | - William J. Panenka
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Emily M. Livingston
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute
| | - Jacob L. Stubbs
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Julia Askew
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Charanveer S. Sahota
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute
| | | | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Linwan Xu
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada
| | - X. Joan Hu
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada
| | - Donna J. Lang
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Melissa L. Woodward
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Kristina M. Gicas
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | | | - Manraj K. Heran
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Su
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - G. William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M. Barr
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - William G. Honer
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Allen E. Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute
- Correspondence to: Allen E. Thornton, Human Neuropsychology Laboratory, Department of Psychology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
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Battaglia AM, Gicas KM, Mamak M, Goldberg JO. Mistakes in interpersonal perceptions: Social cognition in aggressive forensic psychiatry patients. Crim Behav Ment Health 2022; 32:21-34. [PMID: 35178800 DOI: 10.1002/cbm.2228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND While there is an established link between untreated psychosis and aggression, an enhanced understanding of the role of social cognition is still needed. AIMS To examine social cognitive functioning among patients in a specialist forensic mental health service who had been deemed not criminally responsible for acts of violence due to a psychotic disorder. It was hypothesised, first, that such patients would show reduced social cognitive functioning compared with healthy, nonviolent comparison participants and, second, that those who continued to be aggressive while inpatients would demonstrate significant reductions compared to the now nonaggressive group. METHODS The study samples were of 10 recently aggressive and 15 not-recently aggressive patients and 20 healthy, nonviolent comparison participants. Each completed the Toronto Empathy Questionnaire (TEQ), the Reading the Mind in the Eyes Test-Revised (RMET) and the Interpersonal Perception Task-15 (IPT-15). RESULTS There was no significance between group differences on the RMET and TEQ. The patient group as a whole, however, showed significant interpersonal misperceptions, with specific misperceptions on IPT-15 deception and kinship subscales, while at the same time lacking self-awareness of their errors. Misperceptions on the IPT-15 competition subscale were unique to recently aggressive patients. CONCLUSIONS Select aspects of reduced social cognitive functioning were found among not criminally responsible patients with psychosis who had committed violent acts and who continued to act aggressively while forensic inpatients. These findings enhance our understanding of the role of social cognition in predisposing toward violence and the potential importance of incorporating interventions which improve social cognition directly. We suggest also the potential for future research using virtual reality technologies in treatment.
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Affiliation(s)
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Mini Mamak
- Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Joel O Goldberg
- Department of Psychology, York University, Toronto, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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20
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Cho LL, Jones AA, Barbic S, Leonova O, Vila-Rodriguez F, Buchanan T, Lang DJ, William MacEwan G, Procyshyn RM, Panenka WJ, Barr AM, Thornton AE, Gicas KM, Honer WG. Psychometric properties and correlates of the Beck Depression Inventory in a community-based and homeless or precariously housed sample. Journal of Affective Disorders Reports 2021. [DOI: 10.1016/j.jadr.2021.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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21
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Baitz HA, Jones PW, Campbell DA, Jones AA, Gicas KM, Giesbrecht CJ, Loken Thornton W, Barone CC, Wang NY, Panenka WJ, Lang DJ, Vila-Rodriguez F, Leonova O, Barr AM, Procyshyn RM, Buchanan T, Rauscher A, MacEwan GW, Honer WG, Thornton AE. Component Processes of Decision Making in a Community Sample of Precariously Housed Persons: Associations With Learning and Memory, and Health-Risk Behaviors. Front Psychol 2021; 12:571423. [PMID: 34276459 PMCID: PMC8285095 DOI: 10.3389/fpsyg.2021.571423] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 02/16/2021] [Indexed: 11/30/2022] Open
Abstract
The Iowa Gambling Task (IGT) is a widely used measure of decision making, but its value in signifying behaviors associated with adverse, "real-world" consequences has not been consistently demonstrated in persons who are precariously housed or homeless. Studies evaluating the ecological validity of the IGT have primarily relied on traditional IGT scores. However, computational modeling derives underlying component processes of the IGT, which capture specific facets of decision making that may be more closely related to engagement in behaviors associated with negative consequences. This study employed the Prospect Valence Learning (PVL) model to decompose IGT performance into component processes in 294 precariously housed community residents with substance use disorders. Results revealed a predominant focus on gains and a lack of sensitivity to losses in these vulnerable community residents. Hypothesized associations were not detected between component processes and self-reported health-risk behaviors. These findings provide insight into the processes underlying decision making in a vulnerable substance-using population and highlight the challenge of linking specific decision making processes to "real-world" behaviors.
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Affiliation(s)
- Heather A. Baitz
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | - Paul W. Jones
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | - David A. Campbell
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada
- School of Mathematics and Statistics, Carleton University, Ottawa, ON, Canada
| | - Andrea A. Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | - Kristina M. Gicas
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - Chantelle J. Giesbrecht
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | | | | | - Nena Y. Wang
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | - William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | - Donna J. Lang
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M. Barr
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Ric M. Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Rauscher
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - G. William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | - Allen E. Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
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22
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Tang VM, Trought K, Gicas KM, Kozak M, Josselyn SA, Daskalakis ZJ, Blumberger DM, Voineskos D, Knyahnytska Y, Pasricha S, Chung Y, Zhou Y, Isserles M, Wong AHC. Electroconvulsive therapy with a memory reactivation intervention for post-traumatic stress disorder: A randomized controlled trial. Brain Stimul 2021; 14:635-642. [PMID: 33785406 DOI: 10.1016/j.brs.2021.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Post-traumatic Stress Disorder (PTSD) often does not respond to available treatments. Memories are vulnerable to disruption during reconsolidation, and electroconvulsive therapy (ECT) has amnestic effects OBJECTIVE/HYPOTHESIS: To test the use of ECT to disrupt the reconsolidation of traumatic memories as a potential treatment for PTSD METHODS: Participants were adults from the civilian population and were referred for ECT treatment for severe depression with comorbid PTSD symptoms. Twenty-eight participants were randomly assigned to reactivation of a traumatic or non-traumatic memory using audio script driven imagery prior to each ECT treatment. Primary outcomes were change in scores on the Modified PTSD Symptom Scale - Self Report (MPSS-SR) and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Secondary outcomes included a comparison of the change in heart rate while listening to the script RESULTS: Twenty-five female patients who completed a post-ECT assessment were included in the analysis. No significant group differences were found in the MPSS-SR or CAPS-5 scores from pre-ECT to post-ECT or 3-month follow-ups. However, both groups improved at post-ECT and 3-month follow up. Partial eta squared estimates of effect size showed large effect sizes for all outcomes (η2 > 0.13). Changes in heart rate were not significantly different between groups or over time CONCLUSIONS: ECT paired with pre-treatment traumatic memory reactivation was not more effective for treating PTSD symptoms than ECT with non-traumatic memory reactivation. While our primary hypothesis was not supported, our data provides further support for the efficacy of ECT for improving symptoms of PTSD with comorbid depression. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT04027452. IDENTIFIER NCT04027452.
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Affiliation(s)
- Victor M Tang
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kathleen Trought
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Mari Kozak
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Sheena A Josselyn
- Program in Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Ontario, Canada; Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | | | - Daniel M Blumberger
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Daphne Voineskos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Yuliya Knyahnytska
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Suvercha Pasricha
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Yuan Chung
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Young Zhou
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Pharmacology & Toxicology, University of Toronto, Ontario, Canada
| | - Moshe Isserles
- The Jerusalem Center for Mental Health, Jerusalem, Israel
| | - Albert H C Wong
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology & Toxicology, University of Toronto, Ontario, Canada.
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23
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Gicas KM, Cheng A, Panenka WJ, Kim DD, Yau JC, Procyshyn RM, Stubbs JL, Jones AA, Bains S, Thornton AE, Lang DJ, Vertinsky AT, Rauscher A, Honer WG, Barr AM. Differential effects of cannabis exposure during early versus later adolescence on the expression of psychosis in homeless and precariously housed adults. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110084. [PMID: 32890696 DOI: 10.1016/j.pnpbp.2020.110084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/16/2020] [Accepted: 08/26/2020] [Indexed: 12/20/2022]
Abstract
Longitudinal studies of cannabis exposure during early adolescence in the general population frequently report an increased risk of subsequently developing psychotic symptoms or a psychotic illness. However, there is a dearth of knowledge about the effects of early cannabis exposure on psychosis in homeless and precariously housed adults, who represent a population afflicted with high rates of psychosis. The aim of the present study was to examine how early cannabis exposure (by age 15) compared to later first use (after age 15) affected the expression of adult psychosis in this population. Secondary measures of psychopathology, drug use, cognition and brain structure were also collected. 437 subjects were recruited from single room occupancy hotels in the urban setting of the Downtown Eastside of Vancouver, Canada. Psychiatric diagnoses were determined, and psychotic symptom severity was measured with the 5-factor PANSS. Participants completed a battery of neurocognitive tests, and brain structure was assessed using structural and diffusion tensor imaging MRI scans. Results indicated that early cannabis exposure was associated with an increased risk (OR = 1.09, p < .05) of developing substance induced psychosis, whereas later first use increased risk (OR = 2.19, p < .01) of developing schizophrenia or schizoaffective disorder. There was no group difference in neurocognitive function, although differences were observed in the lateral orbitofrontal cortex and white matter tract diffusivity. These findings indicate that early cannabis exposure in this population may increase the risk of developing drug associated psychoses, which could potentially be mediated in part through altered neurodevelopmental brain changes.
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Affiliation(s)
| | - Alex Cheng
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - David D Kim
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jade C Yau
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Simran Bains
- Department of Medicine, Imperial College London, United Kingdom
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Alexandra T Vertinsky
- Department of Radiology, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Alex Rauscher
- Department of Radiology, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
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Gicas KM, Paterson TSE, Narvaez Linares NF, Loken Thornton WJ. Clinical psychological assessment training issues in the COVID-19 era: A survey of the state of the field and considerations for moving forward. Canadian Psychology / Psychologie canadienne 2021. [DOI: 10.1037/cap0000258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Lei M, Rintoul K, Stubbs JL, Kim DD, Jones AA, Hamzah Y, Procyshyn RM, Gicas KM, Cho LL, Panenka WJ, Thornton AE, Lang DJ, MacEwan GW, Honer WG, Barr AM. Characterization of Bodily Pain and Use of Both Prescription and Non-Prescription Opioids in Tenants of Precarious Housing. Subst Use Misuse 2021; 56:1951-1961. [PMID: 34338612 DOI: 10.1080/10826084.2021.1958865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
opioid use, which includes both prescribed and non-prescribed drugs, is relatively common amongst marginalized populations. Past research has shown that among those who use non-prescribed or diverted opioids recreationally, many were first exposed to the drug as prescribed pain medication. Objective: to better understand the relationship between pain and opioid use in tenants of precarious housing. Methods: in the present study, 440 individuals from a cohort living in homeless or precariously housed conditions in a neighborhood with high rates of poverty and drug use were interviewed for their bodily pain and opioid use. We examined the relationship between bodily pain levels, assessed using the Maudsley Addiction Profile questionnaire, and prescribed, non-prescribed and combined self-reported opioid use in the prior 28 days assessed using the Timeline Followback and Doctor-Prescribed Medication Timeline Followback questionnaires. Results: Analysis of the results indicated that sex (female), age (younger) and early exposure to opioids (≤ age 18) predicted current opioid use, but there was no association between current bodily pain levels and opioid use. Conclusions: these unexpected findings indicate the complex nature of the relationship between pain and opioid use in this population.
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Affiliation(s)
- Michelle Lei
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn Rintoul
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - David D Kim
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yasmin Hamzah
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Lianne L Cho
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
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26
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Gicas KM, Honer WG, Wilson RS, Boyle PA, Leurgans SE, Schneider JA, Bennett DA. Association of serial position scores on memory tests and hippocampal-related neuropathologic outcomes. Neurology 2020; 95:e3303-e3312. [PMID: 33144516 DOI: 10.1212/wnl.0000000000010952] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/17/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether serial position scores in verbal memory differentiate hippocampal-related neuropathologic outcomes, we examined these associations in a sample of older adults without dementia who underwent autopsy. METHODS We used data from the Rush Memory and Aging Project, a longitudinal clinical-pathologic cohort study of community-dwelling adults. A total of 701 participants (mean age 82.7, 71.2% female) completed baseline cognitive evaluations and underwent brain autopsy to identify pathologic Alzheimer disease (AD), TDP-43 inclusions (defining limbic-predominant age-related TDP-43 encephalopathy [LATE]), and hippocampal sclerosis. The Consortium to Establish a Registry for Alzheimer's Disease word list memory test immediate recall trials provided serial position scores, which index the proportion of words recalled from the beginning (primacy scores) and end (recency scores) of a word list. Binary and ordinal logistic regressions examined associations between serial position scores and neuropathologic outcomes. Secondary outcomes included Alzheimer dementia and mild cognitive impairment proximate to death. RESULTS Primacy and recency scores were uncorrelated (r = 0.07). Each SD of better primacy score was associated with lower likelihood of neuropathologic changes (24% lower LATE, 31% lower pathologic AD, 37% lower hippocampal sclerosis). For pathologic AD, better baseline primacy scores were associated with a 36% lower likelihood of comorbidity with LATE or hippocampal sclerosis. Primacy scores better discriminated between clinical diagnoses proximate to death, including those with mild cognitive impairment compared to no impairment. Recency scores showed weaker or no associations. CONCLUSIONS Primacy scores may be particularly sensitive markers of AD and related hippocampal neuropathologies. The differential predictive value of serial position scores suggests they offer complementary information about disease outcomes in addition to the routinely used total recall scores.
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Affiliation(s)
- Kristina M Gicas
- From the Department of Psychology (K.M.G.), York University, Toronto; Department of Psychiatry (W.G.H.), University of British Columbia, Vancouver Canada; and Departments of Neurological Sciences (R.S.W., S.E.L., D.A.B.), Psychiatry and Behavioral Sciences (R.S.W., P.A.B.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL.
| | - William G Honer
- From the Department of Psychology (K.M.G.), York University, Toronto; Department of Psychiatry (W.G.H.), University of British Columbia, Vancouver Canada; and Departments of Neurological Sciences (R.S.W., S.E.L., D.A.B.), Psychiatry and Behavioral Sciences (R.S.W., P.A.B.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Robert S Wilson
- From the Department of Psychology (K.M.G.), York University, Toronto; Department of Psychiatry (W.G.H.), University of British Columbia, Vancouver Canada; and Departments of Neurological Sciences (R.S.W., S.E.L., D.A.B.), Psychiatry and Behavioral Sciences (R.S.W., P.A.B.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Patricia A Boyle
- From the Department of Psychology (K.M.G.), York University, Toronto; Department of Psychiatry (W.G.H.), University of British Columbia, Vancouver Canada; and Departments of Neurological Sciences (R.S.W., S.E.L., D.A.B.), Psychiatry and Behavioral Sciences (R.S.W., P.A.B.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Sue E Leurgans
- From the Department of Psychology (K.M.G.), York University, Toronto; Department of Psychiatry (W.G.H.), University of British Columbia, Vancouver Canada; and Departments of Neurological Sciences (R.S.W., S.E.L., D.A.B.), Psychiatry and Behavioral Sciences (R.S.W., P.A.B.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Julie A Schneider
- From the Department of Psychology (K.M.G.), York University, Toronto; Department of Psychiatry (W.G.H.), University of British Columbia, Vancouver Canada; and Departments of Neurological Sciences (R.S.W., S.E.L., D.A.B.), Psychiatry and Behavioral Sciences (R.S.W., P.A.B.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - David A Bennett
- From the Department of Psychology (K.M.G.), York University, Toronto; Department of Psychiatry (W.G.H.), University of British Columbia, Vancouver Canada; and Departments of Neurological Sciences (R.S.W., S.E.L., D.A.B.), Psychiatry and Behavioral Sciences (R.S.W., P.A.B.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
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Zhou LW, Panenka WJ, Al-Momen G, Gicas KM, Thornton AE, Jones AA, Woodward M, Heran MKS, Vertinsky AT, Su W, Barr AM, MacEwan GW, Lang DJ, Rauscher A, Honer WG, Field TS. Cerebral Small Vessel Disease, Risk Factors, and Cognition in Tenants of Precarious Housing. Stroke 2020; 51:3271-3278. [PMID: 33019899 DOI: 10.1161/strokeaha.120.030446] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE We aim to describe the burden, characteristics, and cognitive associations of cerebral small vessel disease in a Canadian sample living with multimorbidity in precarious housing. METHODS Participants received T1, T2-fluid-attenuated inversion recovery, and susceptibility-weighted imaging 3T magnetic resonance imaging sequences and comprehensive clinical, laboratory, and cognitive assessments. Cerebral small vessel disease burden was characterized using a modified Small Vessel Disease (mSVD) score. One point each was given for moderate-severe white matter hyperintensities, ≥1 cerebral microbleeds, and ≥1 lacune. Multivariable regression explored associations between mSVD score, risk factors, and cognitive performance. RESULTS Median age of the 228 participants (77% male) was 44.7 years (range, 23.3-63.2). In n=188 participants with consistent good quality magnetic resonance imaging sequences, mSVD scores were 0 (n=127, 68%), 1 (n=50, 27%), and 2 (n=11, 6%). Overall, one-third had an mSVD ≥1 n=61 (32%); this proportion was unchanged when adding participants with missing sequences n=72/228 (32%). The most prevalent feature was white matter hyperintensities 53/218 (24%) then cerebral microbleed 16/191 (8%) and lacunes 16/228 (7%). Older age (odds ratio, 1.10 [95% CI, 1.05-1.15], P<0.001), higher diastolic blood pressure (odds ratio, 1.05 [95% CI, 1.01-1.09], P=0.008), and a history of injection drug use (odds ratio, 3.13 [95% CI, 1.07-9.16], P=0.037) had significant independent associations with a mSVD score of ≥1 in multivariable analysis. mSVD ≥1 was associated with lower performance on tests of verbal memory, sustained attention, and decision-making, contributing 4% to 5% of the variance in each cognitive domain. CONCLUSIONS The 32% prevalence of cerebral small vessel disease in this young, socially marginalized cohort was higher than expected for age and was associated with poorer cognitive performance.
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Affiliation(s)
- Lily W Zhou
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - William J Panenka
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Ghadeer Al-Momen
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Kristina M Gicas
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Allen E Thornton
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Andrea A Jones
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Melissa Woodward
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Manraj K S Heran
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - A Talia Vertinsky
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Wayne Su
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Alasdair M Barr
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - G William MacEwan
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Donna J Lang
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Alexander Rauscher
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - William G Honer
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Thalia S Field
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
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Woodward ML, Lin J, Gicas KM, Su W, Hui CLM, Honer WG, Chen EYH, Lang DJ. Medial temporal lobe cortical changes in response to exercise interventions in people with early psychosis: A randomized controlled trial. Schizophr Res 2020; 223:87-95. [PMID: 32487465 DOI: 10.1016/j.schres.2020.05.043] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/21/2020] [Accepted: 05/17/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Individuals with early psychosis may have prefrontal-limbic cortical deficits, which are associated with symptom severity and cognitive impairment. This study investigated the impact of an exercise intervention on fronto-temporal cortical plasticity in female participants with early psychosis. METHODS In a cohort of 51 female participants with early psychosis from Hong Kong, we investigated the effects of a 12-week, moderate intensity aerobic or Hatha yoga exercise trial (yoga (N = 21), aerobic (N = 18) or waitlist group (N = 12)) on cortical grey matter. Clinical assessments and structural MRI were completed pre- and post- a 12-week exercise intervention. RESULTS Increases in cortical volume and thickness were observed in the medial temporal cortical regions, primarily in fusiform cortical thickness (F(2, 48) = 4.221, p = 0.020, η2 = 0.150) and volume (F(2, 48) = 3.521, p = 0.037, η2 = 0.128) for participants with early psychosis in the aerobic arm, but not in the yoga and waitlist arms. Increased fusiform cortical thickness (ß = 0.402, p = 0.003) was associated with increased hippocampal volume for all psychosis participants. For the aerobic group only, increases in the entorhinal and fusiform temporal gyri were associated with reduced symptom severity. CONCLUSIONS These findings suggest exercise-induced neuroplasticity in medial temporal cortical regions occurs with aerobic exercise. These changes may be associated with improvements in psychosis symptom severity. People with early psychosis may benefit from exercise interventions, particularly aerobic exercise, as an adjunct treatment to address clinical, physical health, and neuroanatomic concerns. NIH National Library of Medicine ClinicalTrials.gov Registration #: NCT01207219https://clinicaltrials.gov/ct2/show/NCT01207219.
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Affiliation(s)
| | - Jingxia Lin
- School of Nursing, The University of Hong Kong, Hong Kong
| | | | - Wayne Su
- Department of Psychiatry, University of British Columbia, Canada
| | - Christy L M Hui
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Canada
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Canada.
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29
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Jones PW, Thornton AE, Jones AA, Knerich VM, Lang DJ, Woodward ML, Panenka WJ, Su W, Barr AM, Buchanan T, Honer WG, Gicas KM. Amygdala Nuclei Volumes Are Selectively Associated With Social Network Size in Homeless and Precariously Housed Persons. Front Behav Neurosci 2020; 14:97. [PMID: 32612516 PMCID: PMC7309349 DOI: 10.3389/fnbeh.2020.00097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/22/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: The amygdala is a brain region comprised of a group of functionally distinct nuclei that play a central role in social behavior. In homeless and precariously housed individuals, high rates of multimorbidity, and structural aspects of the environment may dysregulate social functioning. This study examined the neurobiological substrates of social connection in homeless and precariously housed persons by examining associations between amygdala nuclei volumes and social network size. Methods: Sixty participants (mean age 43.6 years; 73.3% male) were enrolled from an ongoing study of homeless and precariously housed adults in Vancouver, Canada. Social network size was assessed using the Arizona Social Support Interview Schedule. Amygdala nuclei volumes were extracted from anatomic T1-weighted MRI data. The central and basolateral amygdala nuclei were selected as they are implicated in anxiety-related and social behaviors. The hippocampus was included as a control brain region. Multivariable regression analysis investigated the relationship between amygdala nuclei volumes and social network size. Results: After controlling for age, sex, and total brain volume, individuals with the larger amygdala and central nucleus volumes had a larger network size. This association was not observed for the basolateral amygdala complex, though subsequent analysis found the basal and accessory basal nuclei of the basolateral amygdala were significantly associated with social network size. No association was found for the lateral amygdala nucleus or hippocampus. Conclusions: These findings suggest that select amygdala nuclei may be differentially involved in the social connections of persons with multimorbid illness and social marginalization.
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Affiliation(s)
- Paul W. Jones
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Allen E. Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Andrea A. Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Verena M. Knerich
- Department of Computer Science, Ludwig Maximilians University, Munich, Germany
| | - Donna J. Lang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Melissa L. Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M. Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Kristina M. Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Psychology, York University, Toronto, ON, Canada
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Gicas KM, Jones AA, Thornton AE, Petersson A, Livingston E, Waclawik K, Panenka WJ, Barr AM, Lang DJ, Vila-Rodriguez F, Leonova O, Procyshyn RM, Buchanan T, MacEwan GW, Honer WG. Cognitive decline and mortality in a community-based sample of homeless and precariously housed adults: 9-year prospective study. BJPsych Open 2020; 6:e21. [PMID: 32043436 PMCID: PMC7176832 DOI: 10.1192/bjo.2020.3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Homeless and precariously housed individuals experience a high burden of comorbid illnesses, and excess mortality. Cross-sectional studies report a high rate of cognitive impairment. Long-term trajectories have not been well investigated in this group. AIMS To longitudinally assess risks for premature and/or accelerated cognitive ageing, and the relationship with early mortality in homeless and precariously housed people. METHOD This is a 9-year community-based study of 375 homeless and precariously housed individuals from Vancouver, Canada. Annual cognitive testing assessed verbal learning and memory, and inhibitory control. Linear mixed-effects models examined associations between clinical risk factors (traumatic brain injury, psychotic disorders, viral exposure, alcohol dependence) and cognitive change over 9 years. Cox regression models examined the association between cognition and mortality. RESULTS Traumatic brain injury and alcohol dependence were associated with decline in verbal memory. Inhibitory control declined, independent of risk factors and to a greater extent in those who died during the study. Better inhibitory control was associated with a 6.6% lower risk of mortality at study entry, with a 0.3% greater effect for each year of life. For each one-point increase in the Charlson Comorbidity Index score at study entry, the risk of mortality was 9.9% higher, and was consistent across age. Adjusting for comorbidities, inhibitory control remained a significant predictor of mortality. CONCLUSIONS Findings raise the possibility of a premature onset, and accelerated trajectory, of cognitive ageing in this group of homeless and precariously housed people. Traumatic brain injury, alcohol dependence and cognition could be treatment priorities.
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Affiliation(s)
- Kristina M Gicas
- Department of Psychology, York University, Toronto, Canada.,Department of Psychiatry, University of British Columbia, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Canada
| | | | - Anna Petersson
- Department of Psychology, Simon Fraser University, Canada
| | | | | | | | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Canada
| | | | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Canada
| | | | - William G Honer
- Department of Psychiatry, University of British Columbia; and British Columbia Mental Health and Substance Use Services Research Institute, Canada
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Yau JC, Yu SM, Panenka WJ, Pearce H, Gicas KM, Procyshyn RM, MacCallum C, Honer WG, Barr AM. Characterization of mental health in cannabis dispensary users, using structured clinical interviews and standardized assessment instruments. BMC Psychiatry 2019; 19:335. [PMID: 31675939 PMCID: PMC6825348 DOI: 10.1186/s12888-019-2324-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cannabis is commonly used for its medical properties. In particular, cannabis is purported to have beneficial effects on a wide range of neuropsychiatric conditions. Studies assessing mental health in cannabis dispensary users typically evaluate symptoms using self-report check lists, which provide limited information about symptom severity, and whether subjects meet criteria for a psychiatric diagnosis. There is, therefore, a need for studies which assess mental health in dispensary users with standardized and well validated scientific instruments, such as those used in clinical drug trials. METHODS One hundred medical cannabis users were recruited from a community dispensary. All subjects completed a structured clinical interview with the Mini-International Neuropsychiatric Interview (MINI). Subjects also completed the Perceived Stress Scale-10, PROMIS Fatigue Scale, PROMIS Sleep Disturbance Scale, Beck Depression Inventory, the Patient Health Questionnaire-15 and the Brief Pain Inventory. Details about cannabis use were also recorded. RESULTS Lifetime prevalence of mental illness in this cohort was high, and a large proportion of subjects endorsed psychological symptoms. The proportion of subjects who met criteria for classification of a current psychiatric disorder was low for mood disorders, but high for anxiety disorders and substance abuse/dependence. Cannabis use differed between the main psychiatric conditions. CONCLUSIONS The present results indicate that rates of mental illness may be high in medical cannabis dispensary users. Use of structured clinical assessments combined with standardized symptom severity questionnaires provide a feasible way to provide a more rigorous and detailed evaluation of conditions and symptoms in this population.
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Affiliation(s)
- Jade C. Yau
- 0000 0001 2288 9830grid.17091.3eDepartment of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Shu Min Yu
- 0000 0001 2288 9830grid.17091.3eDepartment of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - William J. Panenka
- 0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Hadley Pearce
- 0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Kristina M. Gicas
- 0000 0004 1936 9430grid.21100.32Department of Psychology, York University, Toronto, Ontario Canada
| | - Ric M. Procyshyn
- 0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Caroline MacCallum
- 0000 0001 2288 9830grid.17091.3eDepartment of Medicine, University of British Columbia, Vancouver, British Columbia Canada
| | - William G. Honer
- 0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Alasdair M. Barr
- 0000 0001 2288 9830grid.17091.3eDepartment of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3 Canada
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Waclawik K, Jones AA, Barbic SP, Gicas KM, O'Connor TA, Smith GN, Leonova O, Mathias S, Barr AM, Procyshyn RM, Lang DJ, Woodward ML, MacEwan GW, Panenka WJ, Yamamoto A, Honer WG, Thornton AE. Cognitive Impairment in Marginally Housed Youth: Prevalence and Risk Factors. Front Public Health 2019; 7:270. [PMID: 31649909 PMCID: PMC6792471 DOI: 10.3389/fpubh.2019.00270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022] Open
Abstract
Objective: Homeless and marginally housed youth are particularly vulnerable members of society, and are known to experience numerous health problems, including psychiatric illness, substance use, and viral infection. Despite the presence of these risk factors for cognitive compromise, there is limited research on the cognitive functioning of homeless and marginally housed youth. The present study examines the degree and pattern of cognitive impairment and associations with key risk factors in a sample of marginally housed young adults. Method: Participants (N = 101) aged 20–29 years old were recruited from single-room occupancy hotels, and underwent cognitive, psychiatric, neurological, and serological assessments. Results: Forty percent of participants were identified as mildly cognitively impaired across multiple domains, and 16% were moderately-severely impaired. Deficits in memory and attention were most prevalent, while impairments in inhibitory control/processing speed and cognitive flexibility were also present but tended to be less severe. Developmental and historical factors (premorbid intellectual functioning, neurological soft signs, earlier exposure to and longer duration of homelessness or marginal housing), as well as current health risks (stimulant dependence and hepatitis C exposure), were associated with cognitive impairment. Conclusions: The strikingly high rate of cognitive impairment in marginally housed young adults represents a major public health concern and is likely to pose a significant barrier to treatment and rehabilitation. These results suggest that the pathway to cognitive impairment involves both developmental vulnerability and modifiable risk factors. This study highlights the need for early interventions that address cognitive impairment and risk factors in marginalized young people.
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Affiliation(s)
- Kristina Waclawik
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Skye P Barbic
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,Providence Health Care and Foundry, Vancouver, BC, Canada
| | - Kristina M Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Geoffrey N Smith
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Steve Mathias
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,Providence Health Care and Foundry, Vancouver, BC, Canada.,St. Paul's Hospital, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Melissa L Woodward
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,St. Paul's Hospital, Vancouver, BC, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
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Gicas KM, Thornton AE, Waclawik K, Wang N, Jones AA, Panenka WJ, Lang DJ, Smith GN, Vila-Rodriguez F, Leonova O, Barr AM, Procyshyn RM, Buchanan T, Su W, Vertinsky AT, Rauscher A, MacEwan GW, Honer WG. Volumes of the Hippocampal Formation Differentiate Component Processes of Memory in a Community Sample of Homeless and Marginally Housed Persons. Arch Clin Neuropsychol 2019; 34:548-562. [PMID: 30407496 DOI: 10.1093/arclin/acy066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/10/2018] [Accepted: 07/17/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Persons who are homeless or marginally housed exhibit significant cognitive dysfunction, with memory being the most impaired domain. Hippocampal subfield volumes have been found to differentially relate to component processes of memory. The neural correlates of memory have not been previously examined in marginalized persons who are understudied and underserved. We examined whether hippocampal subfields and entorhinal cortex volumes are uniquely related to indices of verbal episodic memory using the Hopkins Verbal Learning Test - Revised. METHOD Data was used from a large sample of community dwelling homeless and marginally housed adults (N = 227). Regression analyses were conducted to examine hippocampal subfield volumes (CA1, CA3, CA4, dentate gyrus, subiculum) and entorhinal cortex, and their associations with measures of verbal immediate recall, learning slope, and verbal delayed recall. RESULTS Greater CA3 subfield volume was associated with better performance on an index of encoding (immediate recall), but only in older individuals. Greater CA1 and subiculum volumes were associated with better performance on immediate and delayed recall (measures that tap into retrieval processes), but not with learning slope (a more pure index of encoding). Entorhinal cortex volume was related to all components of memory beyond total hippocampal volume. CONCLUSIONS Our results suggest common neuroanatomical correlates of memory dysfunction in large sample of marginalized persons, and these are uniquely related to different components of memory. These findings have clinical relevance for marginalized populations and theoretical relevance to the growing literature on functional specialization of the hippocampal subfields.
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Affiliation(s)
- Kristina M Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | | | - Nena Wang
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Geoff N Smith
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Alexander Rauscher
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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Zhou LW, Panenka WJ, Jones AA, Gicas KM, Thornton AE, Heran MKS, Volders D, Lang DJ, Vertinsky AT, Rauscher A, Su W, Barr AM, MacEwan GW, Honer WG, Field TS. Prevalence and Risk Factors of Brain Infarcts and Associations With Cognitive Performance in Tenants of Marginal Housing. J Am Heart Assoc 2019; 8:e011412. [PMID: 31242796 PMCID: PMC6662377 DOI: 10.1161/jaha.118.011412] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Homeless and vulnerably housed individuals are at increased risk for multimorbidity compared with the general population. We assessed prevalence of brain infarcts on neuroimaging and associations with vascular risk factors and cognitive performance in a prospective study of residents living in marginal housing. Methods and Results Two hundred twenty‐eight participants underwent structured clinical interviews, targeted clinical, laboratory, and neuropsychological assessments, and magnetic resonance imaging with T1, T2‐fluid‐attenuated inversion recovery and susceptibility‐weighted images. Subjects underwent cognitive testing to assess premorbid IQ, verbal learning and memory, inhibition, sustained attention, mental flexibility, and decision making. In this sample (mean age 44.0 years [SD 9.4], 77% male), prevalence of conventional vascular risk factors was lower than in the general population apart from tobacco use (94%). Ten‐year Framingham risk for any cardiovascular event was 11.4%±9.2%. Brain infarcts were present in 25/228 (11%). All were ischemic (40% cortical, 56% lacunar, 4% both). Participants with infarcts were older than those without (48.9±9.4 versus 43.4±9.2, P=0.006). In a multivariable regression analysis, only age remained a significant predictor of brain infarcts (odds ratio 1.08, 95% CI1.02–1.14, P=0.004). After controlling for age and education, the presence of infarct was a significant predictor of impaired decision making on the Iowa Gambling Task of decision making (β −28.2, 95% CI −42.7 to −14.1, P<0.001). Conclusions Prevalence of infarcts on neuroimaging in this disadvantaged, community‐dwelling cohort was much higher than expected for age and was associated with impaired decision making. Further research is needed to identify individuals at highest risk who may benefit from targeted preventative strategies.
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Affiliation(s)
- Lily W Zhou
- 1 Vancouver Stroke Program Division of Neurology Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - William J Panenka
- 2 Department of Psychiatry University of British Columbia Vancouver British Columbia Canada.,7 British Columbia Provincial Neuropsychiatry Program Vancouver British Columbia Canada.,8 British Columbia Mental Health and Substance Abuse Research Institute Vancouver British Columbia Canada
| | - Andrea A Jones
- 2 Department of Psychiatry University of British Columbia Vancouver British Columbia Canada
| | - Kristina M Gicas
- 3 Department of Psychology Simon Fraser University Burnaby British Columbia Canada
| | - Allen E Thornton
- 3 Department of Psychology Simon Fraser University Burnaby British Columbia Canada
| | - Manraj K S Heran
- 4 Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - David Volders
- 4 Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Donna J Lang
- 4 Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | | | - Alexander Rauscher
- 6 Department of Pediatrics University of British Columbia Vancouver British Columbia Canada
| | - Wayne Su
- 2 Department of Psychiatry University of British Columbia Vancouver British Columbia Canada
| | - Alasdair M Barr
- 5 Department of Anesthesia, Pharmacology & Therapeutics University of British Columbia Vancouver British Columbia Canada
| | - Gordon William MacEwan
- 2 Department of Psychiatry University of British Columbia Vancouver British Columbia Canada
| | - William G Honer
- 2 Department of Psychiatry University of British Columbia Vancouver British Columbia Canada
| | - Thalia S Field
- 1 Vancouver Stroke Program Division of Neurology Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
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Gicas KM, Jones AA, Panenka WJ, Giesbrecht C, Lang DJ, Vila-Rodriguez F, Leonova O, Barr AM, Procyshyn RM, Su W, Rauscher A, Vertinsky AT, Buchanan T, MacEwan GW, Thornton AE, Honer WG. Cognitive profiles and associated structural brain networks in a multimorbid sample of marginalized adults. PLoS One 2019; 14:e0218201. [PMID: 31194834 PMCID: PMC6564539 DOI: 10.1371/journal.pone.0218201] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/28/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Cognition is impaired in homeless and vulnerably housed persons. Within this heterogeneous and multimorbid group, distinct profiles of cognitive dysfunction are evident. However, little is known about the underlying neurobiological substrates. Imaging structural covariance networks provides a novel investigative strategy to characterizing relationships between brain structure and function within these different cognitive subgroups. Method Participants were 208 homeless and vulnerably housed persons. Cluster analysis was used to group individuals on the basis of similarities in cognitive functioning in the areas of attention, memory, and executive functioning. The principles of graph theory were applied to construct two brain networks for each cognitive group, using measures of cortical thickness and gyrification. Global and regional network properties were compared across networks for each of the three cognitive clusters. Results Three cognitive groups were defined by: higher cognitive functioning across domains (Cluster 1); lower cognitive functioning with a decision-making strength (Cluster 3); and an intermediate group with a relative executive functioning weakness (Cluster 2). Between-group differences were observed for cortical thickness, but not gyrification networks. The lower functioning cognitive group exhibited higher segregation and reduced integration, higher centrality in select nodes, and less spatially compact modules compared with the two other groups. Conclusions The cortical thickness network differences of Cluster 3 suggest that major disruptions in structural connectivity underlie cognitive dysfunction in a subgroup of people who have a high multimorbid illness burden and who are vulnerably housed or homeless. The origins, and possible plasticity of these structure-function relationships identified with network analysis warrant further study.
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Affiliation(s)
- Kristina M. Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
- * E-mail:
| | - Andrea A. Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | | | - Donna J. Lang
- Department of Radiology, University of British Columbia, Vancouver, BC Canada
| | | | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Alasdair M. Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC Canada
| | - Ric M. Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Alexander Rauscher
- Department of Paediatrics, University of British Columbia, Vancouver, BC Canada
| | - A. Talia Vertinsky
- Department of Radiology, University of British Columbia, Vancouver, BC Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - G. William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Allen E. Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC Canada
| | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
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Gicas KM, Cheng A, Rawtaer I, Willi TS, Panenka WJ, Lang DJ, Smith GN, Vila-Rodriguez F, Leonova O, Giesbrecht CJ, Jones AA, Barr AM, Procyshyn RM, Buchanan T, MacEwan GW, Su W, Vertinsky AT, Rauscher A, O'Rourke N, Loken Thornton W, Thornton AE, Honer WG. Diffusion tensor imaging of neurocognitive profiles in a community cohort living in marginal housing. Brain Behav 2019; 9:e01233. [PMID: 30724486 PMCID: PMC6422717 DOI: 10.1002/brb3.1233] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 11/13/2018] [Accepted: 01/09/2019] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE We investigated white matter differences associated with distinct neurocognitive profiles derived from a large cohort of marginally housed persons with comorbid physical and mental illnesses. Our prior work identified three profile cluster groups: a high functioning group (Cluster 1), a low functioning group with relative strength in decision-making (Cluster 3), and an intermediary group with a relative decision-making weakness (Cluster 2). This study extends previous findings of cortical gray matter differences between these groups with evidence for putative neurodevelopmental abnormalities in the low cognitive functioning group (i.e., Cluster 3). We hypothesized that altered white matter diffusion would be associated with the lowest functioning neurocognitive profile and would be associated with previously observed gray matter differences. METHOD Participants from a socially impoverished neighborhood in Vancouver, Canada underwent neurocognitive evaluation and neuroimaging. We performed Tract-Based Spatial Statistics using diffusion tensor imaging data from 184 participants to examine whole-brain differences in white matter microstructure between cluster analytically derived neurocognitive profiles, as well as unitary neurocognitive measures. Correlations between frontal gray and white matter were also examined. RESULTS Cluster 3 showed increased diffusion in predominately bilateral frontal and interhemisphere tracts (vs. Clusters 1 and 2), with relatively greater diffusion in the left hemisphere (vs. Cluster 1). Differences in radial diffusivity were more prominent compared with axial diffusivity. A weak association between regional frontal fractional anisotropy and previously defined abnormalities in gyrification was observed. CONCLUSIONS In a socially marginalized sample, we established several patterns in the covariation of white matter diffusion and neurocognitive functioning. These patterns elucidate the neurobiological substrates and vulnerabilities that are apt to underlie functional impairments inherent to this complex and heterogeneous population.
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Affiliation(s)
- Kristina M Gicas
- Department of Psychology, Simon Fraser University, Burnaby, Canada.,Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - Alex Cheng
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - Iris Rawtaer
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - Taylor S Willi
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancover, Canada
| | - Geoff N Smith
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | | | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | | | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancover, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | | | - Alexander Rauscher
- Department of Paediatrics, University of British Columbia, Vancover, Canada
| | - Norm O'Rourke
- Department of Public Health and Centre for Multidisciplinary Research in Aging, University of the Negev, Be'er Sheva, Israel
| | | | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancover, Canada
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Woodward ML, Gicas KM, Warburton DE, White RF, Rauscher A, Leonova O, Su W, Smith GN, Thornton AE, Vertinsky AT, Phillips AA, Goghari VM, Honer WG, Lang DJ. Hippocampal volume and vasculature before and after exercise in treatment-resistant schizophrenia. Schizophr Res 2018; 202:158-165. [PMID: 30539767 DOI: 10.1016/j.schres.2018.06.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 02/08/2018] [Revised: 06/11/2018] [Accepted: 06/20/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Schizophrenia is associated with poor cognitive function and elevated cardiometabolic disease risk. These health concerns may exacerbate neurocognitive dysfunction associated with hippocampal abnormalities, particularly hippocampal volume reductions. Regular exercise is thought to improve symptom severity, reduce depression, and improve cognition in schizophrenia, and may trigger exercise-mediated hippocampal growth. The potential for the benefits of exercise for treatment-resistant schizophrenia patients has not been clearly assessed. This study aims to assess the effect of exercise on hippocampal plasticity and clinical outcomes in chronic schizophrenia. METHODS Seventeen DSM-IV criteria schizophrenia or schizoaffective disorder patients completed a customized moderate intensity 12-week aerobic or weight-bearing exercise program. Adherence rates were 83% ± 9.4%) with 70% of participants completing the entire exercise program. Concomitant neuroimaging, clinical and cognitive assessments were obtained at baseline and 12-weeks. RESULTS At follow-up, symptom severity scores (t(16) = -16.8, p. ≤ 0.0001) and social functioning (t(16) = 4.4, p. = 0.0004) improved. A trend for improved depression scores (t(16) = -2.0, p. = 0.06) with no change in anxiety, or extrapyramidal symptoms were seen. Hippocampal volume increased (t(16) = -2.54, p. = 0.02), specifically in the left CA-1 field (F(16) = -2.33, p. = 0.03). Hippocampal vascular volume was unchanged. Change in hippocampal volume and vascular volume was not significantly correlated with change in symptom severity or affect scores. CONCLUSIONS Adjunct exercise may accelerate symptom improvement in treatment-resistant psychosis patients. While the underlying mechanism remains unclear, these results indicate that chronic schizophrenia patients experience hippocampal plasticity in response to exercise. STUDY REGISTRATION Clinical Trials.govNCT01392885.
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Affiliation(s)
- M L Woodward
- Department of Radiology, University of British Columbia, Canada
| | - K M Gicas
- Department of Psychology, Simon Fraser University, Canada
| | - D E Warburton
- School of Kinesiology, University of British Columbia, Canada; Experimental Medicine Program, University of British Columbia, Canada
| | - R F White
- Department of Psychiatry, University of British Columbia, Canada
| | - A Rauscher
- Department of Pediatrics, University of British Columbia, Canada
| | - O Leonova
- Department of Psychiatry, University of British Columbia, Canada
| | - W Su
- Department of Psychiatry, University of British Columbia, Canada
| | - G N Smith
- Department of Psychiatry, University of British Columbia, Canada
| | - A E Thornton
- Department of Pediatrics, University of British Columbia, Canada
| | - A T Vertinsky
- Department of Radiology, University of British Columbia, Canada
| | - A A Phillips
- School of Kinesiology, University of British Columbia, Canada
| | - V M Goghari
- Department of Psychology & Graduate Department of Psychological Clinical Science, University of Toronto, Canada
| | - W G Honer
- Department of Psychiatry, University of British Columbia, Canada
| | - D J Lang
- Department of Radiology, University of British Columbia, Canada.
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Schmitt T, Thornton AE, Rawtaer I, Barr AM, Gicas KM, Lang DJ, Vertinsky AT, Rauscher A, Procyshyn RM, Buchanan T, Cheng A, MacKay S, Leonova O, Langheimer V, Field TS, Heran MK, Vila-Rodriguez F, O'Connor TA, MacEwan GW, Honer WG, Panenka WJ. Traumatic Brain Injury in a Community-Based Cohort of Homeless and Vulnerably Housed Individuals. J Neurotrauma 2017; 34:3301-3310. [DOI: 10.1089/neu.2017.5076] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Toby Schmitt
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allen E. Thornton
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Iris Rawtaer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alasdair M. Barr
- Department of Pharmacology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kristina M. Gicas
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Donna J. Lang
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - A. Talia Vertinsky
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ric M. Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Cheng
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah MacKay
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Verena Langheimer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thalia S. Field
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manraj K. Heran
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tiffany A. O'Connor
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - G. William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Neuropsychiatry Program, Simon Fraser University, Burnaby, British Columbia, Canada
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Honer WG, Cervantes-Larios A, Jones AA, Vila-Rodriguez F, Montaner JS, Tran H, Nham J, Panenka WJ, Lang DJ, Thornton AE, Vertinsky T, Barr AM, Procyshyn RM, Smith GN, Buchanan T, Krajden M, Krausz M, MacEwan GW, Gicas KM, Leonova O, Langheimer V, Rauscher A, Schultz K. The Hotel Study-Clinical and Health Service Effectiveness in a Cohort of Homeless or Marginally Housed Persons. Can J Psychiatry 2017; 62:482-492. [PMID: 28199798 PMCID: PMC5528984 DOI: 10.1177/0706743717693781] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The Hotel Study was initiated in Vancouver's Downtown East Side (DTES) neighborhood to investigate multimorbidity in homeless or marginally housed people. We evaluated the clinical effectiveness of existing, illness-specific treatment strategies and assessed the effectiveness of health care delivery for multimorbid illnesses. METHOD For context, we mapped the housing locations of patients presenting for 552,062 visits to the catchment hospital emergency department (2005-2013). Aggregate data on 22,519 apprehensions of mentally ill people were provided by the Vancouver Police Department (2009-2015). The primary strategy was a longitudinal cohort study of 375 people living in the DTES (2008-2015). We analysed mortality and evaluated the clinical and health service delivery effectiveness for infection with human immunodeficiency virus or hepatitis C virus, opioid dependence, and psychosis. RESULTS Mapping confirmed the association between poverty and greater number of emergency visits related to substance use and mental illness. The annual change in police apprehensions did not differ between the DTES and other policing districts. During 1581 person-years of cohort observation, the standardized mortality ratio was 8.43 (95% confidence interval, 6.19 to 11.50). Physician visits were common (84.3% of participants over 6 months). Clinical treatment effectiveness was highest for HIV/AIDS, intermediate for opioid dependence, and lowest for psychosis. Health service delivery mechanisms provided examples of poor access, poor treatment adherence, and little effect on multimorbid illnesses. CONCLUSIONS Clinical effectiveness was variable, and illness-specific service delivery appeared to have little effect on multimorbidity. New models of care may need to be implemented.
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Affiliation(s)
- William G Honer
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | - Andrea A Jones
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Fidel Vila-Rodriguez
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Julio S Montaner
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Howard Tran
- 3 Youth Services Section and Mental Health Portfolio, Vancouver Police Department, Vancouver, British Columbia
| | - Jimmy Nham
- 3 Youth Services Section and Mental Health Portfolio, Vancouver Police Department, Vancouver, British Columbia
| | - William J Panenka
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Donna J Lang
- 4 Department of Radiology, University of British Columbia, Vancouver, British Columbia
| | - Allen E Thornton
- 5 Department of Psychology, Simon Fraser University, Burnaby, British Columbia
| | - Talia Vertinsky
- 4 Department of Radiology, University of British Columbia, Vancouver, British Columbia
| | - Alasdair M Barr
- 6 Department of Anesthesia, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia
| | - Ric M Procyshyn
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Geoffrey N Smith
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Tari Buchanan
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Mel Krajden
- 7 Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia
| | - Michael Krausz
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - G William MacEwan
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Kristina M Gicas
- 5 Department of Psychology, Simon Fraser University, Burnaby, British Columbia
| | - Olga Leonova
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Verena Langheimer
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Alexander Rauscher
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Krista Schultz
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
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Gicas KM, Vila-Rodriguez F, Paquet K, Barr AM, Procyshyn RM, Lang DJ, Smith GN, Baitz HA, Giesbrecht CJ, Montaner JS, Krajden M, Krausz M, MacEwan GW, Panenka WJ, Honer WG, Thornton AE. Neurocognitive profiles of marginally housed persons with comorbid substance dependence, viral infection, and psychiatric illness. J Clin Exp Neuropsychol 2014; 36:1009-22. [DOI: 10.1080/13803395.2014.963519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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