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Tognin S, Richter A, Kempton MJ, Modinos G, Antoniades M, Azis M, Allen P, Bossong MG, Perez J, Pantelis C, Nelson B, Amminger P, Riecher-Rössler A, Barrantes-Vidal N, Krebs MO, Glenthøj B, Ruhrmann S, Sachs G, Rutten BPF, de Haan L, van der Gaag M, Valmaggia LR, McGuire P, Antoniades M, Pisani S, Modinos G, de Haan L, van der Gaag M, Velthorst E, Kraan TC, van Dam DS, Burger N, Nelson B, McGorry P, Amminger GP, Pantelis C, Politis A, Goodall J, Riecher-Rössler A, Borgwardt S, Studerus E, Bressan R, Gadelha A, Brietzke E, Asevedo G, Asevedo E, Zugman A, Barrantes-Vidal N, Domínguez-Martínez T, Racciopi A, Kwapil TR, Monsonet M, Hinojosa L, Kazes M, Daban C, Bourgin J, Gay O, Mam-Lam-Fook C, Krebs MO, Nordholm D, Randers L, Krakauer K, Glenthøj L, Glenthøj B, Nordentoft M, Ruhrmann S, Gebhard D, Arnhold J, Klosterkötter J, Sachs G, Lasser I, Winklbaur B, Aschauer H, Delespaul PA, Rutten BP, van Os J, Valmaggia LR, McGuire P. The Relationship Between Grey Matter Volume and Clinical and Functional Outcomes in People at Clinical High Risk for Psychosis. Schizophr Bull Open 2022; 3:sgac040. [PMID: 35903803 PMCID: PMC9309497 DOI: 10.1093/schizbullopen/sgac040] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective To examine the association between baseline alterations in grey matter volume (GMV) and clinical and functional outcomes in people at clinical high risk (CHR) for psychosis. Methods 265 CHR individuals and 92 healthy controls were recruited as part of a prospective multi-center study. After a baseline assessment using magnetic resonance imaging (MRI), participants were followed for at least two years to determine clinical and functional outcomes, including transition to psychosis (according to the Comprehensive Assessment of an At Risk Mental State, CAARMS), level of functioning (according to the Global Assessment of Functioning), and symptomatic remission (according to the CAARMS). GMV was measured in selected cortical and subcortical regions of interest (ROI) based on previous studies (ie orbitofrontal gyrus, cingulate gyrus, gyrus rectus, inferior temporal gyrus, parahippocampal gyrus, striatum, and hippocampus). Using voxel-based morphometry, we analysed the relationship between GMV and clinical and functional outcomes. Results Within the CHR sample, a poor functional outcome (GAF < 65) was associated with relatively lower GMV in the right striatum at baseline (P < .047 after Family Wise Error correction). There were no significant associations between baseline GMV and either subsequent remission or transition to psychosis. Conclusions In CHR individuals, lower striatal GMV was associated with a poor level of overall functioning at follow-up. This finding was not related to effects of antipsychotic or antidepressant medication. The failure to replicate previous associations between GMV and later psychosis onset, despite studying a relatively large sample, is consistent with the findings of recent large-scale multi-center studies.
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Affiliation(s)
- Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Anja Richter
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Gemma Modinos
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Mathilde Antoniades
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Matilda Azis
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Matthijs G Bossong
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Jesus Perez
- CAMEO Early Intervention in Psychosis Services, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Christos Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Carlton South, Victoria, Australia
| | | | | | | | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut (Universitat Autònoma de Barcelona), Fundació Sanitària Sant Pere Claver (Spain), Center for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Marie-Odile Krebs
- University of Paris, GHU-Paris, Sainte-Anne, C'JAAD, Hospitalo-Universitaire department SHU, Inserm U1266, Institut de Psychiatrie (CNRS 3557), Paris, France
| | - Birte Glenthøj
- Center for Neuropsychiatric Schizophrenia Research, CNSR, and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Services Capital Region of Denmark, Mental Health Center Glostrup, Glostrup, Denmark
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital University of Cologne, Cologne, Germany
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Lieuwe de Haan
- Early Psychosis Department, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology and Amsterdam Public Mental Health Research Institute, Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, The Netherlands
| | | | - Lucia R Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London , UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London , UK
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) , UK
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Randers L, Jepsen JRM, Fagerlund B, Nordholm D, Krakauer K, Hjorthøj C, Glenthøj B, Nordentoft M. Generalized neurocognitive impairment in individuals at ultra-high risk for psychosis: The possible key role of slowed processing speed. Brain Behav 2021; 11:e01962. [PMID: 33486897 PMCID: PMC7994693 DOI: 10.1002/brb3.1962] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/06/2020] [Accepted: 10/25/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Widespread neurocognitive impairment is well-established in individuals at ultra-high risk (UHR) for developing psychoses, but it is unknown whether slowed processing speed may underlie impairment in other neurocognitive domains, as found in schizophrenia. The study delineated domain functioning in a UHR sample and examined if neurocognitive slowing might account for deficits across domains. METHODS The cross-sectional study included 50 UHR individuals with no (n = 38) or minimal antipsychotic exposure (n = 12; mean lifetime dose of haloperidol equivalent = 17.56 mg; SD = 13.04) and 50 matched healthy controls. Primary analyses compared group performance across neurocognitive domains before and after covarying for processing speed. To examine the specificity of processing speed effects, post hoc analyses examined the impact of the other neurocognitive domains and intelligence as covariates. RESULTS UHR individuals exhibited significant impairment across all neurocognitive domains (all ps ≤ .010), with medium to large effect sizes (Cohen's ds = -0.53 to -1.12). Only processing speed used as covariate eliminated significant between-group differences in all other domains, reducing unadjusted Cohen's d values with 68% on average, whereas the other domains used as covariates averagely reduced unadjusted Cohen's d values with 20% to 48%. When covarying each of the other domains after their shared variance with speed of processing was removed, all significant between-group domain differences remained (all ps ≤ .024). CONCLUSION Slowed processing speed may underlie generalized neurocognitive impairment in UHR individuals and represent a potential intervention target.
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Affiliation(s)
- Lasse Randers
- Copenhagen Research Center for Mental Health ‐ COREMental Health Center CopenhagenCopenhagen University HospitalCopenhagenDenmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS)Mental Health Center GlostrupCopenhagen University HospitalGlostrupDenmark
- Faculty of Health and Medical SciencesDepartment of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Jens Richardt Møllegaard Jepsen
- Copenhagen Research Center for Mental Health ‐ COREMental Health Center CopenhagenCopenhagen University HospitalCopenhagenDenmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS)Mental Health Center GlostrupCopenhagen University HospitalGlostrupDenmark
- Center for Neuropsychiatric Schizophrenia Research (CNSR)Mental Health Center GlostrupCopenhagen University HospitalGlostrupDenmark
- Child and Adolescent Mental Health CenterMental Health Services Capital Region of DenmarkCopenhagen University HospitalDenmark
| | - Birgitte Fagerlund
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS)Mental Health Center GlostrupCopenhagen University HospitalGlostrupDenmark
- Center for Neuropsychiatric Schizophrenia Research (CNSR)Mental Health Center GlostrupCopenhagen University HospitalGlostrupDenmark
- Faculty of Social SciencesDepartment of PsychologyUniversity of CopenhagenCopenhagenDenmark
| | - Dorte Nordholm
- Copenhagen Research Center for Mental Health ‐ COREMental Health Center CopenhagenCopenhagen University HospitalCopenhagenDenmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS)Mental Health Center GlostrupCopenhagen University HospitalGlostrupDenmark
- Functional Imaging UnitDepartment of Clinical Physiology, Nuclear Medicine and PETCopenhagen University Hospital RigshospitaletGlostrupDenmark
| | - Kristine Krakauer
- Copenhagen Research Center for Mental Health ‐ COREMental Health Center CopenhagenCopenhagen University HospitalCopenhagenDenmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS)Mental Health Center GlostrupCopenhagen University HospitalGlostrupDenmark
- Functional Imaging UnitDepartment of Clinical Physiology, Nuclear Medicine and PETCopenhagen University Hospital RigshospitaletGlostrupDenmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health ‐ COREMental Health Center CopenhagenCopenhagen University HospitalCopenhagenDenmark
- Faculty of Health and Medical SciencesDepartment of Public HealthSection of EpidemiologyUniversity of CopenhagenCopenhagenDenmark
| | - Birte Glenthøj
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS)Mental Health Center GlostrupCopenhagen University HospitalGlostrupDenmark
- Faculty of Health and Medical SciencesDepartment of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
- Center for Neuropsychiatric Schizophrenia Research (CNSR)Mental Health Center GlostrupCopenhagen University HospitalGlostrupDenmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health ‐ COREMental Health Center CopenhagenCopenhagen University HospitalCopenhagenDenmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS)Mental Health Center GlostrupCopenhagen University HospitalGlostrupDenmark
- Faculty of Health and Medical SciencesDepartment of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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Nordholm D, Hjorthøj C, Mondelli V, Krakauer K, Randers L, Dazzan P, Nordentoft M. Are attenuated positive symptoms and cortisol levels associated? Schizophr Res 2021; 228:621-623. [PMID: 33248883 DOI: 10.1016/j.schres.2020.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/22/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Dorte Nordholm
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Kildegårdsvej 28, opg. 15, Hellerup, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Research Collaboration at Psychiatric Centre North Zealand, Dyrehavevej 48, Hillerød, Denmark.
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Kildegårdsvej 28, opg. 15, Hellerup, Denmark; University of Copenhagen, Department of Public Health, Section of Epidemiology, Denmark
| | - Valeria Mondelli
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom; National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley, NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Kristine Krakauer
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Kildegårdsvej 28, opg. 15, Hellerup, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Lasse Randers
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Kildegårdsvej 28, opg. 15, Hellerup, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Paola Dazzan
- National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley, NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, United Kingdom
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Kildegårdsvej 28, opg. 15, Hellerup, Denmark
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Randers L, Fagerlund B, Jepsen JRM, Nordholm D, Krakauer K, Hjorthøj C, Glenthøj B, Nordentoft M. Interview and questionnaire assessment of cognitive impairment in subjects at ultra-high risk for psychosis: Associations with cognitive test performance, psychosocial functioning, and positive symptoms. Psychiatry Res 2020; 294:113498. [PMID: 33157481 DOI: 10.1016/j.psychres.2020.113498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/01/2020] [Indexed: 02/01/2023]
Abstract
Impaired cognitive test performance is well-documented in subjects at ultra-high risk (UHR) for psychosis. However, assessment of cognitive deficits as manifested in real life is a neglected area of UHR research that may add to the understanding of cognitive impairment and its relationship with psychosocial functioning and positive symptomatology. This study applied the interview-based Schizophrenia Cognition Rating Scale (SCoRS) and the questionnaire-based Behavior Rating Inventory of Executive Function - Adult Version (BRIEF-A) in a cross-sectional sample of 39 UHR subjects and 50 healthy controls. Cognitive test performance, psychosocial functioning, and positive symptoms were also assessed. The UHR subjects demonstrated significant cognitive impairment, with large effect sizes for the SCoRS and BRIEF-A composite outcome variables (rs = -0.67 to -0.80) and a neurocognitive composite score (d = -0.97). Within the UHR group, several significant associations between worse cognitive ratings and worse cognitive test performance (rs = -0.210 to -0.343), poorer psychosocial functioning (rs = -0.058 to -0.728), and worse positive symptoms (rs= 0.415 to 0.478) were found. Worse cognitive test performance showed significant associations with more pronounced positive symptoms (rs = -0.299 to -0.457). Interview and questionnaire assessment may hold promise for supplementing traditional performance-based cognitive assessment in identifying treatment targets in the UHR population.
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Affiliation(s)
- Lasse Randers
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark.
| | - Birgitte Fagerlund
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Denmark; Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Denmark; University of Copenhagen, Faculty of Social Sciences, Department of Psychology, Copenhagen, Denmark
| | - Jens Richardt M Jepsen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Denmark; Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Denmark; Child and Adolescent Mental Health Center, Mental Health Services Capital Region of Denmark, Copenhagen University Hospital, Denmark
| | - Dorte Nordholm
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Denmark; Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - Kristine Krakauer
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Denmark; Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Department of Public Health, Section of Epidemiology, Copenhagen, Denmark
| | - Birte Glenthøj
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Denmark; Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark
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Albert N, Randers L, Allott K, Jensen HD, Melau M, Hjorthøj C, Nordentoft M. Cognitive functioning following discontinuation of antipsychotic medication. A naturalistic sub-group analysis from the OPUS II trial. Psychol Med 2019; 49:1138-1147. [PMID: 30058511 DOI: 10.1017/s0033291718001836] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The effect of antipsychotics medication on cognitive functioning in patients diagnosed with schizophrenia is poorly understood. Some studies of second generation antipsychotics indicated that they improved cognitive functioning while other studies have found that they decrease the level of cognitive functioning. METHOD We included patients with schizophrenia who were in treatment with antipsychotics 1.5 years (baseline) after initiation of treatment and followed them up 3.5 years later (n = 189). At follow-up 60 (32%) had discontinued their antipsychotic treatment and 129 (68%) were still taking antipsychotics. Using the Brief Assessment of Cognition in Schizophrenia (BACS) we assessed cognition at baseline and follow-up. RESULTS The patients who discontinued their medication had a higher level of cognitive functioning in all domains at baseline, as well as Global cognitive function [mean z-score -1.50 (s.d. 1.24) v. -2.27 (s.d. 1.30), p = 0.00015]. After controlling for relevant confounders those who discontinued antipsychotic medication improved significantly more than those who remained on antipsychotic medication during the course of the follow-up on the Token Motor task [estimated mean change difference -0.46 (95% CI -0.89 to -0.04)], the Speed of Processing Domain [estimated mean change difference -0.38 (95% CI -0.68 to -0.08)] and global cognition [estimated mean change difference -0.36 (95% CI -0.66 to -0.07)]. CONCLUSION Due to the naturalistic design, we cannot conclude on the direction of the relationship between antipsychotics and cognition. There is no evidence that discontinuation of medication had a negative effect on cognitive functioning. Rather, we found that that discontinuation of medication was associated with better cognitive functioning.
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Affiliation(s)
- Nikolai Albert
- Copenhagen University Hospital, Mental Health Centre Copenhagen,Copenhagen,Denmark
| | - Lasse Randers
- Copenhagen University Hospital, Mental Health Centre Copenhagen,Copenhagen,Denmark
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health,Melbourne,Australia
| | - Heidi Dorthe Jensen
- Copenhagen University Hospital, Mental Health Centre Copenhagen,Copenhagen,Denmark
| | - Marianne Melau
- Copenhagen University Hospital, Mental Health Centre Copenhagen,Copenhagen,Denmark
| | - Carsten Hjorthøj
- Copenhagen University Hospital, Mental Health Centre Copenhagen,Copenhagen,Denmark
| | - Merete Nordentoft
- Copenhagen University Hospital, Mental Health Centre Copenhagen,Copenhagen,Denmark
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Madsen HK, Nordholm D, Krakauer K, Randers L, Nordentoft M. Psychopathology and social functioning of 42 subjects from a Danish ultra high-risk cohort. Early Interv Psychiatry 2018; 12:1181-1187. [PMID: 28422422 DOI: 10.1111/eip.12438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/04/2017] [Accepted: 01/19/2017] [Indexed: 11/30/2022]
Abstract
AIM To make a thorough characterization of the co-morbidity, psychopathology and demographics in the first Danish ultra high-risk (UHR) sample. METHOD Forty-two UHR subjects went through comprehensive interviews assessing their psychopathology, psychiatric disorders, substance use and family history of psychiatric disorders. RESULTS All UHR subjects met the criteria of at least 1 axis I diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and met on average four diagnoses (both axis I and II), mostly within the areas of depression, anxiety and substance abuse. A total of 48% had schizotypal personality disorder and 19% had borderline personality disorder. Level of functioning was low with a mean score on the Social and Occupational Functioning Assessment Scale corresponding to "major impairment in several areas," and mean scores in the Global Functioning: Social and Role scales between "moderate impairment in social functioning" and "very serious impairment independently." Forty-seven percent were unemployed and 29% on sick leave. Fifty-five percent relied financially on public support. CONCLUSION As seen in previous UHR populations, Danish UHR subjects had low function socio-economically and met criteria of several psychiatric diagnoses, suggesting that they require pharmacological and non-pharmacological psychiatric treatment as well as vocational and educational guidance and support.
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Affiliation(s)
- Helle Karkov Madsen
- Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dorte Nordholm
- Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.,Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS); Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Copenhagen, Denmark
| | - Kristine Krakauer
- Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.,Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS); Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Copenhagen, Denmark
| | - Lasse Randers
- Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.,Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS); Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Copenhagen, Denmark
| | - Merete Nordentoft
- Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
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7
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Dannevang AL, Randers L, Gondan M, Krakauer K, Nordholm D, Nordentoft M. Premorbid adjustment in individuals at ultra-high risk for developing psychosis: a case-control study. Early Interv Psychiatry 2018; 12:839-847. [PMID: 27684654 DOI: 10.1111/eip.12375] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 05/22/2016] [Accepted: 06/12/2016] [Indexed: 11/30/2022]
Abstract
AIM Deterioration in premorbid adjustment is related to ultra-high risk (UHR) individuals developing psychosis, but it has not been examined how UHR individuals' development differs compared to healthy controls. This study investigates differences in premorbid adjustment between UHR individuals and a healthy control group. METHOD A total of 48 UHR individuals and 50 healthy controls matched on group level for age, gender and parents' socio-economic status were included in the study. Both groups were assessed with the Premorbid Adjustment Scale (PAS). Based on the PAS scores, composite social and academic scales were computed. RESULTS Compared to the healthy controls the UHR individuals' social and academic premorbid adjustment declined across age periods. Social premorbid adjustment declined particularly between late adolescence and adulthood. Academic premorbid adjustment declined particularly between childhood and early adolescence. The UHR individuals had more premorbid adjustment difficulties on both the social and academic scale, and on the individual PAS scales. CONCLUSION From childhood UHR individuals have lower levels of social and academic premorbid adjustment compared to healthy controls, and the difficulties increase with age. As such, social and academic premorbid adjustment could be an important focus for early intervention.
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Affiliation(s)
- Anders L Dannevang
- Department of Psychology, Copenhagen, Denmark.,Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Lasse Randers
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark.,Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Kristine Krakauer
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark.,Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dorte Nordholm
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark.,Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, Copenhagen University Hospital, Copenhagen, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
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Nordholm D, Rostrup E, Mondelli V, Randers L, Nielsen MØ, Wulff S, Nørbak-Emig H, Broberg BV, Krakauer K, Dazzan P, Zunszain PA, Nordentoft M, Glenthøj B. Multiple measures of HPA axis function in ultra high risk and first-episode schizophrenia patients. Psychoneuroendocrinology 2018; 92:72-80. [PMID: 29635174 DOI: 10.1016/j.psyneuen.2018.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Abnormalities within hypothalamus-pituitary-adrenal (HPA) axis might interact with other neurobiological systems to enhance the risk of psychosis. Most of the neurodevelopmental and HPA axis changes occur in adolescence; this is also the period when prodromal and psychotic symptoms occur for the first time. More knowledge about how various stress components interact can advance understanding of the link between psychosis and the HPA axis. METHOD We examined 41 ultra high-risk (UHR) patients and 40 antipsychotic-naïve first-episode schizophrenia (FES) patients and compared them with 47 matched controls. The Perceived Stress Scale and the Recent Life Events Questionnaire were used to assess the stress levels. Day-time saliva samples were taken to measure cortisol. The pituitary gland volume was measured manually on the structural MRI using stereology. RESULTS Only the UHR patients, had a higher cortisol increase just after awakening (p = 0.009) compared to healthy controls. In UHR patients, we found a negative correlation between cortisol increase after awakening and symptom severity (p = 0.008). Pituitary gland volume and diurnal cortisol were not significantly different among the three groups. There was no correlation between pituitary gland volume, perceived stress/recent life events and any of the cortisol measures or symptoms. CONCLUSION Symptom severity during the very early phase of illness (UHR) seems to be associated with altered cortisol increase. Longitudinal studies in UHR patients would be useful to examine how stress levels affect the course of the illness.
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Affiliation(s)
- Dorte Nordholm
- Mental Health Centre Copenhagen, University of Copenhagen, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark.
| | - Egill Rostrup
- Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet - Glostrup Hospital, Copenhagen, Denmark
| | - Valeria Mondelli
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom; National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley, NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Lasse Randers
- Mental Health Centre Copenhagen, University of Copenhagen, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Mette Ø Nielsen
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Sanne Wulff
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Henrik Nørbak-Emig
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Brian V Broberg
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Kristine Krakauer
- Mental Health Centre Copenhagen, University of Copenhagen, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Paola Dazzan
- National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley, NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, United Kingdom
| | - Patricia A Zunszain
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom; National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley, NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | | | - Birte Glenthøj
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Denmark
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9
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Krakauer K, Nordentoft M, Glenthøj BY, Raghava JM, Nordholm D, Randers L, Glenthøj LB, Ebdrup BH, Rostrup E. White matter maturation during 12 months in individuals at ultra-high-risk for psychosis. Acta Psychiatr Scand 2018; 137:65-78. [PMID: 29143980 DOI: 10.1111/acps.12835] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The neurodevelopmental hypothesis of psychosis suggests that disrupted white matter (WM) maturation underlies disease onset. In this longitudinal study, we investigated WM connectivity and compared WM changes between individuals at ultra-high-risk for psychosis (UHR) and healthy controls (HCs). METHOD Thirty UHR individuals and 23 HCs underwent MR diffusion tensor imaging before and after 12 months of non-manualized standard care. Positive and negative symptoms and level of functioning were assessed. Tract-based spatial statistics were employed. RESULTS During 12 months, none of the UHR individuals transitioned to psychosis. Both UHR individuals and HCs increased significantly in fractional anisotropy (FA). UHR individuals showed significant FA increases predominantly in the left superior longitudinal fasciculus (SLF) (P = 0.01), and HCs showed significant FA increases in the left uncinate fasciculus (P = 0.03). Within UHR individuals, a significant positive correlation between FA change and age was observed predominantly in the left SLF (P = 0.02). Within HCs, no significant correlation between FA change and age was observed. No significant correlations between baseline FA and clinical outcomes were observed; however, FA changes were significantly positively correlated to changes in negative symptoms (P = 0.04). CONCLUSION As normal brain maturation occurs in a posterior to frontal direction, our findings could suggest disturbed WM maturation in UHR individuals.
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Affiliation(s)
- K Krakauer
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark.,Functional Imaging Unit, FIUNIT, Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - M Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| | - B Y Glenthøj
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark.,Centre for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| | - J M Raghava
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark.,Functional Imaging Unit, FIUNIT, Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark.,Centre for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| | - D Nordholm
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| | - L Randers
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| | - L B Glenthøj
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| | - B H Ebdrup
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark.,Centre for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| | - E Rostrup
- Functional Imaging Unit, FIUNIT, Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark.,Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark
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10
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Krakauer K, Ebdrup BH, Glenthøj BY, Raghava JM, Nordholm D, Randers L, Rostrup E, Nordentoft M. Patterns of white matter microstructure in individuals at ultra-high-risk for psychosis: associations to level of functioning and clinical symptoms. Psychol Med 2017; 47:2689-2707. [PMID: 28464976 DOI: 10.1017/s0033291717001210] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Individuals at ultra-high-risk (UHR) for psychosis present with emerging symptoms and decline in functioning. Previous univariate analyses have indicated widespread white matter (WM) aberrations in multiple brain regions in UHR individuals and patients with schizophrenia. Using multivariate statistics, we investigated whole brain WM microstructure and associations between WM, clinical symptoms, and level of functioning in UHR individuals. METHODS Forty-five UHR individuals and 45 matched healthy controls (HCs) underwent magnetic resonance diffusion tensor imaging (DTI) at 3 Tesla. UHR individuals were assessed with the Comprehensive Assessment of At-Risk Mental States, Scale for the Assessment of Negative Symptoms, and Social and Occupational Functioning Assessment Scale. Partial least-squares correlation analysis (PLSC) was used as statistical method. RESULTS PLSC group comparisons revealed one significant latent variable (LV) accounting for 52% of the cross-block covariance. This LV indicated a pattern of lower fractional anisotropy (FA), axial diffusivity (AD), and mode of anisotropy (MO) concomitant with higher radial diffusivity (RD) in widespread brain regions in UHR individuals compared with HCs. Within UHR individuals, PLSC revealed five significant LVs associated with symptoms and level of functioning. The first LV accounted for 31% of the cross-block covariance and indicated a pattern where higher symptom score and lower level of functioning correlated to lower FA, AD, MO, and higher RD. CONCLUSIONS UHR individuals demonstrate complex brain patterns of WM abnormalities. Despite the subtle psychopathology of UHR individuals, aberrations in WM appear associated with positive and negative symptoms as well as level of functioning.
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Affiliation(s)
- K Krakauer
- Mental Health Centre Copenhagen,Copenhagen University Hospital,DK-2900 Hellerup,Denmark
| | - B H Ebdrup
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS,DK-2600 Glostrup,Denmark
| | - B Y Glenthøj
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS,DK-2600 Glostrup,Denmark
| | - J M Raghava
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS,DK-2600 Glostrup,Denmark
| | - D Nordholm
- Mental Health Centre Copenhagen,Copenhagen University Hospital,DK-2900 Hellerup,Denmark
| | - L Randers
- Mental Health Centre Copenhagen,Copenhagen University Hospital,DK-2900 Hellerup,Denmark
| | - E Rostrup
- Functional Imaging Unit,Clinical Physiology,Nuclear Medicine and PET,Copenhagen University Hospital Rigshospitalet,DK-2600 Glostrup,Denmark
| | - M Nordentoft
- Mental Health Centre Copenhagen,Copenhagen University Hospital,DK-2900 Hellerup,Denmark
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11
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Miskowiak KW, Macoveanu J, Vinberg M, Assentoft E, Randers L, Harmer CJ, Ehrenreich H, Paulson OB, Knudsen GM, Siebner HR, Kessing LV. Effects of erythropoietin on memory-relevant neurocircuitry activity and recall in mood disorders. Acta Psychiatr Scand 2016; 134:249-59. [PMID: 27259062 DOI: 10.1111/acps.12597] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Erythropoietin (EPO) improves verbal memory and reverses subfield hippocampal volume loss across depression and bipolar disorder (BD). This study aimed to investigate with functional magnetic resonance imaging (fMRI) whether these effects were accompanied by functional changes in memory-relevant neuro-circuits in this cohort. METHOD Eighty-four patients with treatment-resistant unipolar depression who were moderately depressed or BD in remission were randomized to eight weekly EPO (40 000 IU) or saline infusions in a double-blind, parallel-group design. Participants underwent whole-brain fMRI at 3T, mood ratings, and blood tests at baseline and week 14. During fMRI, participants performed a picture encoding task followed by postscan recall. RESULTS Sixty-two patients had complete data (EPO: N = 32, saline: N = 30). EPO improved picture recall and increased encoding-related activity in dorsolateral prefrontal cortex (dlPFC) and temporo-parietal regions, but not in hippocampus. Recall correlated with activity in the identified dlPFC and temporo-parietal regions at baseline, and change in recall correlated with activity change in these regions from baseline to follow-up across the entire cohort. The effects of EPO were not correlated with change in mood, red blood cells, blood pressure, or medication. CONCLUSION The findings highlight enhanced encoding-related dlPFC and temporo-parietal activity as key neuronal underpinnings of EPO-associated memory improvement.
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Affiliation(s)
- K W Miskowiak
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - J Macoveanu
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Center for Integrated Molecular Brain Imaging, Rigshospitalet, Copenhagen, Denmark
| | - M Vinberg
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - E Assentoft
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - L Randers
- Psychiatric Centre Copenhagen, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - C J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - H Ehrenreich
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - O B Paulson
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Center for Integrated Molecular Brain Imaging, Rigshospitalet, Copenhagen, Denmark.,Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - G M Knudsen
- Center for Integrated Molecular Brain Imaging, Rigshospitalet, Copenhagen, Denmark.,Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - H R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Center for Integrated Molecular Brain Imaging, Rigshospitalet, Copenhagen, Denmark.,Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - L V Kessing
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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12
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Andreasson K, Krogh J, Wenneberg C, Jessen HKL, Krakauer K, Gluud C, Thomsen RR, Randers L, Nordentoft M. EFFECTIVENESS OF DIALECTICAL BEHAVIOR THERAPY VERSUS COLLABORATIVE ASSESSMENT AND MANAGEMENT OF SUICIDALITY TREATMENT FOR REDUCTION OF SELF-HARM IN ADULTS WITH BORDERLINE PERSONALITY TRAITS AND DISORDER-A RANDOMIZED OBSERVER-BLINDED CLINICAL TRIAL. Depress Anxiety 2016; 33:520-30. [PMID: 26854478 DOI: 10.1002/da.22472] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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: 07/25/2015] [Revised: 12/09/2015] [Accepted: 12/29/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Many psychological treatments have shown effect on reducing self-harm in adults with borderline personality disorder. There is a need of brief psychotherapeutical treatment alternative for suicide prevention in specialized outpatient clinics. METHODS/DESIGN The DiaS trial was designed as a pragmatic single-center, two-armed, parallel-group observer-blinded, randomized clinical superiority trial. The participants had at least two criteria from the borderline personality disorder diagnosis and a recent suicide attempt (within a month). The participants were offered 16 weeks of dialectical behavior therapy (DBT) versus up to 16 weeks of collaborative assessment and management of suicidality (CAMS) treatment. The primary composite outcome was the number of participants with a new self-harm (nonsuicidal self-injury [NSSI] or suicide attempt) at week 28 from baseline. Other exploratory outcomes were: severity of borderline symptoms, depressive symptoms, hopelessness, suicide ideation, and self-esteem. RESULTS At 28 weeks, the number of participants with new self-harm in the DBT group was 21 of 57 (36.8%) versus 12 of 51 (23.5%) in the CAMS treatment (OR: 1.90; 95% CI: 0.80-4.40; P = .14). When assessing the effect of DBT versus CAMS treatment on the individual components of the primary outcome, we observed no significant differences in the number of NSSI (OR: 1.60; 95% CI: 0.70-3.90; P = .31) or number of attempted suicides (OR: 2.24; 95% CI: 0.80-7.50; P = .12). CONCLUSION In adults with borderline personality traits and disorder and a recent suicide attempt, DBT does not seem superior compared with CAMS for reduction of number of self-harm or suicide attempts. However, further randomized clinical trials may be needed.
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Affiliation(s)
- Kate Andreasson
- Research Unit, Mental Health Center Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.,Research Unit, Mental Health Center North Zealand, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Krogh
- Research Unit, Mental Health Center Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Christina Wenneberg
- Research Unit, Mental Health Center Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Helle K L Jessen
- Research Unit, Mental Health Center Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Krakauer
- Research Unit, Mental Health Center Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gluud
- The Copenhagen Trial Unit, Center for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Lasse Randers
- Research Unit, Mental Health Center Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Research Unit, Mental Health Center Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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13
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Glenthøj LB, Fagerlund B, Randers L, Hjorthøj CR, Wenneberg C, Krakauer K, Vosgerau A, Gluud C, Medalia A, Roberts DL, Nordentoft M. The FOCUS trial: cognitive remediation plus standard treatment versus standard treatment for patients at ultra-high risk for psychosis: study protocol for a randomised controlled trial. Trials 2015; 16:25. [PMID: 25623736 PMCID: PMC4318160 DOI: 10.1186/s13063-014-0542-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/23/2014] [Indexed: 12/31/2022] Open
Abstract
Background Cognitive deficits are a distinct feature among people at ultra-high risk (UHR) for psychosis and pose a barrier to functional recovery. Insufficient evidence exists on how to ameliorate these cognitive deficits in patients at UHR for psychosis and hence improve daily living and quality of life. The aim of the trial is to investigate whether cognitive remediation can improve cognitive and psychosocial function in patients at UHR for psychosis. Methods The FOCUS trial (Function and Overall Cognition in Ultra-high risk States) is a randomised, parallel group, observer-blinded clinical trial enrolling 126 patients meeting the standardised criteria of being at UHR for psychosis. Patients are recruited from psychiatric in- and outpatient facilities in the Copenhagen catchment area. Patients are randomised to one of the two treatment arms: cognitive remediation plus standard treatment versus standard treatment. The cognitive remediation consists of 24 weekly group-based and manualised sessions targeting neurocognition and social cognition. In addition to the group sessions, the patients will be offered 12 individual sessions aiming at maximising the transfer of the effects of the cognitive training to their everyday lives. Follow-up assessments will be conducted at 6 and 12 months after randomisation. The primary outcome is the composite score on the Brief Assessment of Cognition in Schizophrenia at cessation of treatment after 6 months. Secondary outcomes are social and daily functioning, psychosis-like symptoms, negative symptomatology, and depressive symptomatology as measured with the Personal and Social Performance Scale, Brief Psychiatric Rating Scale-Expanded Version, Scale for the Assessment of Negative Symptoms, and the Montgomery-Åsberg Depression Rating Scale. Discussion This is the first trial to evaluate the effects of neurocognitive and social cognitive remediation in UHR patients. The FOCUS trial results will provide evidence on the effect of targeted and comprehensive cognitive rehabilitation on cognition, daily living, and symptomatology as well as long-term outcome in preventing transition to psychosis in UHR patients. Trial registration ClinicalTrials.gov NCT 02098408. Date of registration 18 March 2014.
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Affiliation(s)
- Louise B Glenthøj
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2400, Copenhagen, Denmark. .,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600, Glostrup, Denmark.
| | - Birgitte Fagerlund
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600, Glostrup, Denmark. .,Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Copenhagen University Hospital, DK-2600, Glostrup, Denmark.
| | - Lasse Randers
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2400, Copenhagen, Denmark. .,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600, Glostrup, Denmark.
| | - Carsten R Hjorthøj
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2400, Copenhagen, Denmark.
| | - Christina Wenneberg
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2400, Copenhagen, Denmark. .,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600, Glostrup, Denmark.
| | - Kristine Krakauer
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2400, Copenhagen, Denmark. .,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600, Glostrup, Denmark.
| | - Astrid Vosgerau
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2400, Copenhagen, Denmark. .,Centre for Rehabilitation for Brain Injury, DK-2300, Copenhagen, Denmark.
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, DK-2100, Copenhagen, Denmark.
| | - Alice Medalia
- Columbia University Medical Center, New York, NY, 10032, USA.
| | - David L Roberts
- Department of Psychiatry, Division of Schizophrenia and Related Disorders, University of Texas Health Science Center, San Antonio, TX, 78229, USA.
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2400, Copenhagen, Denmark. .,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600, Glostrup, Denmark.
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14
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Austin SF, Mors O, Secher RG, Hjorthøj CR, Albert N, Bertelsen M, Jensen H, Jeppesen P, Petersen L, Randers L, Thorup A, Nordentoft M. Predictors of recovery in first episode psychosis: the OPUS cohort at 10 year follow-up. Schizophr Res 2013; 150:163-8. [PMID: 23932664 DOI: 10.1016/j.schres.2013.07.031] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/24/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Recovery, the optimal goal in treatment, is the attainment of both symptomatic and functional remission over a sustained period of time. Identification of factors that promote recovery can help develop interventions that facilitate good outcomes for people with first episode psychosis. AIM To examine long-term outcomes within a cohort of people with first episode psychosis in relation to symptom remission, functioning and recovery, 10 years after diagnosis. METHOD The study had a prospective design. Participants from the OPUS trial (1998-2000) (n=496) completed a series of interviews and questionnaires to measure current levels of psychopathology and social/vocational functioning, ten years after diagnosis. Predictors of recovery were identified using socio-demographic and clinical characteristics collected at baseline. RESULTS A total of 304 participants were interviewed, giving a follow-up rate of 61%. A total of 42 people (14%) met the criteria for symptomatic and psychosocial recovery at 10 years. A multivariable binary logistic regression analysis indicated that baseline predictors accounted for 22% of the variance of full recovery. Lower severity of negative symptoms at baseline (Odds Ratio (OR) 0.53, 95% confidence interval CI 0.36-0.78, p<0.001) and earlier age of diagnosis (OR 0.92, 95% CI 0.86-0.99, p<0.05) predicted better rates of recovery at 10 years. CONCLUSION Results of this study indicated that negative symptoms could play a central role in the process of recovery from schizophrenia. A challenge for clinicians and researchers is to understand the mechanisms behind negative symptoms and develop interventions that can prevent or ameliorate these symptoms in order to promote recovery.
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Affiliation(s)
- Stephen F Austin
- Center for Psychiatric Research, Aarhus University, Denmark; Psychiatric Center Copenhagen, University of Copenhagen, Denmark.
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15
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Altman SA, Zastawny TH, Randers L, Lin Z, Lumpkin JA, Remacle J, Dizdaroglu M, Rao G. tert.-butyl hydroperoxide-mediated DNA base damage in cultured mammalian cells. Mutat Res 1994; 306:35-44. [PMID: 7512201 DOI: 10.1016/0027-5107(94)90165-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
tert.-Butyl hydroperoxide has been utilized to study the effect of oxidative stress on living cells; however, its effect on DNA bases in cells has not been characterized. In the present work, we have investigated DNA base damage in mammalian cells exposed to this organic hydroperoxide. SP2/0 derived murine hybridoma cells were treated with 4 concentrations of tert.-butyl hydroperoxide for varying periods of time. Chromatin was isolated from treated and control cells and subsequently analyzed by gas chromatography-mass spectrometry with selected-ion monitoring for DNA base damage. Quantification of damaged DNA bases was achieved by isotope-dilution mass spectrometry. The amounts of 8 products were significantly higher than control levels in cells treated with tert.-butyl hydroperoxide at a concentration range of 0.01-0.1 mM. At concentrations from 1.0 to 10 mM, product formation was inhibited and the amounts of products were similar to those in control cells. The bimodal nature of the dose-response may be qualitatively analogous to previous reports of bimodal killing of E. coli bacteria by hydrogen peroxide. The nature of the identified DNA base lesions suggests the involvement of the hydroxyl radical in their formation. tert.-Butyl hydroperoxide is known to produce the tert.-butoxyl radical in reactions with metal ions. However, it is unlikely that the tert.-butoxyl radical produces these DNA lesions. It is suggested that DNA base damage arises from tert.-butyl hydroperoxide-mediated oxidative stress in cells, resulting in formation of hydroxyl radicals in close proximity to DNA. The inhibition of product formation at high concentrations of tert.-butyl hydroperoxide may be explained by the scavenging of tert.-butoxyl radical by tert.-butyl hydroperoxide resulting in inhibition of oxidative stress. The plausibility of the scavenging mechanism was evaluated with a mathematical simulation of the dose-response for DNA damage in solutions containing hydrogen peroxide. The simulation model predicted a bimodal dose-response which agreed qualitatively with the results in this study and with other in vivo and in vitro studies reported in the literature.
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Affiliation(s)
- S A Altman
- Department of Chemical and Biochemical Engineering, University of Maryland Baltimore County 21228
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Abstract
A hemocytometer-based trypan blue dye exclusion cell quantitation and viability assay was compared with a similar assay using simultaneous fluorometric staining with fluorescein diacetate and propidium iodide. Viable and nonviable cell densities were measured, and culture viability was calculated both during the normal growth cycle of a murine hybridoma and in response to the application of millimolar concentrations of either tert-butyl hydroperoxide or ferrous iron. During the early phase of rapid hybridoma cell growth, assay-based differences in viable cell density were not significant. As the culture aged, the trypan blue dye exclusion assay significantly overestimated cell viability, thereby underestimating nonviable cell density and yielding an erroneous estimation of the overall viability of the culture. Because of its lack of ambiguity in the identification of stained, nonviable cells and its resulting increased accuracy in the estimation of culture viability, the fluorometric assay was considered a better choice for the evaluation of cell viability.
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Affiliation(s)
- S A Altman
- Department of Chemical and Biochemical Engineering, College of Engineering, University of Maryland Baltimore County 21228
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17
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Kwong SC, Randers L, Rao G. On-line assessment of metabolic activities based on culture redox potential and dissolved oxygen profiles during aerobic fermentation. Biotechnol Prog 1993; 8:576-9. [PMID: 1369041 DOI: 10.1021/bp00018a016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report here on the utility of on-line culture redox potential and dissolved oxygen measurements to identify metabolic changes in fermentation by Corynebacterium glutamicum under aerobic conditions. Metabolic changes were identified by observing discrepancies in the profile of culture redox potential and dissolved oxygen. On the basis of these measurements, we can identify the end of the lag phase, threonine exhaustion, and glucose exhaustion during fermentation.
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Affiliation(s)
- S C Kwong
- Chemical and Biochemical Engineering Program, University of Maryland, Baltimore 21228
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18
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Abstract
In this study we examined the utility of NAD(P)H fluorescence for monitoring aerobic fermentations of the threonine auxotroph
Corynebacterium glutamicum
ATCC 14296. Instead of attempting complicated mathematical corrections for inner-filter effects, we found that it is possible to use the information contained in the on-line NAD(P)H fluorescence signal to assess culture metabolic activities during fermentation. The first derivative of the filtered fluorescence signal, which approximates the turnover rate of the NAD(P)H pool, can be used to precisely identify the temporal points of threonine and glucose exhaustion.
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Affiliation(s)
- S C Kwong
- Chemical and Biochemical Engineering Program and Medical Biotechnology Center of the Maryland Biotechnology Institute, University of Maryland, Baltimore, Maryland 21228
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