scholarly journals Longitudinal Changes in Brain Gyrification in Schizophrenia Spectrum Disorders

2021 ◽  
Vol 13 ◽  
Author(s):  
Tien Viet Pham ◽  
Daiki Sasabayashi ◽  
Tsutomu Takahashi ◽  
Yoichiro Takayanagi ◽  
Manabu Kubota ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
First Episode ◽  
Schizophrenia Spectrum Disorders ◽  
Longitudinal Changes ◽  
Schizophrenia Group ◽  
Schizophrenia Spectrum ◽  
The Right ◽  
Schizotypal Disorder ◽  
Over Time

Previous magnetic resonance imaging (MRI) studies reported increased brain gyrification in schizophrenia and schizotypal disorder, a prototypic disorder within the schizophrenia spectrum. This may reflect deviations in early neurodevelopment; however, it currently remains unclear whether the gyrification pattern longitudinally changes over the course of the schizophrenia spectrum. The present MRI study using FreeSurfer compared longitudinal changes (mean inter-scan interval of 2.7 years) in the local gyrification index (LGI) in the entire cortex among 23 patients with first-episode schizophrenia, 14 with schizotypal disorder, and 39 healthy controls. Significant differences were observed in longitudinal LGI changes between these groups; the schizophrenia group exhibited a progressive decline in LGI, predominantly in the fronto-temporal regions, whereas LGI increased over time in several brain regions in the schizotypal and control groups. In the schizophrenia group, a greater reduction in LGI over time in the right precentral and post central regions correlated with smaller improvements in negative symptoms during the follow-up period. The cumulative medication dosage during follow-up negatively correlated with a longitudinal LGI increase in the right superior parietal area in the schizotypal group, but did not affect longitudinal LGI changes in the schizophrenia group. Collectively, these results suggest that gyrification patterns in the schizophrenia spectrum reflect both early neurodevelopmental abnormalities as a vulnerability factor and active brain pathology in the early stages of schizophrenia.

The association between pre-morbid adjustment, duration of untreated psychosis and outcome in first-episode psychosis

2008 ◽  
Vol 38 (8) ◽  
pp. 1157-1166 ◽  
Author(s):  
P. Jeppesen ◽  
L. Petersen ◽  
A. Thorup ◽  
M.-B. Abel ◽  
J. Øhlenschlæger ◽  
...  
Keyword(s):  
Social Network ◽  
Negative Symptoms ◽  
Social Adaptation ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Duration Of Untreated Psychosis ◽  
Schizophrenia Spectrum Disorders ◽  
School Adaptation ◽  
Schizophrenia Spectrum

BackgroundThe association between the duration of untreated psychosis (DUP) and outcome of schizophrenia may be confounded by other factors such as poor pre-morbid adjustment. The aim of the present study was to examine the independent contributions of DUP and of pre-morbid adjustment to the clinical and social outcomes of schizophrenia.MethodA longitudinal, prospective, 2-year follow-up study of 423 patients with first-episode schizophrenia-spectrum psychosis was conducted. Patients were comprehensively assessed at entry, 1-year and 2-year follow-up. At entry, DUP was measured by IRAOS (an instrument for the assessment of onset and early course of schizophrenia) and pre-morbid adjustment was measured by the Pre-morbid Adjustment Scale (PAS) as ‘pre-morbid social adaptation’ and ‘pre-morbid school adaptation’. Outcome measures included the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), the Social Network Schedule and social information. Multiple linear regression models were used for data analysis.ResultsThe median DUP was 48 weeks, which is long compared to other studies. Longer DUP was independently associated with more psychotic symptoms at entry, 1-year and 2-year follow-up. Poorer pre-morbid social adaptation was independently associated with more negative symptoms and smaller social network at entry and 1-year follow-up. Poorer pre-morbid school adaptation was independently associated with poor vocational outcome at 1-year and 2-year follow-up.ConclusionsLonger DUP is associated with poorer 2-year outcome of psychosis in schizophrenia-spectrum disorders, when pre-morbid functioning and other prognostic factors are controlled for. Impaired pre-morbid development is independently associated with more negative symptoms and poorer social outcome.

scholarly journals S121. OPUS 20, 20 YEAR FOLLOW-UP ON THE OPUS TRIAL

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S81-S82
Author(s):  
Marie Starzer ◽  
Carsten Hjorthøj ◽  
Nikolai Albert ◽  
Merete Nordentoft ◽  
Helene Lund Sørensen
Keyword(s):  
Negative Symptoms ◽  
Participation Rate ◽  
First Episode ◽  
Episode Psychosis ◽  
Health Project ◽  
Gaf Scores ◽  
Positive And Negative Symptoms ◽  
Over Time

Abstract Background Since the first OPUS trial 20 years ago, structured clinical assessments have been collected from a cohort of first episode psychosis patients at 2, 5 and 10 years follow-up. They found that the symptomatology of patients clustered in distinct groups, and they were able to determine stable long-term trajectories of positive and negative symptoms. The Suffolk County Medical health project has followed patients after a first episode psychosis for 20 years. They also found a stable course of trajectories but with an overall significant worsening of symptom severity over time. The 20 year OPUS follow-up will give us the first opportunity to assess the long term outcome in a large representative cohort treated within modern mental health services with treatment available for all. Methods From 1998 to 2000 578 participants were randomized to OPUS or TAU. Baseline characteristics of the cohort were as follows: mean age 26.6 years, 59% were males, 66% had a diagnosis of schizophrenia and 27% had a secondary diagnosis of alcohol or substance abuse At the 20 year follow-up the investigators will be blinded to the original treatment allocation. The patients who wish to participate will be assessed using SAPS, SANS, SCAN, PSP and GAF. Socio-demographic factors and suicidal ideation will be register via self report. Cognitive function will be tested using BACS and all participants will be asked to fill out a number of self-rating questioners including WHO quality of life-BREF, self-perceived health, strengths and difficulties, the parenting scale and self-perceived negative symptoms. Using national Danish registers we can collect information on all former participants regarding the use of psychiatric and general healthcare services, medication, supported housing or homelessness, employment status, substance abuse and mortality. Results The OPUS 20 study started collecting data in Jan 2018. We are attempting to contact as many patients as possible from the 578 participants in the original OPUS cohort. At the time of writing we had included data and attempted contact to 322 participants. Overall 104 people (31,7%) have agreed to participate in the interviews. In the follow-up 10 years ago, the participation-rate was 60% so this is a big drop in participation rate. 41 (14%) have died, 31 (9,5%) were lost due to emigration, homelessness or hidden identity and/or disempowerment. 70 (21,3%) didn’t wish to participate and 76 (23,2%) never responded. Discussion Psychotic disorders and schizophrenia in particular are associated with progressive worsening of symptoms and profound social impairment, and as such are still very stigmatized. Results from the 10 year OPUS follow-up found stable trajectories of positive and negative symptoms over time, with a tendency of reduction and stabilization of positive symptoms but less variation of negative symptoms. They found poor but stable social functioning with a mean GAF score of 55 after 10 years. The Suffolk County mental health project also found stable trajectories of psychopathology measured with SAPS and SANS. They however found progressive worsening of GAF scores declining form 49 points at the beginning to 36 after 20 years. So far we have seen stable GAF scores and SAPS and SANS scores compared to OPUS 10. This gives rise to some optimism about the prognosis for schizophrenia compared to the findings of the Suffolk study. In our study the extensive interviews combined with the data collected form Danish registers give us a unique opportunity to look at the long term course of illness after FEP. The ability to test if previous findings are robust over time will be essential to the development of targeted interventions, differentiated to the needs of different patient groups.

scholarly journals Predictors of Remission and Recovery in a First-Episode Schizophrenia Spectrum Disorder Sample: 2-Year Follow-up of the OPUS Trial

2008 ◽  
Vol 53 (10) ◽  
pp. 660-670 ◽  
Author(s):  
Lone Petersen ◽  
Anne Thorup ◽  
Johan Øqhlenschlæger ◽  
Torben Øqstergaard Christensen ◽  
Pia Jeppesen ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Negative Symptoms ◽  
Spectrum Disorder ◽  
First Episode ◽  
Schizophrenia Spectrum Disorder ◽  
Adherence To Medication ◽  
Premorbid Adjustment ◽  
Schizophrenia Spectrum ◽  
First Episode Schizophrenia

Objective: To examine the frequency and predictors of good outcome for patients with first-episode schizophrenia spectrum disorder (SSD). Method: We conducted a 2-year follow-up of a cohort of patients ( n = 547) with first-episode SSD. We evaluated the patients on demographic variables, diagnosis, duration of untreated psychosis (DUP), premorbid functioning, psychotic and negative symptoms, substance abuse, adherence to medication, and service use. ORs were calculated with logistic regression analyses. Results: A total of 369 patients (67%) participated in the follow-up interview. After 2 years, 36% remitted and 17% were considered fully recovered. Full recovery was associated with shorter DUP, better premorbid adjustment, fewer negative symptoms at baseline, no substance abuse at baseline, and adherence to medication and OPUS treatment. Conclusions: Several predictive factors were identified, and focus should be on potentially malleable predictors of outcome, for example, reducing DUP and paying special attention to patients who are unlikely to achieve good outcome, for example, patients with a substance abuse problem and poor premorbid adjustment.

Hallucinations without delusions in patients with first-episode psychosis: Clinical correlates and implications for pathophysiological models

2016 ◽  
Vol 33 (S1) ◽  
pp. S32-S32
Author(s):  
I. Melle
Keyword(s):  
Negative Symptoms ◽  
Clinical Symptoms ◽  
Age At Onset ◽  
Diagnostic Interview ◽  
Clinical Profile ◽  
First Episode ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum ◽  
Spectrum Disorders ◽  
Competing Interest

IntroductionThe symptomatic distribution in schizophrenia spectrum disorder is heterogeneous. Patients may experience hallucinations, delusions and combinations thereof, in addition to disorganized and negative symptoms. We have previously found that patients with monosymptomatic hallucinations exhibited a different clinical profile than patients with monosymptomatic delusions or combinations of the two; with an earlier age at onset and more suicidal symptoms.AimsTo replicate findings in a new group of patients with schizophrenia spectrum disorders.MethodsA total of 421 consecutive patients with schizophrenia spectrum disorders were included into the study. They were comprehensively assessed by specifically trained psychiatrists or clinical psychologists; using the SCID for DSM-IV for diagnostic purposes, the PANSS to assess current clinical symptoms and CDSS to assess current depression. Lifetime presence of different symptom types was ascertained during the diagnostic interview.ResultsA total of 346 (82%) had experienced both hallucinations and delusion, 63 (15%) had experienced delusions without hallucinations, 10 (2.5%) had experienced hallucinations without delusions and 2 patients (0.5%) had neither but experienced negative and severely disorganized symptoms. Contrary to hypothesis, we did not find any statistically significant differences in age at onset and in clinical symptoms (including suicidality) between these groups. We also did not find any differences in the type of hallucinatory experiences between hallucinating groups.ConclusionsIn a new sample of patients, we did not replicate previous findings of a different clinical profile in patients with monosymptomatic hallucinations. This type of psychotic disorder is relatively rare, which might pose a problem concerning statistical strength.Disclosure of interestThe author has not supplied his declaration of competing interest.

Deinstitutionalization revisited: a 5-year follow-up of a randomized clinical trial of hospital-based rehabilitation versus specialized assertive intervention (OPUS) versus standard treatment for patients with first-episode schizophrenia spectrum disorders

2010 ◽  
Vol 40 (10) ◽  
pp. 1619-1626 ◽  
Author(s):  
M. Nordentoft ◽  
J. Øhlenschlæger ◽  
A. Thorup ◽  
L. Petersen ◽  
Pia Jeppesen ◽  
...  
Keyword(s):  
Standard Treatment ◽  
Supported Housing ◽  
First Episode ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum ◽  
Episode Psychosis ◽  
Bed Days ◽  
Spectrum Disorders ◽  
First Episode Schizophrenia

BackgroundThe effects of hospital-based rehabilitation including weekly supportive psychodynamic therapy compared with specialized assertive intervention and standard treatment has not previously been investigated in first-episode psychosis. The aim of the study was to examine long-term effect on use of institutional care of different intensive interventions for patients with first-episode schizophrenia spectrum disorder on use of psychiatric bed days and days in supported housing.MethodA total of 94 severely ill patients with first-episode schizophrenia spectrum disorders were included in a special part of the Copenhagen OPUS trial and randomized to either the specialized assertive intervention program (OPUS), standard treatment or hospital-based rehabilitation.ResultsIt was a stable pattern that patients randomized to hospital-based rehabilitation spent more days in psychiatric wards and in supported housing throughout the 5-year follow-up period compared with the two other groups. Patients in OPUS treatment spent significantly fewer days in psychiatric wards and supported housing in the first 3 years compared with patients in hospital-based rehabilitation. Due to attrition and small sample size, differences in level of psychotic and negative symptoms at 5-year follow-up could not be evaluated.ConclusionsThe study indicates that hospital-based rehabilitation together with weekly supportive psychodynamic therapy was associated with a continued increased use of psychiatric bed days and days in supported housing. The data cannot justify using hospital-based rehabilitation in first-episode psychosis.

scholarly journals S115. EVALUATION OF THE CLINICAL UTILITY OF SYMPTOM DIMENSIONS ON LONG-TERM CLINICAL AND FUNCTIONAL OUTCOMES IN FIRST EPISODE PSYCHOSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S78-S78
Author(s):  
Ege Bor ◽  
Diego Quattrone ◽  
Victoria Rodriguez ◽  
Luis Alameda ◽  
Sinan Guloksuz ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Utility ◽  
Negative Symptoms ◽  
First Episode ◽  
Global Functioning ◽  
Symptom Dimensions ◽  
Episode Psychosis ◽  
Over Time

Abstract Background Current clinical utility of diagnostic categories in patients with psychosis is in debate. Alternatively, symptom-based dimensional approaches are suggested, but research on their utility and longitudinal stability is at its early phases, showing lack of consistencies. The aims of this prospective study are: 1) to test the stability of structure of symptom dimensions in first episode psychosis patients; 2) to explore the utility of symptom dimensions in predicting clinical and functional outcomes. Methods This study included a total of 208 with first episode of psychosis-spectrum disorders aged 18–65 years who presented to psychiatric services in South London, recruited as part of the Genetics and Psychosis Outcome (GAP) case-control study and EU-GEI multicentre case-control study. A subsample of 114 patients were traced after a mean of 6.5 years. Psychopathology was assessed at baseline and at follow-up using OPCRIT and tested with bifactor model, encompassing one general psychosis dimension and five specific symptom dimensions (positive, negative, disorganisation, mania, and depression). Follow up measures on functional outcome (assessed with GAF scale) and clinical outcomes (number and total length of hospitalisations) were derived from clinical records. Predictor role of baseline symptom dimensions was tested by multiple linear regression to predict global functioning; and by negative binomial regression for length of hospitalisation and number of hospital admissions. Results Factor loadings of disorganisation dimension were most likely to change longitudinally while loadings of positive dimension were most stable. Regarding dimension stability over time, all positive, disorganised and depressive symptoms significantly improved over time while manic and negative symptoms did not significantly differ. In terms of prediction of outcome, baseline manic symptoms were associated with reduced risk of hospitalisation (adj OR 1.56; 95% CI 1.01–2.38), reduced length of hospitalisation (adj IRR= 0.73; 95% CI 0.56–0.95) and better global functioning (β=5.21; 95% CI 2.46–7.95) at follow up. Similarly, depressive symptoms were associated with reduced length of hospitalisation (adj IRR= 0.77; CI 0.61–0.97). On the other hand, baseline positive symptoms were associated with increased risk of hospitalisation (adj OR 1.93; 95% CI 1.25–2.96). No other significant associations were found between the rest of symptom dimensions and outcomes. Discussion This study provides new evidence on the longitudinal stability of bifactor model of psychosis and, shows that all except manic and negative symptoms significantly improved over time. Whereas affective symptoms (including mania and depression) were associated with good prognosis, positive symptoms seem to predict poor clinical outcomes. The particular and different influence of affective and psychotic symptoms on long-term functional and clinical outcomes may have therapeutic implications and support the potential clinical utility of incorporating symptom-based approach in further outcome research.

scholarly journals The Impact of Magnetic Resonance Imaging-Detected White Matter Hyperintensities on Longitudinal Changes in Regional Cerebral Blood Flow

2007 ◽  
Vol 28 (1) ◽  
pp. 190-197 ◽  
Author(s):  
Michael A Kraut ◽  
Lori L Beason-Held ◽  
Wendy D Elkins ◽  
Susan M Resnick
Keyword(s):  
White Matter ◽  
White Matter Hyperintensities ◽  
White Matter Disease ◽  
Resonance Imaging ◽  
Regional Cerebral Blood ◽  
Longitudinal Changes ◽  
Mri Scans ◽  
The Right ◽  
Over Time

White matter hyperintensities are frequently detected on cranial magnetic resonance imaging (MRI) scans of older adults. Given the presumed ischemic contribution to the etiology of these lesions and the posited import of resting brain activity on cognitive function, we hypothesized that longitudinal changes in MRI-detected white matter disease, and its severity at a given time point, would be associated with changes in regional cerebral blood flow (rCBF) over time. We evaluated MRI scans and resting H215O positron emission tomographic rCBF at baseline and after an average of 7.7-year follow-up in Baltimore Longitudinal Study of Aging participants without dementia. Differences in patterns of rCBF were evident at baseline and at follow-up between the group of subjects showing increased white matter disease over the 8-year interval compared with the group with stable white matter ratings. Furthermore, longitudinal changes over time in rCBF also differed between the two groups. Specifically, the group with progressive white matter abnormalities showed greater increase in the right inferior temporal gyrus/fusiform gyrus, right anterior cingulate, and the rostral aspect of the left superior temporal gyrus. Regions of greater longitudinal decrease in this group were evident in the right inferior parietal lobule and at the right occipital pole. Changes in white matter disease over time and its severity at any given time are associated significantly with both cross-sectional and longitudinal patterns of rCBF. The longitudinal increases may reflect cortical compensation mechanisms for reduced efficacy of interregional neural communications that result from white matter deterioration.

Dissecting the functional outcomes of first episode schizophrenia spectrum disorders: a 10-year follow-up study in the PAFIP cohort

2019 ◽  
pp. 1-14 ◽  
Author(s):  
Rosa Ayesa-Arriola ◽  
Víctor Ortíz-García de la Foz ◽  
Obdulia Martínez-García ◽  
Esther Setién-Suero ◽  
María Luz Ramírez ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Sociodemographic Factors ◽  
First Episode ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum ◽  
Intervention Service ◽  
Treatment Plans ◽  
Cluster Analytic ◽  
First Episode Schizophrenia

Abstract Background The aim of the current study was to examine the heterogeneity of functional outcomes in first episode psychosis (FEP) patients and related clinical, neurocognitive and sociodemographic factors using a cluster analytic approach. Method A large sample of FEP patients (N = 209) was functionally reassessed 10 years after the first contact with an early intervention service. Multiple baseline, 3-year and 10-year follow-up variables were explored. Results The cluster analysis emphasized the existence of six independent clusters of functioning: one cluster was normal overall (42.16%), two clusters showed moderate interpersonal (9.63%) or instrumental (12.65%) deficits, two clusters showed more severe interpersonal (12.05%) or interpersonal and instrumental (13.85%) deficits and there was a significantly overall impaired cluster (9.63%). Cluster comparisons showed that several baseline and follow-up factors were differentially involved in functional outcomes. Conclusions The current study demonstrated that distinct clusters of functioning in FEP patients can be identified. The fact that a variety of profiles was observed contributes to a better understanding of the nature of the heterogeneity characterizing FEP patients and has clinical implications for developing individualized treatment plans.

scholarly journals T155. PROGRESSION OF NEUROANATOMICAL ABNORMALITIES AFTER FIRST-EPISODE OF PSYCHOSIS: A 3-YEAR LONGITUDINAL STRUCTURAL MRI STUDY

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S289-S290
Author(s):  
Theophilus Akudjedu ◽  
Giulia Tronchin ◽  
Shane McInerney ◽  
Cathy Scanlon ◽  
Joanne Kenney ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Structural Mri ◽  
Ventricular Volume ◽  
Imaging Biomarkers ◽  
First Episode ◽  
Subcortical Structures ◽  
The Right ◽  
Over Time

Abstract Background The extent and location of longitudinal morphometric changes after first-episode of psychosis (FEP) remains unclear. We investigated the progressive profile of ventricular and cortico-subcortical regions over a 3-year period in FEP patients compared with healthy controls (HC), and whether any progressive neuroanatomical changes were related to clinical factors. Methods High resolution 1.5T T1-weighted MR images were obtained from 28 FEP patients and 28 HCs shortly after presentation to services and again after 3-year follow-up. The longitudinal FreeSurfer pipeline (v.5.3.0) was used for regional volumetric and cortical reconstruction image analyses. Repeated-measures ANCOVA and vertex-wise linear regression analyses were used to compare progressive changes in relation to subcortical structures/ventricles and thickness across the cortical mantle, respectively, between groups. Partial correlations were used to determine associations of progressive neuroanatomical change with clinical and functional characteristics. Results Compared with controls, patients displayed progressively reduced volume of the caudate [F(1,51)=5.86, p=0.02, Hedges’ g=0.66], putamen [F(1,51)=6.06, p=0.02, g=0.67] and thalamus [F(1,51)=6.99, p=0.01, g=0.72], with a trend for increased lateral ventricular volume [F(1,51)=3.37, p=0.07, g=0.50] more prominent on the right [F(1, 51)=4.03, p=0.05], and significantly increased rate of cortical thinning [F(1,52)=5.11, p=0.028)] at a mean difference of 0.844% [95% CI (0.095, 1.593)] in the left lateral orbitofrontal region (LLOFR) over the 3-year period. In FEP individuals, greater reduction in putamen volume over time was associated with low cumulative antipsychotic medication dose (r=0.49, p=0.01), and increasing lateral ventricular volume over time was associated with worsening negative symptoms (r=0.41, p=0.04) and poorer global assessment of functioning (r=-0.41, p=0.04). Discussion Our results demonstrate existence of localised progressive structural disturbance in the subnetwork of the cortico-striato-thalamo-cortical circuitry after the onset of psychosis. Furthermore, increasing ventricular volume is a neuroanatomical marker of poorer clinical and functional outcome. These findings lend weight to the evidence of early progressive brain changes in psychotic disorders and thus, this knowledge could potentially contribute to the identification of imaging biomarkers for timely intervention.

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