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de Boer N, Vermeulen J, Lin B, van Os J, ten Have M, de Graaf R, van Dorsselaer S, Bak M, Rutten B, Batalla A, Guloksuz S, Luykx JJ. Longitudinal associations between alcohol use, smoking, genetic risk scoring and symptoms of depression in the general population: a prospective 6-year cohort study. Psychol Med 2023; 53:1409-1417. [PMID: 35023464 PMCID: PMC10009403 DOI: 10.1017/s0033291721002968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/28/2021] [Accepted: 07/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Alcohol consumption, smoking and mood disorders are leading contributors to the global burden of disease and are highly comorbid. Yet, their interrelationships have remained elusive. The aim of this study was to examine the multi-cross-sectional and longitudinal associations between (change in) smoking and alcohol use and (change in) number of depressive symptoms. METHODS In this prospective, longitudinal study, 6646 adults from the general population were included with follow-up measurements after 3 and 6 years. Linear mixed-effects models were used to test multi-cross-sectional and longitudinal associations, with smoking behaviour, alcohol use and genetic risk scores for smoking and alcohol use as independent variables and depressive symptoms as dependent variables. RESULTS In the multi-cross-sectional analysis, smoking status and number of cigarettes per day were positively associated with depressive symptoms (p < 0.001). Moderate drinking was associated with less symptoms of depression compared to non-use (p = 0.011). Longitudinally, decreases in the numbers of cigarettes per day and alcoholic drinks per week as well as alcohol cessation were associated with a reduction of depressive symptoms (p = 0.001-0.028). Results of genetic risk score analyses aligned with these findings. CONCLUSIONS While cross-sectionally smoking and moderate alcohol use show opposing associations with depressive symptoms, decreases in smoking behaviour as well as alcohol consumption are associated with improvements in depressive symptoms over time. Although we cannot infer causality, these results open avenues to further investigate interventions targeting smoking and alcohol behaviours in people suffering from depressive symptoms.
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Affiliation(s)
- N. de Boer
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J. Vermeulen
- Department of Psychiatry, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - B. Lin
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J. van Os
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M. ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - R. de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - S. van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - M. Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- FACT, Mondriaan Mental Health, Maastricht, The Netherlands
| | - B. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A. Batalla
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - S. Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - J. J. Luykx
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- GGNet Mental Health, Apeldoorn, The Netherlands
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Erzin G, Pries L, Dimitrakopoulos S, Ralli I, Xenaki LA, Soldatos R, Vlachos I, Selakovic M, Foteli S, Kosteletos I, Nianiakas N, Mantonakis L, Rizos E, Kollias K, Os J, Guloksuz S, Stefanis N. Longitudinal association between exposome score for schizophrenia and clinical features: results from the Athens First-Episode Psychosis Research Study. Eur Psychiatry 2022. [PMCID: PMC9567635 DOI: 10.1192/j.eurpsy.2022.1963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Previously, environmental vulnerability for schizophrenia assessed through exposome score for schizophrenia (ES-SCZ) was associated with the risk for psychosis development. Objectives The current study aims to investigate the longitudinal association between ES-SCZ and symptom severity in individuals with first episode psychosis (FEP) to understand how environmental exposures affect illness course. Methods Baseline and 1-month follow-up assessments were available for 225 individuals with FEP from the Athens FEP Research Study. The Positive and Negative Syndrome Scale (PANSS) was used to measure clinical features. In accordance with previous reports, the ES-SCZ was calculated by summing log-odds weighted environmental exposures (childhood adversities, winter birth, and cannabis use). To model the course of clinical features over time the effects of the ES-SCZ-by-time interaction, ES-SCZ, and time were analyzed with multilevel regression analyses. Age, sex, and education were added as covariates Results The analyses of change of PANSS total score over time indicated that clinical features decreased from baseline to the 1-month follow-up assessment. The association between ES-SCZ and PANSS total score were not statistically significant. The analyses of the PANSS total score over time indicated an ES-SCZ-by-time interaction (B = 2.82 [95% CI 0.28; 5.35], P-value = 0.029), meaning the decrease of the PANSS total score over time were dependent on ES-SCZ and individuals with high ES-SCZ showed less improvement Conclusions The findings show that the total environmental predisposition to schizophrenia (ES-SCZ) not only increases the risk for psychosis development but may also influences the illness course. Disclosure No significant relationships.
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Martinez M, Fichera C, Fusar-Poli L, Rodolico A, Guloksuz S, Aguglia E, Signorelli M. Association between polygenic risk scores for psychiatric disorders and social cognition: a systematic review. Eur Psychiatry 2022. [PMCID: PMC9567603 DOI: 10.1192/j.eurpsy.2022.2262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Social cognition refers to a complex set of mental abilities that support the construction of adequate social competence and adaptation. Impairments in social cognition can be found in several psychiatric disorders, particularly in psychoses. Polygenic Risk Scores (PRSs) represent single metrics of molecular genetic risk and are a predictor of the genetic susceptibility to diseases, although they explain only a small part of the risk. Objectives To explore the association between PRS for psychiatric disorders and social cognition. Methods We conducted a systematic search in PubMed and Scopus according to the PRISMA guidelines up to August 2021. We included papers evaluating PRS and social cognition with psychometric scales. Articles concerning single-nucleotide polymorphisms and biological measures of social cognition (e.g., neuroimaging, peripheral biomarkers) were excluded. Results We initially retrieved 150 articles. After removing duplicates, we screened 133 titles and abstracts and preliminary selected 19 papers. Participants recruited in the papers of interest were either people with schizophrenia, ASD or ADHD, their family members or healthy subjects. Articles evaluated the association between different psychometrical measures of social cognition and PRS for schizophrenia, Autism Spectrum Disorder and ADHD. Conclusions Literature regarding the association between PRS for psychiatric disorders and social cognition is heterogeneous in terms of populations, genetic risk evaluation, and outcome tools. Given the critical role played by social cognition in the onset and progression of mental disorders and its association with real-world functioning, future research should try to disentangle the complex genetic basis of this domain. Disclosure No significant relationships.
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Rutten BPF, Guloksuz S, Boks M, van Os J, Luykx JJ, van Winkel R. [Interplay between genetic background and environmental factors in psychiatry: current situation and future prospects]. Tijdschr Psychiatr 2022; 64:317-322. [PMID: 35735044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The hypothesis that etiopathogeneses of psychiatric disorders are determined by interplay between genetic background and environmental factors, as well their interactions can increasingly be put to direct scientific test, based on a wave of methodological, technological and knowledge developments.<br> AIM: To provide insight into and to provide perspective on some important scientific developments and facilitate challenges in this area.<br> METHOD: Narrative overview of the scientific literature and formulation of a concept and future perspective.<br> RESULTS: The overview points to concrete progress in the fields of genetic epidemiology, environmental analyses, gene-environment interactions and epigenetics in psychiatry. For example, recent studies have provided evidence for the existence of interactions and correlations between genetic and environmental factors, interdependence of risk-influencing effects of environmental factors, and translational neurobiological studies have identified biological processes that influence the impact of (or the response to) environmental influences on individuals mediate. These important steps to translate epidemiological research into testable biological hypotheses are facilitated by new techniques and the availability of large and relevant clinical and biological datasets.<br> CONCLUSION: Scientific progress on the interplay between genetic background and environmental factors enriches the conceptual framework of the etiopathogenesis of mental disorders and provides a future perspective in which we are likely to receive answers to a number of clinically relevant questions in the coming decade.<br>.
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Pries L, Klingenberg B, Menne‐Lothmann C, Decoster J, van Winkel R, Collip D, Delespaul P, De Hert M, Derom C, Thiery E, Jacobs N, Wichers M, Cinar O, Lin BD, Luykx JJ, Rutten BPF, van Os J, Guloksuz S. Polygenic liability for schizophrenia and childhood adversity influences daily-life emotion dysregulation and psychosis proneness. Acta Psychiatr Scand 2020; 141:465-475. [PMID: 32027017 PMCID: PMC7318228 DOI: 10.1111/acps.13158] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/23/2020] [Accepted: 02/02/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To test whether polygenic risk score for schizophrenia (PRS-S) interacts with childhood adversity and daily-life stressors to influence momentary mental state domains (negative affect, positive affect, and subtle psychosis expression) and stress-sensitivity measures. METHODS The data were retrieved from a general population twin cohort including 593 adolescents and young adults. Childhood adversity was assessed using the Childhood Trauma Questionnaire. Daily-life stressors and momentary mental state domains were measured using ecological momentary assessment. PRS-S was trained on the latest Psychiatric Genetics Consortium schizophrenia meta-analysis. The analyses were conducted using multilevel mixed-effects tobit regression models. RESULTS Both childhood adversity and daily-life stressors were associated with increased negative affect, decreased positive affect, and increased subtle psychosis expression, while PRS-S was only associated with increased positive affect. No gene-environment correlation was detected. There is novel evidence for interaction effects between PRS-S and childhood adversity to influence momentary mental states [negative affect (b = 0.07, P = 0.013), positive affect (b = -0.05, P = 0.043), and subtle psychosis expression (b = 0.11, P = 0.007)] and stress-sensitivity measures. CONCLUSION Exposure to childhood adversities, particularly in individuals with high PRS-S, is pleiotropically associated with emotion dysregulation and psychosis proneness.
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Affiliation(s)
- L.‐K. Pries
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - B. Klingenberg
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - C. Menne‐Lothmann
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - J. Decoster
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Department of NeurosciencesUniversity Psychiatric Centre KU LeuvenKU LeuvenLeuvenBelgium,Brothers of CharityUniversity Psychiatric Centre Sint‐Kamillus BierbeekBierbeekBelgium
| | - R. van Winkel
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Department of NeurosciencesUniversity Psychiatric Centre KU LeuvenKU LeuvenLeuvenBelgium
| | - D. Collip
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - P. Delespaul
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - M. De Hert
- Department of NeurosciencesUniversity Psychiatric Centre KU LeuvenKU LeuvenLeuvenBelgium,Antwerp Health Law and Ethics Chair – AHLECUniversity AntwerpAntwerpBelgium
| | - C. Derom
- Centre of Human GeneticsUniversity Hospitals LeuvenKU LeuvenLeuvenBelgium,Department of Obstetrics and GynecologyGhent University HospitalsGhent UniversityGhentBelgium
| | - E. Thiery
- Department of NeurologyGhent University HospitalGhent UniversityGhentBelgium
| | - N. Jacobs
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Faculty of Psychology and Educational SciencesOpen University of the NetherlandsHeerlenThe Netherlands
| | - M. Wichers
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Department of PsychiatryInterdisciplinary Center Psychopathology and Emotion Regulation (ICPE)University of GroningenUniversity Medical Center GroningenThe Netherlands
| | - O. Cinar
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - B. D. Lin
- Department of Translational NeuroscienceUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - J. J. Luykx
- Department of Translational NeuroscienceUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,Department of PsychiatryUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,GGNet Mental HealthApeldoornThe Netherlands
| | - B. P. F. Rutten
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - J. van Os
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Department of PsychiatryUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,Department of Psychosis StudiesInstitute of PsychiatryKing's Health PartnersKing's College LondonLondonUK
| | - S. Guloksuz
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Department of PsychiatryYale School of MedicineNew HavenCTUSA
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Abstract
IntroductionAlthough history of childhood trauma is present in nearly 50% of bipolar patients, the effects of childhood trauma on the course of bipolar disorder are rarely investigated. Thus, we aimed to investigate the effects of childhood trauma on psychotic symptoms seen in patients with bipolar disorder.MethodsOne-hundred DSM-IV-TR diagnosed bipolar patients who were either manic or depressive were recruited from inpatient units of Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery. Patients were initially evaluated by Young Mania Rating Scale (YMRS), Montgomery-Asperg Depression Rating Scale (MADRS), Scales for Assessment of Positive Symptoms. Patients were also evaluated by Childhood Trauma Questionnaire (CTQ) and Dissociative Experiences Scale in euthymia which was defined by scores of < 7 in YMRS, < 4 in MADRASResultsThere were no differences between the patients with and without a history of psychotic episode in terms of age at onset, duration of illness and episode characteristics. Patients with a history of psychotic episode were hospitalized more. CTQ physical abuse scores were higher in male comparing to female. CTQ sexual abuse scores were higher in female comparing to male. CTQ emotional abuse, physical neglect, physical abuse and total scores were higher in patients who had at least one psychotic episode in lifetime than in patients without a history of psychotic episode.ConclusionThe history of childhood trauma should be investigated and therapeutic interventions for childhood trauma should be added to the standard treatment plan of bipolar patients.
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Riese F, Guloksuz S, Roventa C, Fair J, Haravuori H, Rolko T, Flynn D, Giacco D, Banjac V, Jovanovic N, Bayat N, Palumbo C, Rusaka M, Kilic O, Augėnaitė J, Nawka A, Zenger M, Kekin I, Wuyts P, Barrett E, Bausch-Becker N, Mikaliūnas J, del Valle E, Feffer K, Lomax G, Marques J, Jauhar S. Pharmaceutical industry interactions of psychiatric trainees from 20 European countries. Eur Psychiatry 2020; 30:284-90. [DOI: 10.1016/j.eurpsy.2014.09.417] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/15/2014] [Accepted: 09/21/2014] [Indexed: 11/30/2022] Open
Abstract
AbstractBackground:Interactions between the pharmaceutical industry (PI) and psychiatrists have been under scrutiny recently, though there is little empirical evidence on the nature of the relationship and its intensity at psychiatry trainee level. We therefore studied the level of PI interactions and the underlying beliefs and attitudes in a large sample of European psychiatric trainees.Methods:One thousand four hundred and forty-four psychiatric trainees in 20 European countries were assessed cross-sectionally, with a 62-item questionnaire.Results:The total number of PI interactions in the preceding two months varied between countries, with least interactions in The Netherlands (M (Mean) = 0.92, SD = 1.44, range = 0–12) and most in Portugal (M = 19.06, SD = 17.44, range = 0–100). Trainees were more likely to believe that PI interactions have no impact on their own prescribing behaviour than that of other physicians (M = 3.30, SD = 1.26 vs. M = 2.39, SD = 1.06 on a 5-point Likert scale: 1 “completely disagree” to 5 “completely agree”). Assigning an educational role to the pharmaceutical industry was associated with more interactions and higher gift value (IRR (incidence rate ratio) = 1.21, 95%CI = 1.12–1.30 and OR = 1.18, 95%CI = 1.02–1.37).Conclusions:There are frequent interactions between European psychiatric trainees and the PI, with significant variation between countries. We identified several factors affecting this interaction, including attribution of an educational role to the PI. Creating alternative educational opportunities and specific training dedicated to PI interactions may therefore help to reduce the impact of the PI on psychiatric training.
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Pandit R, Cianci D, ter Hark SE, Winter‐van Rossum I, Ebdrup BH, Broberg BV, Garcia‐Portilla MP, Bobes J, Vinkers CH, Kahn RS, Guloksuz S, Huitema ADR, Luykx JJ. Phenotypic factors associated with amisulpride-induced weight gain in first-episode psychosis patients (from the OPTiMiSE cohort). Acta Psychiatr Scand 2019; 140:283-290. [PMID: 31323113 PMCID: PMC6771865 DOI: 10.1111/acps.13074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Antipsychotic-induced weight gain (AiWG) is a debilitating adverse effect of most antipsychotics. First-episode psychosis patients are particularly vulnerable to the detrimental consequences of AiWG. Amisulpride has good efficacy and tolerability. We here aimed to identify the phenotypic factors associated with amisulpride-induced weight gain in first-episode psychosis patients. METHOD Data were collected from the Optimization of Treatment and Management of Schizophrenia in Europe trial. Multivariable regression models with various phenotypic variables (N = 305) were performed with absolute AiWG and clinically relevant AiWG (≥7% AiWG) as outcomes. RESULTS Four weeks of amisulpride treatment increased body weight from 69.7 to 72.4 kg (P < 0.001). In the regression model of absolute AiWG, unemployment (β = 0.94, P = 0.016), younger age (β = -0.07, P = 0.031) and absence of current comorbid major depression disorder (β = -1.61, P = 0.034) were positively associated with absolute AiWG. In the regression model of clinically relevant AiWG, unemployment (OR = 2.83, P = 0.001), schizophreniform disorder (OR = 2.00, P = 0.025) and low baseline weight (OR = 0.97, P = 0.032) increased the likelihood of clinically relevant AiWG. CONCLUSIONS Clinicians prescribing amisulpride should consider the relatively high susceptibility to AiWG in unemployed first-episode patients with psychosis, in particular young subjects with a diagnosis of schizophreniform disorder. We advise to carefully monitor these patients and, when needed, implement weight-reducing strategies.
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Affiliation(s)
- R. Pandit
- Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - D. Cianci
- Department of Biostatistics and Research SupportJulius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUniversity of UtrechtUtrechtthe Netherlands
| | - S. E. ter Hark
- Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - I. Winter‐van Rossum
- Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - B. H. Ebdrup
- Centre for Neuropsychiatric Schizophrenia ResearchCNSR & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINSMental Health Centre GlostrupCopenhagen University HospitalGlostrupDenmark,Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - B. V. Broberg
- Centre for Neuropsychiatric Schizophrenia ResearchCNSR & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINSMental Health Centre GlostrupCopenhagen University HospitalGlostrupDenmark
| | - M. P. Garcia‐Portilla
- Department of Psychiatry and CIBERSAMUniversity of OviedoOviedoSpain,Instituto de Investigación Biosanitaria del Principado de Asturias (ISPA)OviedoSpain
| | - J. Bobes
- Department of Psychiatry and CIBERSAMUniversity of OviedoOviedoSpain,Instituto de Investigación Biosanitaria del Principado de Asturias (ISPA)OviedoSpain
| | - C. H. Vinkers
- Department of PsychiatryAmsterdam UMC (location VUmc)Amsterdamthe Netherlands,Department of Anatomy and NeurosciencesAmsterdam UMC (location VUmc)Amsterdamthe Netherlands
| | - R. S. Kahn
- Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PsychiatryIcahn School of MedicineMount SinaiNew YorkUSA
| | - S. Guloksuz
- Department of Psychiatry and NeuropsychologySchool for Mental HealthNeuroscience Maastricht University Medical CenterMaastrichtthe Netherlands,Department of PsychiatryYale School of MedicineNew HavenCTUSA
| | - A. D. R. Huitema
- Department of Pharmacy PharmacologyThe Netherlands Cancer InstituteAmsterdamthe Netherlands,Department of Clinical PharmacyUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - J. J. Luykx
- Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,GGNet Mental HealthApeldoornthe Netherlands
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Abstract
The concept of schizophrenia only covers the 30% poor outcome fraction of a much broader multidimensional psychotic syndrome, yet paradoxically has become the dominant prism through which everything 'psychotic' is observed, even affective states with mild psychosis labelled 'ultra-high risk' (for schizophrenia). The inability of psychiatry to frame psychosis as multidimensional syndromal variation of largely unpredictable course and outcome - within and between individuals - hampers research and recovery-oriented practice. 'Psychosis' remains firmly associated with 'schizophrenia', as evidenced by a vigorous stream of high-impact but non-replicable attempts to 'reverse-engineer' the hypothesized biological disease entity, using case-control paradigms that cannot distinguish between risk for illness onset and risk for poor outcome. In this paper, the main issues surrounding the concept of schizophrenia are described. We tentatively conclude that with the advent of broad spectrum phenotypes covering autism and addiction in DSM5, the prospect for introducing a psychosis spectrum disorder - and modernizing psychiatry - appears to be within reach.
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Affiliation(s)
- S Guloksuz
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,the Netherlands
| | - J van Os
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,the Netherlands
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Abstract
Galvanized with the availability of sophisticated statistical techniques and large datasets, network medicine has emerged as an active area of investigation. Following this trend, network methods have been utilized to understand the interplay between symptoms of mental disorders. This realistic approach that may provide an improved framework into understanding mental conditions and underlying mechanisms is certainly to be welcomed. However, we have noticed that symptom network studies tend to lose sight of the fundamentals, overlook major limitations embedded in study designs, and make inferences that are difficult to justify with current findings. There is concern that disregarding these flaws may halt the progress of the network approach in psychiatry. Therefore, in this paper, we first attempt to identify the pitfalls: (1) a reductionist understanding of medicine and psychiatry, thereby inadvertently reintroducing the dichotomy of medicine (lung cancer) and psychiatry (depression), (2) a shortsighted view of signs and symptoms, (3) overlooking the limitations of available datasets based on scales with embedded latent class structures, (4) overestimating the importance of the current findings beyond what is supported by the study design. By addressing current issues, the hope is to navigate this rapidly growing field to a more methodologically sound and reproducible path that will contribute to our understanding of mental disorders and its underlying mechanisms.
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Affiliation(s)
- S Guloksuz
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - L-K Pries
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - J van Os
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
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Altinoz MA, Guloksuz S, Elmaci İ. Rabies virus vaccine as an immune adjuvant against cancers and glioblastoma: new studies may resurrect a neglected potential. Clin Transl Oncol 2017; 19:785-792. [DOI: 10.1007/s12094-017-1613-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/07/2017] [Indexed: 12/01/2022]
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Kilic O, Sonmez E, Guloksuz S, Pinto da Costa M. Psychiatry Trainees in Turkey Considers Leaving the Country. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionThe brain drain of mental health professionals is an important issue especially for developing countries with inadequate recruitment rates. The European Federation of Psychiatric Trainees (EFPT) investigated the extent of migration among trainees across Europe by Brain Drain research project. Results from a non-EU country, with the lowest number of mental health professionals per 100 000 population across OECD countries might provide important clues.ObjectiveTo identify attitudes towards and behaviors towards international migration among psychiatry trainees from Turkey.MethodAn online survey was conducted among psychiatry trainees from Turkey in 2013, as part of the EFPT Brain Drain Research Project.ResultsOf 107 trainees surveyed, 74% considered living abroad. However, the rate of having even short mobility experience was just 13%, and these were mainly educational visits. More than half of those who visited a foreign country reported to have a satisfactory experience, which might explain the positive influence of these visits on attitudes towards migration. Responders perceived academic conditions as the most important aspect of training that needs to be improved, in line with the fact that inadequate training programs were important reasons for migrating.ConclusionOverall, psychiatry trainees in Turkey tend to remain in their country of origin, which may protect healthcare system against the detriment of workforce loss. The relatively low rate of migration may also reflect the legislative barriers (e.g. being o non-EU country) impeding migrating. Our findings also suggest that the unmet educational needs of trainees require immediate attention.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Guloksuz S, van Nierop M, Lieb R, van Winkel R, Wittchen HU, van Os J. Evidence that the presence of psychosis in non-psychotic disorder is environment-dependent and mediated by severity of non-psychotic psychopathology. Psychol Med 2015; 45:2389-2401. [PMID: 25804288 DOI: 10.1017/s0033291715000380] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [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: 12/20/2022]
Abstract
BACKGROUND Evidence suggests that in affective, non-psychotic disorders: (i) environmental exposures increase risk of subthreshold psychotic experiences (PEs) and strengthen connectivity between domains of affective and subthreshold psychotic psychopathology; and (ii) PEs are a marker of illness severity. METHOD In 3021 adolescents from the Early Developmental Stages of Psychopathology cohort, we tested whether the association between PEs and presence of DSM-IV mood disorder (MD)/obsessive-compulsive disorder (OCD) would be moderated by risk factors for psychosis (cannabis use, childhood trauma and urbanicity), using the interaction contrast ratio (ICR) method. Furthermore, we analysed whether the interaction between environment and PEs was mediated by non-psychotic psychopathology. RESULTS The association between PEs and MD/OCD was moderated by urbanicity (ICR = 2.46, p = 0.005), cannabis use (ICR = 3.76, p = 0.010) and, suggestively, trauma (ICR = 1.91, p = 0.063). Exposure to more than one environmental risk factor increased the likelihood of co-expression of PEs in a dose-response fashion. Moderating effects of environmental exposures were largely mediated by the severity of general non-psychotic psychopathology (percentage explained 56-68%, all p < 0.001). Within individuals with MD/OCD, the association between PEs and help-seeking behaviour, as an index of severity, was moderated by trauma (ICR = 1.87, p = 0.009) and urbanicity (ICR = 1.48, p = 0.005), but not by cannabis use. CONCLUSIONS In non-psychotic disorder, environmental factors increase the likelihood of psychosis admixture and help-seeking behaviour through an increase in general psychopathology. The findings are compatible with a relational model of psychopathology in which more severe clinical states are the result of environment-induced disturbances spreading through a psychopathology network.
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Affiliation(s)
- S Guloksuz
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, EURON,Maastricht,The Netherlands
| | - M van Nierop
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, EURON,Maastricht,The Netherlands
| | - R Lieb
- Epidemiology and Health Psychology, Institute of Psychology, University of Basel,Basel,Switzerland
| | - R van Winkel
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, EURON,Maastricht,The Netherlands
| | - H-U Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technical University Dresden,Dresden,Germany
| | - J van Os
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, EURON,Maastricht,The Netherlands
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Riese F, Guloksuz S, Roventa C, Fair J, Haravuori H, Rolko T, Flynn D, Giacco D, Banjac V, Jovanovic N, Bayat N, Palumbo C, Rusaka M, Kilic O, Augėnaitė J, Nawka A, Zenger M, Kekin I, Wuyts P, Barrett E, Bausch-Becker N, Mikaliunas J, del Valle E, Feffer K, Lomax G, Gama Marques J, Jauhar S. 721 – European psychiatric trainees and their interactions with the pharmaceutical industry: results from the efpt-prirs study. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)75941-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gama Marques J, Andlauer O, Banjac V, Guloksuz S, Jauhar S, Kilic O, Mitkovic M, Nawka A, Palumbo C, Pantovic M, Pinto da Costa M, Riese F. P-852 - Access to information in psychiatric training (ATIIPT) among the delegates to the european federation of psychiatric trainees (EFPT) 2011 forum. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)75019-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Giacco D, Luciano M, Del Vecchio V, Baldass N, Teodorides N, De Vriendt N, Piirika P, Courtois A, Gerber S, Lahera G, Riese F, Bendix M, Guloksuz S, Aslantas Erteki B, Oakley C, Fiorillo A. P-1140 - A survey from the WPA early career Psychiatrists council: what about training and practice of psychotherapy across Europe? Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)75307-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Jauhar S, Guloksuz S, Marques J, Nawka A, Roventa C, Psaras R, Andlauer O, Lydall G, De Vriendt N, Mendonca L, Van Zanten J, Dumiterscu I, Nwachukwu I, Riese F. How do european psychiatry trainees prescribe when treating depression, and what influences decision-making? (Survey of the European Federation of Psychiatric Trainees Research Group). Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72953-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
ObjectivesDespite recent recent evidence and subsequent guidelines that have suggested factors such as side-effect profile and cost should be taken into account when prescribing antidepressant medication, relatively little evidence exists on decision-making in clinical practice.Our Pan-European Research Group looked at clinical practice regarding antidepressants amongst Psychiatry trainees, treatments trainees would desire themselves, and factors influencing decision-making.MethodsA semi-structured survey was constructed from recent literature, was piloted, and a homogenous sample size of at least 50 agreed upon from each country, with 50% the minimum response rate. It was distributed via web-link, questioning preference of antidepressant for patients, and factors influencing choice. Trainees were asked for their preference should they develop a moderate to severe depressive episode, and require medication.ResultsTreatment choices are summarised in Table 1. 79% of trainees would prescribe similar antidepressants for themselves as for patients.Factors influencing decision-making mapped onto three main domains: cost, efficacy and side-effect profile (5% other reasons). 86% (n = 548) of those who responded felt efficacy most important, 38% (n = 237) felt side-effect profile most important and 6% (n = 33) considered cost of most importance.ConclusionsSome differences exist in choice of antidepressant for European trainees and their patients, and factors affecting choice conflict with evidence base and guideline suggestions.
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Jauhar S, Guloksuz S, Gama Marques J, Bendix M, Lydall G, Andlauer O, Gerber S, Roventa C, Van Zanten J, De Vriendt N, Nawka A, Nwachukw I, Dobrzynska E, Mufic A, Nazaraliev A, Dumitrescu I, Mendonca L, Riese F. P03-343 - Treatment choice in psychiatry? How would European trainees treat psychosis for their patients and themselves, and what influences decision-making? Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70949-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Jauhar S, Lydall G, Riese F, Gama Marques J, Bendix M, Andlauer O, Gerber S, De Vriendt N, Dumitrescu I, Nawka A, Guloksuz S, Mendonca L, Nwachukw I, Psaras R, Roventa C, Giacco D, Mufic A, Dobrzynska E, Nazaraliev A, Van Zanten J. PW01-264 - How would European trainees treat bipolar disorder for their patients and themselves, and what influences decision-making? Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71577-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Riese F, Jauhar S, Guloksuz S, Andlauer O, Lydall G, Gama Marques J, Van Zanten J, Bendix M, Giacco D, Gerber S, Mendonca L, Nawka A, De Vriendt N, Nazaraliev A, Psaras R, Nwachukw I, Roventa C, Atay O, Coccia F, Barry H, Nikitopoulos J, Rusaka M, Kudinova M, Mitkovic M, Ostrovschi N, Sos P, Wuyts P, Rakos I, Volpe U. P02-184 - The European federation of psychiatric trainees’ psychiatric resident - industry relationship survey (EFPT-PRIRS). Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70799-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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