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JAMA Psychiatry Sep 2022The behavioral and cognitive symptoms of severe psychotic disorders overlap with those seen in dementia. However, shared brain alterations remain disputed, and their...
IMPORTANCE
The behavioral and cognitive symptoms of severe psychotic disorders overlap with those seen in dementia. However, shared brain alterations remain disputed, and their relevance for patients in at-risk disease stages has not been explored so far.
OBJECTIVE
To use machine learning to compare the expression of structural magnetic resonance imaging (MRI) patterns of behavioral-variant frontotemporal dementia (bvFTD), Alzheimer disease (AD), and schizophrenia; estimate predictability in patients with bvFTD and schizophrenia based on sociodemographic, clinical, and biological data; and examine prognostic value, genetic underpinnings, and progression in patients with clinical high-risk (CHR) states for psychosis or recent-onset depression (ROD).
DESIGN, SETTING, AND PARTICIPANTS
This study included 1870 individuals from 5 cohorts, including (1) patients with bvFTD (n = 108), established AD (n = 44), mild cognitive impairment or early-stage AD (n = 96), schizophrenia (n = 157), or major depression (n = 102) to derive and compare diagnostic patterns and (2) patients with CHR (n = 160) or ROD (n = 161) to test patterns' prognostic relevance and progression. Healthy individuals (n = 1042) were used for age-related and cohort-related data calibration. Data were collected from January 1996 to July 2019 and analyzed between April 2020 and April 2022.
MAIN OUTCOMES AND MEASURES
Case assignments based on diagnostic patterns; sociodemographic, clinical, and biological data; 2-year functional outcomes and genetic separability of patients with CHR and ROD with high vs low pattern expression; and pattern progression from baseline to follow-up MRI scans in patients with nonrecovery vs preserved recovery.
RESULTS
Of 1870 included patients, 902 (48.2%) were female, and the mean (SD) age was 38.0 (19.3) years. The bvFTD pattern comprising prefrontal, insular, and limbic volume reductions was more expressed in patients with schizophrenia (65 of 157 [41.2%]) and major depression (22 of 102 [21.6%]) than the temporo-limbic AD patterns (28 of 157 [17.8%] and 3 of 102 [2.9%], respectively). bvFTD expression was predicted by high body mass index, psychomotor slowing, affective disinhibition, and paranoid ideation (R2 = 0.11). The schizophrenia pattern was expressed in 92 of 108 patients (85.5%) with bvFTD and was linked to the C9orf72 variant, oligoclonal banding in the cerebrospinal fluid, cognitive impairment, and younger age (R2 = 0.29). bvFTD and schizophrenia pattern expressions forecasted 2-year psychosocial impairments in patients with CHR and were predicted by polygenic risk scores for frontotemporal dementia, AD, and schizophrenia. Findings were not associated with AD or accelerated brain aging. Finally, 1-year bvFTD/schizophrenia pattern progression distinguished patients with nonrecovery from those with preserved recovery.
CONCLUSIONS AND RELEVANCE
Neurobiological links may exist between bvFTD and psychosis focusing on prefrontal and salience system alterations. Further transdiagnostic investigations are needed to identify shared pathophysiological processes underlying the neuroanatomical interface between the 2 disease spectra.
Topics: Adult; Alzheimer Disease; Brain; Female; Frontotemporal Dementia; Humans; Machine Learning; Magnetic Resonance Imaging; Male; Neuropsychological Tests; Psychotic Disorders; Schizophrenia
PubMed: 35921104
DOI: 10.1001/jamapsychiatry.2022.2075 -
Frontiers in Psychiatry 2022Cognitive impairment is among the core dimensions in schizophrenia and is a significant predictor of everyday functioning in people with schizophrenia. Given the...
BACKGROUND
Cognitive impairment is among the core dimensions in schizophrenia and is a significant predictor of everyday functioning in people with schizophrenia. Given the enormous burden of schizophrenia, the search for its clinically relevant biomarkers is essential. Researchers have been trying to elucidate factors of cognitive impairment as well as personal performance, but the search is still ongoing. The aim of the study was to search for associations between BDNF, CRP, IL-6 and clinical symptoms, cognitive and personal performance in patients with paranoid schizophrenia.
METHODS
A total of 86 patients (53.5% women, mean age 31.1 ± 6.5) with paranoid schizophrenia (F20.0; ICD-10) in remission were examined. Clinical and neuropsychological examination included the Positive and Negative Syndrome Scale, Personal and Social Performance Scale, Calgary Depression Scale for Schizophrenia and the Brief Assessment of Cognitive Function in Schizophrenia. IL-6, BDNF, CRP levels were determined in the patients' blood serum.
RESULTS
Cognitive impairment was revealed in 79.1% of patients and was more profound in patients with higher number of hospitalizations ( = 0.006). The average BDNF levels were 13.38 ± 15.84 ng/ml, CRP concentration was 2.09 ± 2.54 mg/l, and IL-6 levels were 12.14 ± 5.88 pg/ml. There were no differences in biomarker levels or BACS results in patients that had different antipsychotic therapy or differed in the presence of anticholinergic therapy. CRP levels were higher in patients with longer disease duration, lower age of onset, more impaired personal social performance and processing speed. IL-6 was higher in individuals with lower working memory scores. PANSS negative subscale score negatively correlated and PSP score positively correlated with most cognitive domains. A linear regression established that the first episode vs. multiple episodes of schizophrenia could statistically significantly predict personal and social performance and cognition, including speech fluency and planning, as well as CRP levels.
CONCLUSIONS
This study continues the search for biomarkers of schizophrenia and cognitive impairment in schizophrenia to improve the reliability of diagnosing the disorder and find new treatment approaches. The role of the number of psychoses experienced (first episode vs. multiple episodes of schizophrenia) in cognition, personal and social performance and inflammation is shown.
PubMed: 35873262
DOI: 10.3389/fpsyt.2022.943869 -
International Journal of Environmental... Jun 2022The theme, strength, and duration of a delusion are considered important in distinguishing one psychosis of old age from another. Research results, however, are mostly... (Review)
Review
The theme, strength, and duration of a delusion are considered important in distinguishing one psychosis of old age from another. Research results, however, are mostly based on studies conducted on one form of psychosis, namely schizophrenia. The aim of this hypothesis-driven narrative review is to gather clinically important information about the psychosis identified as delusional disorder (DD), as it affects persons of senior age. We hypothesized that DD becomes relatively prevalent in old age, especially in women; and that it is associated with demonstrable brain changes, which, in turn, are associated with cognitive defects and poor pharmacological response, thus increasing the risk of aggression and suicide. Computerized searches in PubMed and ClinicalTrials.gov were conducted using the following search terms: (delusional disorder) AND (elderly OR old OR aged OR psychogeriatrics). A total of 16 recent studies (including case reports) were reviewed. Our hypotheses could not be definitively confirmed because research evidence is lacking. In order to improve eventual outcomes, our literature search demonstrates the need for more targeted, well-designed studies.
Topics: Aged; Female; Humans; Psychotic Disorders; Schizophrenia, Paranoid; Suicide
PubMed: 35805570
DOI: 10.3390/ijerph19137911 -
Cureus May 2022Schizophrenia is a chronic psychiatric disorder that classically presents with distortions of thought, behavior, and perceptions that are often misdiagnosed. One...
Schizophrenia is a chronic psychiatric disorder that classically presents with distortions of thought, behavior, and perceptions that are often misdiagnosed. One difficulty in diagnosing schizophrenia is due to its phenotypically heterogeneous condition that can be precipitated by a combination of genetic, epigenetic, and environmental factors. The prevalence of schizophrenia is roughly 1%, but it is often misdiagnosed. Possible differential diagnoses include depression or bipolar disorder with psychosis, psychosis due to a medical condition, schizotypal and schizoid personality disorders, and neurocognitive disorders. In this case report, a 31-year-old male presents with thoughts of suicide following a recent exacerbation of his hallucinations. On presentation, the patient presented with a historical diagnosis of "paranoid schizophrenia" as well as a history of traumatic brain injury (TBI), poly-substance use disorder, and a family history of schizophrenia. This case serves to highlight the difficulties of making an accurate diagnosis and providing evidenced-based treatment.
PubMed: 35800823
DOI: 10.7759/cureus.25488 -
Schizophrenia Research Aug 2022Paranoid ideas are the most common abnormal beliefs in the schizophrenia spectrum, are also prevalent in non-clinical populations, and are highly correlated with other...
Paranoid ideas are the most common abnormal beliefs in the schizophrenia spectrum, are also prevalent in non-clinical populations, and are highly correlated with other mental health problems such as anxiety, depression and low levels of well-being. Two previous studies with the same British population sample used confirmatory factor analysis and network analysis to show that the spectrum of paranoid beliefs is made up of four factors or dimensions (i.e., interpersonal sensitivity, mistrust, ideas of reference and ideas of persecution). The aims of this study are: 1) to explore the distribution and the structure of paranoid beliefs in a Spanish general population by applying the network approach and 2) to use network analysis to explore for the first time whether specific domains of paranoid ideation (i.e., dimensions) are specifically associated with mental health correlates such as depression, anxiety, loneliness, and well-being. We found a continuous distribution of paranoid beliefs among the 1328 individuals constituting the sample (e.g., 29,2 % did not endorse any items, 4.6 % endorsed half of the items, while 0.8 % endorsed all paranoid items). Paranoid ideas form three dimensions; interpersonal sensitivity, mistrust, and ideas of persecution (ideas of reference did not form a separate factor). The network model showed that loneliness has a pivotal role in connecting paranoid ideation with general psychopathology measures (i.e., depression, anxiety, loneliness and well-being). Research and clinical implications derived from our findings are also discussed.
Topics: Humans; Interpersonal Relations; Loneliness; Mental Health; Paranoid Disorders; Risk Factors
PubMed: 35717741
DOI: 10.1016/j.schres.2022.06.005 -
Frontiers in Psychiatry 2022Modified electroconvulsive therapy (MECT) is a viable therapeutic option for patients with mood disorders and schizophrenia. We found that there is a relationship...
INTRODUCTION
Modified electroconvulsive therapy (MECT) is a viable therapeutic option for patients with mood disorders and schizophrenia. We found that there is a relationship between MECT and leukocytosis. To the best of our knowledge, this is the first case of this problem. There are no relevant guidelines recommending the risk of leukocytosis caused by MECT, nor the method to reduce the risk. We hope to share this case to provide a reference for the prevention and treatment of similar patients with leukocytosis during or after MECT and remind psychiatrists to pay attention to this risk of leukocytosis before making the decision of MECT while knowing how to deal with it.
CASE PRESENTATION
We describe a case of a 24-year-old woman diagnosed with Paranoid personality disorder (PPD) whose symptoms began at 19 years old. Her main clinical manifestations are feeling targeted, cheated, tracked, misunderstood, and repeating action. Since antipsychotic treatment was ineffective, we considered MECT. After MECT, the patient's body temperature increased, and leukocytosis was found. After excluding infection and other possibilities, we added 1,000 ml physiological saline to the patient through the vein. The white blood cell (WBC) count returned to normal in a short time.
CONCLUSION
Before MECT, it is necessary to screen blood cytology. During and after MECT, we should be alert to leukocytosis that may be related to MECT and deal with it correctly in time.
PubMed: 35693976
DOI: 10.3389/fpsyt.2022.899847 -
Psychiatria Polska Feb 2022The consequence of social exclusion of the mentally ill patients is often a worsening of the course of the disease and prognosis. The psychiatric diagnosis is very... (Review)
Review
The consequence of social exclusion of the mentally ill patients is often a worsening of the course of the disease and prognosis. The psychiatric diagnosis is very important for the so-called labeling, which is one of the stages of the stigma process, and it also has a lot of social implications. The purpose of this work is to take look at the issue of psychiatric diagnosis, especially the diagnosis of paranoid schizophrenia and its consequences for the patient's social functioning. The authors of the article have reviewed the literature on the importance of psychiatric diagnosis in the context of self-stigmatization of mental illness and have presented, based on medical records, a clinical case of a patient who had significant difficulties in accepting the diagnosis of paranoid schizophrenia. The stigma of mental illness is the reason of subjectively experienced suffering for people with psychiatric diagnosis and their relatives, but it is also relevant to public health. Psychiatric diagnosis has significant social consequences, which is why it is so important that the process of diagnosis is not a routine activity for psychiatrists, free from ethical reflection.
Topics: Humans; Mental Disorders; Mentally Ill Persons; Psychiatry; Social Stigma; Stereotyping
PubMed: 35569157
DOI: 10.12740/PP/OnlineFirst/124774 -
The Malaysian Journal of Medical... Apr 2022Schizophrenia is a multifactorial disease in which genetic factors play a greater role than other factors. The genes of importance in schizophrenia patients are the...
BACKGROUND
Schizophrenia is a multifactorial disease in which genetic factors play a greater role than other factors. The genes of importance in schizophrenia patients are the genes that encode for neurotransmitters associated with low minor allele frequency (MAF) scores. This study was aimed to determine the association of genetic variations in , and with the risk of paranoid schizophrenia (PS) in patients admitted to Prof HB Saanin Psychiatric Hospital, West Sumatra, Indonesia.
METHODS
Genotyping analysis through polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and PCR-amplification refractory mutation system (ARMS) was performed in 100 PS patients and 100 healthy controls. Chi-square and Fisher's exact tests were used to compare the frequencies of genotype and allotype between the PS and control groups. Odds ratio (OR) with 95% confidence interval (95% CI) were calculated to determine the relative risk of PS with respect to genetic variations.
RESULTS
Polymorphism rs13142920 in was associated with significantly elevated risk of PS ( 0.020; OR = 1.60 [95% CI: 1.08, 2.39]). However, rs4680 and rs2073499 polymorphisms were not significantly associated with PS.
CONCLUSION
The rs13142920 polymorphism holds great potential as a genetic marker in PS patients.
PubMed: 35528814
DOI: 10.21315/mjms2022.29.2.4 -
Psychiatria Polska Dec 2021The aim of the study was to determine and analyze the correlation between the concentrations of selected metalloproteinases and their inhibitors (TIMP-1 and TIMP-2) in...
OBJECTIVES
The aim of the study was to determine and analyze the correlation between the concentrations of selected metalloproteinases and their inhibitors (TIMP-1 and TIMP-2) in patients with dementia and schizophrenia.
METHODS
The concentration of two collagenases and metalloendopeptidase was determined in the study. The study included 29 patients with lateonset dementia, 25 patients with paranoid schizophrenia and 25 healthy controls who were age-matched with the study groups. Symptoms of dementia were evaluated using the Short Mental State Assessment Scale, whereas the symptoms of schizophrenia were assessed using the Positive and Negative Assessment Scale. Blood samples were collected from the participants and the concentrations of MMP-1, MMP7, MMP-13, TIMP-1, and TIMP-2 in the blood serum were evaluated using ELISA method.
RESULTS
A two-fold increase in the concentration of MMP-1 and a slight increase in MMP-13 was observed in dementia patients compared to other groups, as well as a lower level of MMP-7 and TIMP-1 and a higher level of TIMP-2 compared to the control group. Patients with schizophreniashowed lower MMP-7 and higher TIMP-2 serum level compared to the controls. No differences in the concentration of MMP-1, MMP-13 and TIMP-1 levels were noticed. In people with late onset dementia an increase in collagenolytic activity was demonstrated.
CONCLUSIONS
Increase in collagenolytic activity may indicate an increased remodeling within the central nervous system in late onset dementia. The differencein the fluctuation of the concentrations of the studied enzymes and their inhibitors in dementia and schizophrenia indicates their different involvement in the pathogenesis of these disorders.
Topics: Central Nervous System; Dementia; Humans; Matrix Metalloproteinase 1; Matrix Metalloproteinase 13; Matrix Metalloproteinase 2; Matrix Metalloproteinase 7; Matrix Metalloproteinase 9; Neurodegenerative Diseases; Schizophrenia; Tissue Inhibitor of Metalloproteinase-1; Tissue Inhibitor of Metalloproteinase-2
PubMed: 35472224
DOI: 10.12740/PP/126662 -
Psychology and Psychotherapy Sep 2022SlowMo is the first blended digital therapy for paranoia, showing significant small-moderate reductions in paranoia in a recent large-scale randomized controlled trial... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
SlowMo is the first blended digital therapy for paranoia, showing significant small-moderate reductions in paranoia in a recent large-scale randomized controlled trial (RCT). This study explored the subjective service-user experience of the SlowMo therapy content and design; the experience of the blended therapy approach, including the triangle of the therapeutic alliance; and the experience of the digital aspects of the intervention.
DESIGN
Qualitative co-produced sub-study of an RCT.
METHODS
Participants were 22 adult service users with schizophrenia-spectrum psychosis and persistent distressing paranoia, who completed at least one SlowMo therapy session and a 24-week follow-up, at one of 3 sites in Oxford, London, and Sussex, UK. They were interviewed by peer researchers, using a topic guide co-produced by the Patient and Public Involvement (PPI) team. The transcribed data were analysed thematically. Multiple coding and triangulation, and lay peer researcher validation were used to reach a consensus on the final theme structure.
RESULTS
Six core themes were identified: (i) starting the SlowMo journey; (ii) the central role of the supportive therapist; (iii) slowing things down; (iv) value and learning from social connections; (v) approaches and challenges of technology; and (vi) improvements in paranoia and well-being.
CONCLUSIONS
For these service users, slowing down for a moment was helpful, and integrated into thinking over time. Learning from social connections reflected reduced isolation, and enhanced learning through videos, vignettes, and peers. The central role of the supportive therapist and the triangle of alliance between service user, therapist, and digital platform were effective in promoting positive therapeutic outcomes.
Topics: Adult; Humans; Paranoid Disorders; Patient Participation; Research Design; Schizophrenia; Therapeutic Alliance
PubMed: 35445520
DOI: 10.1111/papt.12393