Psychosis breakthrough on antipsychotic maintenance: results from a nationwide study

2019 ◽  
Vol 50 (8) ◽  
pp. 1356-1367 ◽  
Author(s):  
Jose M. Rubio ◽  
Heidi Taipale ◽  
Christoph U. Correll ◽  
Antti Tanskanen ◽  
John M. Kane ◽  
...  
Keyword(s):  
Median Duration ◽  
Incidence Rates ◽  
Continuous Treatment ◽  
Future Research ◽  
Schizophrenia Spectrum Disorders ◽  
Maintenance Medication ◽  
Schizophrenia Spectrum ◽  
Treatment Onset ◽  
Long Acting

AbstractBackgroundThere is uncertainty about the incidence of breakthrough psychosis in treatment adherent patients, and the role that factors, such as cumulative antipsychotic exposure, play in this phenomenon.MethodsIn a nationwide cohort of individuals treated for schizophrenia-spectrum disorders in Finland between 1 January 1996 and 31 December 2015, ‘Breakthrough Psychosis on Antipsychotic Maintenance Medication’ (BAMM) was defined as hospitalization for psychosis despite ongoing continuous treatment with long-acting injectable antipsychotics (LAIs) or oral antipsychotics (OAPs) for ⩾8 weeks. Incidence rates, survival curves, and risk factors were presented.ResultsIn a cohort of 16 031 continuous LAI treatment episodes with virtually assured adherence [median duration = 441 days, interquartile range (IQR) = 155–1277], BAMM incidence was 31.5%. For 42 867 OAPs treatment episodes (median duration = 483 days, IQR = 167–1491), for whom adherence was modeled by the PRE2DUP method, BAMM incidence was 31.1%. Factors related to illness instability at treatment onset were associated with BAMM, although median time to BAMM was 291 days (IQR = 121–876) for LAIs and 344 days (IQR = 142–989) for OAPs, and 27.4% (N= 1386) of the BAMM events in the LAI, and 32.9% (N= 4378) in the OAP group occurred despite >1 year since last hospitalization at treatment onset. Cumulative antipsychotic exposure was not a consistent risk factor.ConclusionBAMM was relatively common even when adherence was confirmed with LAIs. Illness instability at treatment onset accounted for most cases, but relapse after years of continuous treatment was still prevalent. There was insufficient evidence to support causality between cumulative antipsychotic exposure and BAMM. Future research needs to address the role of symptom severity and neurobiology in BAMM.

Imaging the “social brain” in schizophrenia: A systematic review of neuroimaging studies of social reward and punishment

2020 ◽  
Author(s):  
Jessica Mow ◽  
Arti Gandhi ◽  
Daniel Fulford
Keyword(s):  
Brain Activity ◽  
Interaction Network ◽  
Social Motivation ◽  
Social Impairment ◽  
Future Research ◽  
Social Reward ◽  
Schizophrenia Spectrum Disorders ◽  
Social Stimuli ◽  
Schizophrenia Spectrum ◽  
Reward And Punishment

Decreased social functioning and high levels of loneliness and social isolation are common in schizophrenia spectrum disorders (SSD), contributing to reduced quality of life. One key contributor to social impairment is low social motivation, which may stem from aberrant neural processing of socially rewarding or punishing stimuli. To summarize research on the neurobiology of social motivation in SSD, we performed a systematic literature review of neuroimaging studies involving the presentation of social stimuli intended to elicit feelings of reward and/or punishment. Across 11 studies meeting criteria, people with SSD demonstrated weaker modulation of brain activity in regions within a proposed social interaction network, including prefrontal, cingulate, and striatal regions, as well as the amygdala and insula. Firm conclusions regarding neural differences in SSD in these regions, as well as connections within networks, are limited due to conceptual and methodological inconsistencies across the available studies. We conclude by making recommendations for the study of social reward and punishment processing in SSD in future research.

Insecure attachment is associated with paranoia but not hallucinations in psychotic patients: the mediating role of negative self-esteem

2014 ◽  
Vol 45 (7) ◽  
pp. 1495-1507 ◽  
Author(s):  
S. Wickham ◽  
K. Sitko ◽  
R. P. Bentall
Keyword(s):  
Attachment Style ◽  
Attachment Styles ◽  
Self Esteem ◽  
Insecure Attachment ◽  
Future Research ◽  
Schizophrenia Spectrum Disorders ◽  
Attachment Representations ◽  
Co Morbidity ◽  
The Relationship

BackgroundA growing body of research has investigated associations between insecure attachment styles and psychosis. However, despite good theoretical and epidemiological reasons for hypothesising that insecure attachment may be specifically implicated in paranoid delusions, few studies have considered the role it plays in specific symptoms.MethodWe examined the relationship between attachment style, paranoid beliefs and hallucinatory experiences in a sample of 176 people with a diagnosis of schizophrenia spectrum disorders and 113 healthy controls. We also investigated the possible role of negative self-esteem in mediating this association.ResultsInsecure attachment predicted paranoia but not hallucinations after co-morbidity between the symptoms was controlled for. Negative self-esteem partially mediated the association between attachment anxiety and clinical paranoia, and fully mediated the relationship between attachment avoidance and clinical paranoia.ConclusionsIt may be fruitful to explore attachment representations in psychological treatments for paranoid patients. If future research confirms the importance of disrupted attachment as a risk factor for persecutory delusions, consideration might be given to how to protect vulnerable young people, for example those raised in children's homes.

The Role of Medical Comorbidity in the Rapid Psychiatric Readmission of Patients With Schizophrenia-spectrum Disorders

2021 ◽  
Vol 27 (1) ◽  
pp. 14-22
Author(s):  
LAUREN E. REEVES ◽  
LAUREN WEINSTOCK ◽  
GARY EPSTEIN-LUBOW ◽  
JANE METRIK ◽  
BRANDON A. GAUDIANO
Keyword(s):  
Medical Comorbidity ◽  
Schizophrenia Spectrum Disorders ◽  
Psychiatric Readmission ◽  
Schizophrenia Spectrum ◽  
Spectrum Disorders

The Schizophrenia Spectrum

2018 ◽  
pp. 208-230
Author(s):  
Marco Del Giudice
Keyword(s):  
General Pattern ◽  
Future Research ◽  
Evolutionary Models ◽  
Schizophrenia Spectrum Disorders ◽  
External Reality ◽  
Schizotypal Personality ◽  
Schizophrenia Spectrum ◽  
New Directions ◽  
Loss Of Contact ◽  
Developmental Features

The chapter discusses schizophrenia spectrum disorders (SSDs), including schizophrenia and schizotypal personality disorder (SPD). Schizophrenia and related disorders are part of the broader spectrum of psychosis, a cluster of genetically and phenotypically related conditions marked by loss of contact with external reality. After an overview of these disorders, their developmental features, and the main risk factors identified in the epidemiological literature, the chapter critically reviews existing evolutionary models and suggests new directions for research. The final section applies the criteria developed earlier in the book to classify the disorders within the fast-slow-defense (FSD) model and identify functionally distinct subtypes. The author concludes that most instances of SSDs can be classified as fast spectrum (F-type) conditions; however, there are indications of heterogeneity within these conditions, and future research is likely to identify exceptions to the general pattern.

scholarly journals Hallucinations Under Psychedelics and in the Schizophrenia Spectrum: An Interdisciplinary and Multiscale Comparison

2020 ◽  
Vol 46 (6) ◽  
pp. 1396-1408 ◽  
Author(s):  
Pantelis Leptourgos ◽  
Martin Fortier-Davy ◽  
Robin Carhart-Harris ◽  
Philip R Corlett ◽  
David Dupuis ◽  
...  
Keyword(s):  
Brain Imaging ◽  
Working Group ◽  
Future Research ◽  
Schizophrenia Spectrum Disorders ◽  
Drug Induced ◽  
Computational Approaches ◽  
Schizophrenia Spectrum ◽  
Multidisciplinary Working ◽  
Similarities And Differences ◽  
Spectrum Disorders

Abstract The recent renaissance of psychedelic science has reignited interest in the similarity of drug-induced experiences to those more commonly observed in psychiatric contexts such as the schizophrenia-spectrum. This report from a multidisciplinary working group of the International Consortium on Hallucinations Research (ICHR) addresses this issue, putting special emphasis on hallucinatory experiences. We review evidence collected at different scales of understanding, from pharmacology to brain-imaging, phenomenology and anthropology, highlighting similarities and differences between hallucinations under psychedelics and in the schizophrenia-spectrum disorders. Finally, we attempt to integrate these findings using computational approaches and conclude with recommendations for future research.

scholarly journals A novel approach to cardiovascular disturbances in patients with schizophrenia spectrum disorders treated with long-acting injectable medication

2019 ◽  
Vol Volume 15 ◽  
pp. 349-355 ◽  
Author(s):  
Minodora Andor ◽  
Liana Dehelean ◽  
Ana-Maria Romosan ◽  
Valentina Buda ◽  
Gabriela Radu ◽  
...  
Keyword(s):  
Schizophrenia Spectrum Disorders ◽  
Novel Approach ◽  
Schizophrenia Spectrum ◽  
Spectrum Disorders ◽  
Long Acting

scholarly journals S176. A PRELIMINARY INVESTIGATION OF COMT GENE INVOLVEMENT IN COGNITIVE FLEXIBILITY AND ATTENTION IN SCHIZOPHRENIA SPECTRUM DISORDERS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S104-S105
Author(s):  
Kim Morris ◽  
Brian Dean ◽  
Will Woods ◽  
Matthew Hughes ◽  
Sean Carruthers ◽  
...  
Keyword(s):  
Cognitive Performance ◽  
Cognitive Flexibility ◽  
Cognitive Abilities ◽  
Comt Gene ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum ◽  
Comt Activity ◽  
Spectrum Disorders ◽  
Functional Snp

Abstract Background Schizophrenia spectrum disorders (SSD) are often characterised by a plateau or decline in cognitive abilities early in the prodrome. The cause of developmental alteration remains unknown, and investigation of genetic involvement in cognitive function in these disorders may assist the understanding of the underlying neurobiological mechanisms involved. Variation at two single nucleotide polymorphisms (SNPs) of the catechol-O-methyltransferase (COMT) gene have previously shown an influence on COMT protein levels and cognition; rs4680 and rs4818. Here we investigate the influence of the nonsynonymous “Val/Met” SNP rs4680 and a second functional SNP, rs4818, on tasks of cognitive flexibility and attention. Methods The sample comprised 48 healthy controls (HC; age = 31.95 ± 12.80; 25 males, 23 females), and 43 with a diagnosis of SSD (age = 41.64 ± 10.36; 26 males, 17 females). Measures of cognitive flexibility and attention included the Wisconsin Card Sorting Test (WCST), Continuous Performance Test-Identical Pairs version (CPT-IP), Trail Making Test (TMT), and the D-KEFS Colour Word Interference Test (CWIT). Due to small cohort sizes, in our preliminary analyses we chose to compare people who should be most severely affected because of inheriting COMT haplotypes associated with poor cognitive functioning (GG rs4818 / GG rs4680: G-G haplotype) to those with haplotypes associated with better cognitive functioning (CC rs4818 / AA rs4680: C-A haplotype). Multivariate analysis of variance factors included COMT haplotype, diagnosis (HC and SSD), and gender, with Bonferroni correction for multiple comparisons; age was included as a covariate. Analyses were also conducted based on a non-functional SNP of the COMT gene; rs165599, as a negative control. Results SSD exhibited reduced cognitive performance compared to HC; F(4, 75) = 8.810, p < .001. Investigation of C-A haplotype revealed an interaction with diagnosis on cognitive performance; F(8, 154) = 2.075, p = .041; SSD had reduced performance compared to HC for the WCST, CPT-IP, and TMT in C-A haplotypes (all p < .05). COMT haplotype also interacted with gender on cognitive performance (C-A haplotype; F(8, 154) = 2.315, p = .023, G-G haplotype; F(8, 154) = 2.706, p = .008). Males who were C-A non-carriers and /or G-G haplotype (high COMT activity groups) performed better on CPT-IP (both p < .05) and worse on CWIT (both p < .05) compared to females. Control SNP rs165599 revealed no main effects or significant interactions (all p > .05). Discussion The role of the COMT gene in the cognitive abilities of SSD remains contentious as gene expression does not differ from a healthy population. This preliminary analysis revealed an interaction between diagnosis and COMT haplotype, however, this only reached statistical significance for the C-A haplotype, where SSD with C-A haplotype and C-A non-carriers had reduced performance compared to HC on most tasks except TMT. The different effects found across the tasks, which probed various elements of cognitive flexibility and attention, supports a nuanced role of COMT in cognitive function. Further, high COMT activity was beneficial for males on CPT-IP but not CWIT compared to females. Gender interaction remains a significant consideration in studies of the COMT gene, likely involving the catechol-estrogens which are substrates of COMT. As expected there was no significant results with control SNP rs165599, indicating that findings were due to the influence of SNPs rs4680 and rs4818 on COMT activity.

Cognitive and Prepulse Inhibition Deficits in Psychometrically High Schizotypal Subjects in the General Population: Relevance to Schizophrenia Research

2012 ◽  
Vol 18 (4) ◽  
pp. 643-656 ◽  
Author(s):  
Stella G. Giakoumaki
Keyword(s):  
Cognitive Function ◽  
General Population ◽  
Prepulse Inhibition ◽  
Future Research ◽  
Attention And Memory ◽  
Schizophrenia Spectrum Disorders ◽  
Schizotypal Personality ◽  
Psychosis Proneness ◽  
Schizophrenia Spectrum ◽  
The Relationship

AbstractSchizophrenia and schizotypal personality disorder share common clinical profiles, neurobiological and genetic substrates along with Prepulse Inhibition and cognitive deficits; among those, executive, attention, and memory dysfunctions are more consistent. Schizotypy is considered to be a non-specific “psychosis-proneness,” and understanding the relationship between schizotypal traits and cognitive function in the general population is a promising approach for endophenotypic research in schizophrenia spectrum disorders. In this review, findings for executive function, attention, memory, and Prepulse Inhibition impairments in psychometrically defined schizotypal subjects have been summarized and compared to schizophrenia patients and their unaffected first-degree relatives. Cognitive flexibility, sustained attention, working memory, and Prepulse Inhibition impairments were consistently reported in high schizotypal subjects in accordance to schizophrenia patients. Genetic studies assessing the effects of various candidate gene polymorphisms in schizotypal traits and cognitive function are promising, further supporting a polygenic mode of inheritance. The implications of the findings, methodological issues, and suggestions for future research are discussed. (JINS, 2012, 18, 1–14)

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