bluuebunny/crossref_metadata_2025 huggingface dataset:
MR defecography in obstructed Defecation syndrome
Authors: Elfiky S M , Sheha A S , Idris M Y
Published: May 2020

Background

ODS is an emerging clinical problem, especially for adult female patients (80%–90%). The pathophysiology of ODS remains to be clearly defined. This is because anatomic defects, such as internal rectal prolapse and rectocele, may be associated with functional alterations, such as paradoxical puborectalis contraction and spastic external sphincter contraction.

Aim of the Work

Obstructed defecation syndrome (ODS) is a type of constipation characterized by fragmented stools, need for straining at defecation, sense of incomplete evacuation, tenesmus, urgency and pelvic heaviness. This study is aimed to assess and compare and matching the role of Dynamic magnetic resonance imaging (MRI defecography) with the cilincal diagnosis in such patients.

Pateints and Methods

This retrospective, case-control study was conducted on twenty patients suffering from obstructive defecation syndrome that have been diagnosed clinically. The patients age is ranged between 16 and 69 years old.

Results

Statistically MRI study showed significant anatomical defects (p < 0.05) as the followings: Most of patients had Rectocele (65%), Disenergic Pelvic Syndrome (DPS) because of pelvic floor descents in (55%) of patients. Intossusception(45%),Cystocele (30%), interocele(25%), Anismus(15%) and uterine prolapsed (15%)

Conclusion

MRI has good value to detect abnormalities pertinent to posterior compartment in pelvis. Results of MR imaging showed positive agreement with clinical diagnosis of ODS in65% of patients. MRI showed 90% sensitivity, specificity, positive and negative predictive values as well as accuracy. MRI assessment of the posterior pelvic compartment can be indicated to detect the anatomical defects and lead to more successfully patient management and subsequently decreases the rate of postoperative recurrence.
Role of Magnetic Resonance Imaging in Evaluation of post traumatic Vertebral Column
Authors: Gamaleldin M M , Osman A M , Fadol N A
Published: May 2020

Background

Trauma of the vertebral column is potentially devastating as they may lead to significant neurological damage as the clinical and prognostic spectrum of the effects of spinal injuries is vast. Timely imaging studies can help mitigate these possibly life threatening complications. There is a dearth of studies that purely evaluate the role of MR imaging after spinal trauma.

Aim of the work

Hence, this study was undertaken to assess the ability of MRI in identifying traumatic injuries to the tissue structures of the spine.

Methods

The study performed over 20 cases after spinal vertebral traumatic injuries then underwent MR imaging in the period 2016 till March 2018. The osseous and non-osseous structures namely; Para vertebral tissues, Vertebrae, Anterior Longitudinal Ligament (ALL), Posterior Longitudinal Ligament (PLL), Intervertebral Disc, Ligamentum Flavum, Interspinous Ligament and the Spinal Cord were evaluated. The data were classified to; patient's age, sex, mode of trauma, region of imaging, main findings, associated findings and others. The statistically significant and non-significant relations between primary data and different post-traumatic findings of MRI were thus calculated.

Results

Of the 20 patients, 85% of patients were male, common ages affected were 20-30 and >40 years with 30% for each. The site of injury was the cervical spine (30%) and thoracolumbar spine was the next highest in occurrence with 25%. L1 was the commonest level exposed to fracture (30%). Cord compression was the commonest MRI main finding in post trauma (60 %), but syrinx was (5%). In associated findings; the spinal muscles spasm was the commonest (40%) and ligamentum flavum injury comprised (15%). Bone marrow edema was the highest (35%) as other findings. There were statically significant relations between age and T12 vertebral fracture and between mode of trauma and facet joint affection.

Conclusion

MRI was found to be the best modality in detecting injuries to the spinal cord and the ligaments and as well as for detection of vertebral fractures and also bone marrow edema. Though more studies required for further highlight the advancing ability of the MRI.
Bond Risk Premiums with Machine Learning
Authors: Bianchi Daniele , Büchner Matthias , Tamoni Andrea
Published: May 2020

We show that machine learning methods, in particular, extreme trees and neural networks (NNs), provide strong statistical evidence in favor of bond return predictability. NN forecasts based on macroeconomic and yield information translate into economic gains that are larger than those obtained using yields alone. Interestingly, the nature of unspanned factors changes along the yield curve: stock- and labor-market-related variables are more relevant for short-term maturities, whereas output and income variables matter more for longer maturities. Finally, NN forecasts correlate with proxies for time-varying risk aversion and uncertainty, lending support to models featuring both channels.
T73. COGNITIVE CLUSTERING IN SCHIZOPHRENIA SPECTRUM DISORDER AND THE ASSOCIATION WITH BRAIN VOLUME
Authors: Oomen Priscilla , Begemann Marieke , de Muinck Keizer Hannah , Sommer Iris
Published: May 2020

Background

Cognitive impairment is a core feature of schizophrenia spectrum disorder (SSD), and appears in both mild and severe forms. As cognition is crucial for functioning in daily life, it is important to understand these impairments. Large heterogeneity exists within these cognitive impairments, and different cognitive profiles may be associated with dissimilar structural brain volumes. Such cognitive brain profiles may be relevant biomarkers for more homogeneous subclasses to be used for both prognosis and choice of optimal care.

Methods

The population consisted of 85 individuals with schizophrenia spectrum disorder (mean age 27 years, 64 males) and 40 healthy controls (mean age 24 years, 31 males). To identify cognitive clusters, hierarchical clustering analyses were conducted using performance on the Brief Assessment of Cognition in Schizophrenia (BACS) battery. The emerging cognitive clusters were compared in performance on the BACS, diagnosis and whole brain volume.

Results

Hierarchical clustering analyses revealed three cognitive profiles: cluster 1 “relatively intact” cluster 2 “mild-moderate impairment” and cluster 3 “severe impairment”. Cluster 1 comprised of 68% healthy controls vs 32% SSD patients, whereas clusters 3 comprised of 89% SSD patients vs 11% healthy controls. Cluster 2 was a rather mixed cluster with 25% healthy controls and 75% SSD patients. Whole brain volume shows a continuum towards smaller brain volume in the more impaired clusters with a significant difference shown in whole brain volume between cluster 1 and 3.

Discussion

These findings support the concept that cognitive heterogeneity among individuals with schizophrenia spectrum disorder can be reduced by using cognitive clustering methods. Furthermore, cognitive clusters are associated with brain volume sizes, indicating different underlying brain structure. Future research should focus on the predictive power of such clusters.
T98. CHARACTERIZING THE CLINICAL COURSE IN SCHIZOPHRENIA WITH DIGITAL PHENOTYPING
Authors: Torous John , Wisniewski Hannnah , Camacho Erica , Henson Philip , Rodriguez-Villa Elena , Hays Ryan , Lagan Sarah , Vaidyam Aditya , Keshavan Matcheri
Published: May 2020

Background

Digital phenotyping methods offer the potential to better understand the lived experiences of patients with serious mental illnesses like schizophrenia. Yet to date it is unclear if the digital biomarkers offered from this method are unique to certain conditions like schizophrenia, or rather are shared by diverse populations, and to what degree digital phenotyping data are correlated with patient and clinician assessments.

Methods

50 patients with schizophrenia and 50 matched healthy controls collected smartphone digital phenotyping data for a three month duration including measures of geolocation, physical activity, screen use, cognition, and self reported surveys. In-clinic assessments at study start and at three months assessed cognition (Brief Assessment of Cognition in Schizophrenia), psychosis symptoms (Positive and Negative Symptom Scale; PANSS) and other measures. Clustering and correlational methods were utilized to compare active and passive data streams both within and across groups.

Results

Adherence to active data (surveys and cognitive assessments) on the phone was roughly 50%, both for those with schizophrenia as well as for the healthy controls. Four unique clusters that included both active and passive data emerged for each group and the clusters were distinct with unique symptoms, cognition, and passive data metrics. Each group also possessed distinct correlations between active and passive data, with the schizophrenia group having more statistically significant findings especially around sleep.

Discussion

Digital phenotyping methods offer the potential to identify unique clusters of patients based on both their self reported as well as passive data. Future research will explore the utility of these clusters in predicting functional outcomes and offering personalized treatment.
T110. CLINICAL CHARACTERISTICS OF FORMAL THOUGHT DISORDER IN SCHIZOPHRENIA
Authors: Lee Euijin , Park Jong-Ik , Jung Han-Yong
Published: May 2020

Background

Our study aimed to present the distinctive correlates of formal thought disorder in patients with schizophrenia, using the Clinical Language Disorder Rating Scale (CLANG)

Methods

We compared the formal thought disorder and other clinical characteristics between schizophrenia patients with (n = 82) and without (n = 80) formal thought disorder. Psychometric scales including the CLANG, Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Calgery Depression Scale for Schizophrenia (CDSS) and Word Fluency Test (WFT) were used

Results

After adjusting the effects of age, sex and total scores on the BPRS, YMRS and WFT, the subjects with disorganized speech presented significantly higher score on the poverty of contents of abnormal syntax (F = 7.08, P = 0.01), lack of semantic association (F = 8.02, P =0.01), disclosure failure (F = 60.97, P < 0.001), pragmatics disorder (F = 11.94, P = 0.01), dysarthria (F = 13.61, P < 0.001), and paraphasic error (F = 8.25, P = 0.01) items than those without formal thought disorder. With defining the mentioned item scores as covariates, binary logistic regression model predicted that disclosure failure (adjusted odds ratio [aOR] = 5.88, P < 0.001) and pragmatics disorder (aOR = 2.17, P = 0.04) were distinctive correlates of formal thought disorder in patients with schizophrenia.

Discussion

Disclosure failure and pragmatics disorder might be used as the distinctive indexes for formal thought disorder in patients with schizophrenia.
T134. THE ROLE OF THE DEFAULT MODE NETWORK IN SCHIZOPHRENIA AND AUDITORY VERBAL HALLUCINATIONS – AN INVESTIGATION OF DYNAMIC FMRI RESTING STATE CONNECTIVITY
Authors: Weber Sarah , Johnsen Erik , Kroken Rune , Løberg Else-Marie , Kandilarova Sevdalina , Stoyanov Drozdstoy , Kompus Kristiina , Hugdahl Kenneth
Published: May 2020

Background

There is a wealth of evidence showing aberrant functional connectivity (FC) in schizophrenia but with considerable variability in findings across studies. Dynamic FC is an extension of traditional static FC, in that such analyses allow for explorations of temporal changes in connectivity. Thereby they also provide more detailed information on connectivity abnormalities in psychiatric disorders such as schizophrenia.

Methods

The current study investigated dynamic FC in a sample of 80 schizophrenia patients and 80 matched healthy control subjects. Furthermore, relationships with auditory verbal hallucinations (AVH), a core symptom of schizophrenia, were explored. Two measures of AVH were used, one measure of current AVH severity assessed on the day of scanning, and one trait-measure where AVH were assessed repeatedly over the course of one year.

Results

Compared to healthy controls, schizophrenia patients showed increased dwell times in states with high connectivity within the default mode network (DMN). Current AVH severity did not show a significant relationship with dynamic FC. However, the trait-measure of AVH proneness over one year showed a significant relationship with dynamic FC. Patients with high AVH proneness spent less time in connectivity states characterized by strong anti-correlation between the DMN and task-positive networks.

Discussion

The results provide further evidence for a DMN dysfunction in schizophrenia, which could be linked to thought disturbances in relation to an increased internal focus of cognitive processing. The effects of AVH proneness on dynamic FC support theoretical models of AVH which have proposed an instability of the DMN and impaired cognitive control in AVH patients. The results also point to AVH proneness as a potential marker for identifying distinct subgroups of schizophrenia patients.
T137. THE RELATIONSHIP BETWEEN CORTICOSTRIATAL CONNECTIVITY AND STRIATAL DOPAMINE FUNCTION IN SCHIZOPHRENIA: AN 18F-DOPA PET AND DIFFUSION TENSOR IMAGING STUDY
Authors: Shin Sangho , Kim Euitae
Published: May 2020

Background

Striatal dopamine dysfunction caused by cortical abnormalities is a leading hypothesis of schizophrenia pathophysiology, which underlies in majority of treatment-responsive patients. Although supported by findings that prefrontal cortical lesions lead to striatal dopamine dysregulation and that recently, prefrontal structural volume is negatively correlated with striatal dopamine synthesis, the relationship between corticostriatal connectivity and striatal dopamine synthesis has not been tested in patients with schizophrenia. We therefore investigated the relationship between corticostriatal connectivity and striatal dopamine synthesis capacity in treatment-responsive patients with schizophrenia, and compared them to treatment-resistant patients and healthy control subjects.

Methods

Twenty-four patients with schizophrenia and twelve matched healthy control subjects underwent 18F-DOPA PET scans to measure dopamine synthesis capacity (indexed as the influx rate constant Kicer), structural and diffusion 3T MRI. Connectivity(indexed as Fractional anisotropy, FA) were assessed in 3 major corticostriatal tracts (dorsolateral prefrontal cortex-associative striatum, ventromedial prefrontal cortex-limbic striatum, and pre/primary motor cortex-sensorimotor striatum). Furthermore, these measures were tested whether they were correlated with a measure of Wisconsin Card Sorting Test (WCST).

Results

Treatment responsive patients showed a negative correlation between connectivity of dorsolateral prefrontal cortex-associative striatum and striatal dopamine synthesis capacity of associative striatum, but this was not evident in treatment-resistant patients. Furthermore, WCST negatively correlated with Kicer in associative striatum and positively correlated with FA in dorsolateral prefrontal cortex-associative striatum in whole subjects and treatment responsive patients but not in treatment-resistant patients.

Discussion

These findings demonstrate that different mechanisms underlie the pathophysiology of treatment-responsive and treatment-resistant schizophrenia and especially, connectivity of dorsolateral prefrontal cortex-associative striatum is a core part for the different pathophysiology.
T145. EFFECTS OF CANNABIDIOL ON EMOTION PROCESSING IN PSYCHOSIS RISK: AN FMRI INVESTIGATION
Authors: Davies Cathy , Wilson Robin , Appiah-Kusi Elizabeth , Brammer Michael , Perez Jesus , Murray Robin , Allen Paul , Bossong Matthijs , McGuire Philip , Bhattacharyya Sagnik
Published: May 2020

Background

There is currently a lack of effective pharmacological treatment for people at Clinical High Risk of Psychosis (CHR), who present with emotional dysregulation and high levels of anxiety. These individuals also show altered neural responses to emotional stimuli in key brain regions implicated in psychosis onset, including the striatum and medial temporal lobe. Cannabidiol (CBD), a non-intoxicating constituent of the cannabis plant, is thought to have antipsychotic and anxiolytic properties. The effects of CBD on brain function in CHR individuals during emotion processing has not been tested before.

Methods

In a randomised, double-blind, placebo-controlled, parallel-group design, 33 CHR individuals received a single oral 600mg dose of CBD or matched placebo, while 19 healthy controls did not receive any drug. Participants were studied using an emotion processing functional magnetic resonance imaging (fMRI) paradigm. Using a region-of-interest approach, we examined the differences in brain activation related to the CHR state and the effects of CBD, indexed using the blood oxygen level-dependent haemodynamic response fMRI signal.

Results

Compared to controls (n=19), CHR participants receiving placebo (n=15) showed significantly greater activation in the medial temporal lobe and less activation in the striatum during emotion processing. Within these same regions, activation in the CBD group (n=15) was (significantly) intermediate between that of the placebo and control groups. That is, CBD attenuated medial temporal and enhanced striatal activation in CHR participants.

Discussion

These findings suggest that CBD modulates the function of brain regions strongly implicated in psychosis onset and altered emotion processing. Further research is required to examine whether these neurofunctional effects translate into clinical efficacy after a period of treatment.
T151. THE FINDINGS OF CAROTID AND CARDIAC ULTRASONOGRAPHY IN YOUNG SCHIZOPHRENIC PATIENTS
Authors: Tsai Shangying , Hsiao Cheng-Yi , Chen Pao-Huan
Published: May 2020

Background

Patients with schizophrenia (SCZ) are at high risk of cardiovascular disease before reaching geriatric age and tend to prematurely die from CVD. Data of the direct measurement of cardiac function in patients with SCZ before middle age remain limited. We attempt to compare the results of carotid and cardiac ultrasonography of young schizophrenic patients with those of mentally healthy adults.

Methods

We recruited 27 physically healthy adults with schizophrenia (DSM-IV) aged less than 45 years and 27 age-matched controls to undergo the carotid and cardiac ultrasound echo-color Doppler to obtain the carotid intima-media thickness (cIMT, to detect the presence and extent of atherosclerosis in an artery) and cardiac function. Blood pressure, body mass index, and clinical information were also obtained.

Results

Among the echocardiography parameters, SCZ patients had significantly higher heart rate (p< 0.005) and ejection fraction (EF, parameter of pumping ability of the heart) (p<0.001), and lower right ventricular diastolic pressure (RVSP, equaling the pulmonary artery pressure) (p<0.05) and pulse pressure (the systolic minus the diastolic pressure, predicting the risk of CVD) (p<0.01) than those of control subjects. The mean CPZ equivalent of second generation antipsychotics (SGA) taken by SCZ patients was significantly positively correlated to the RVSP (γ= 0.046, p=0.029). There were no differences in body mass index, cIMT, and other echocardiography parameters between these two groups.

Discussion

Higher heart rate and EF may reflect the autonomic over-activity in SCZ patients. Contrary to our hypothesis, the risk of pre-clinical cardiac dysfunction and vascular atherosclerosis is not elevated in SCZ patients before midlife. However, higher dosage of SGA may increase the risk of pulmonary hypertension.
T155. PROGRESSION OF NEUROANATOMICAL ABNORMALITIES AFTER FIRST-EPISODE OF PSYCHOSIS: A 3-YEAR LONGITUDINAL STRUCTURAL MRI STUDY
Authors: Akudjedu Theophilus , Tronchin Giulia , McInerney Shane , Scanlon Cathy , Kenney Joanne , McFarland John , Barker Gareth , McCarthy Peter , Cannon Dara , McDonald Colm , Hallahan Brian
Published: May 2020

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.
T174. ANTIPSYCHOTICS AND THE MICROBIOME
Authors: Chen Anderson , Park Taeyang , Li Kevin , Delisi Lynn
Published: May 2020

Background

Gut microbial diversity is influenced by many factors including aging and environmental factors and it has an important implication on various physiologic functions and disease processes. Studying microbial communities and its diversity may be used as a predictor or biomarker for disease development.

Methods

In-depth literature review was conducted of literature within the last 5 years via database search of Pubmed, PsycInfo, EMBASE, and Google Scholar with Boolean combinations of the following keywords: antipsychotics AND (microbiome OR “metabolic syndrome”), microbiome AND (gender OR aging).

Results

2,360 articles were initially retrieved. 27 articles remained after excluding for non-English articles and relevance. Notable findings include that patients treated with both risperidone and olanzapine have less diverse microbiomes with a higher ratio of Firmicutes to Bacteroidetes. Additionally, patients treated with olanzapine have been shown to have increased actinobacteria and increased ratio of Firmicutes to Bacteroidetes. The ratio of Firmicutes to Bacteroidetes correlates directly to the extent of olanzapine induced weight gain. Patients concurrently treated with olanzapine and antibiotics not only stopped weight gain but also reversed it. This has been a target of potential medication intervention, specifically focused on antagonism of histamine-1 and -3 receptors which is speculated to inhibit the askewed Firmicutes to Bacteroidetes ratio. Similarly, the gender differences in relative microbiome levels of Bacteroidetes are suspected to correlate to the increased olanzapine induced weight gain seen in women versus men. Additionally, patients with schizophrenia who were treated with Bifidobacterium breve A1, a probiotic supplement, showed improvements in their affective, positive, and negative symptoms.

Discussion

There is a large paucity of research into the relationship between the microbiome and psychotropic medications. This dynamic should be further studied within multiple populations to better understand the gut biome’s effects on psychiatric disorders.
T178. MICROPIPETTE-GUIDED DRUG ADMINISTRATION (MDA) METHOD AS A NOVEL PHARMACOLOGICAL TREATMENT METHOD IN MICE: PRECLINICAL VALIDATION USING RISPERIDONE IN THE MATERNAL IMMUNE ACTIVATION MODEL OF NEURODEVELOPMENTAL DISORDERS
Authors: Scarborough Joseph , Müller Flavia , Dorner-Ciossek Cornelia , Arban Roberto , Rosenbrock Holger , Meyer Urs , Richetto Juliet
Published: May 2020

Background

Pharmacological treatments in laboratory rodents remain a cornerstone of preclinical psychopharmacological research and drug development. There are numerous ways how acute or chronic pharmacological treatments can be implemented, with each method having certain advantages and drawbacks. To overcome the main disadvantages of conventional administration routes, we implemented and validated a novel treatment method in mice, which we refer to as the Micropipette-guided drug administration (MDA) method.

Methods

The MDA administration method is based on using sweetened condensed milk solution as vehicle for pharmacological substances, which motivates the animals to consume vehicle and/or drug solutions voluntarily in the presence of the experimenter. First, we measured the corticosterone and pharmacokinetic changes after the administration of a vehicle or drug (Risperidone) solution via traditional oral gavage or by MDA. We then conducted a chronic treatment paradigm in the maternal immune activation model (MIA). Offspring treatment with risperidone started on post-natal day 70 and lasted for a total of 6 weeks, with behavioral testing occurring during the last two weeks of the treatment window.

Results

In a proof-of-concept study, we show that the pharmacokinetic profiles of the atypical antipsychotic drug, risperidone, are similar when administered via the MDA procedure or via the conventional oral gavage method. Unlike the latter, however, MDA did not induce the stress hormone, corticosterone. Furthermore, we assessed the suitability and validity of the MDA method in a mouse model of maternal immune activation, which is frequently used as a model of immune-mediated neurodevelopmental disorders. Using this model, we found that chronic treatment (> 4 weeks, once per day) with risperidone via MDA led to a dose-dependent mitigation of MIA-induced social interaction deficits and amphetamine hypersensitivity.

Discussion

Taken together, the MDA procedure described represents a novel pharmacological administration method for per os treatments in mice, which is easy to implement, cost effective, non-invasive, and less stressful for the animals than conventional oral gavage methods. Moreover, it allows for a more consistent and continual control of the dosages administered to the animals compared to methods involving the dissolution of a substance in the drinking water or contained within the food of the animals.
T210. REVIEW OF USE OF ADJUNCTIVE PSYCHOSTIMULANTS IN PATIENTS WITH SCHIZOPHRENIA: A RETROSPECTIVE STUDY
Authors: Zhand Naista , Osborne Roisin , Stuyt Marika , Hatko Anna , Labelle Alain
Published: May 2020

Background

Augmentation with psychostimulants has been postulated as one of the potential treatment options for negative and/or cognitive symptoms of schizophrenia. However, the major drawback for use of these agents is a potential risk of relapse or worsening of psychosis through direct or indirect dopamine agonism activity. Therefore a great deal of caution is required when using stimulants in individuals with psychosis. The present study aims to review the rate of adjunct psychostimulant prescription, and their efficacy and safety in a real life setting. Furthermore, we intend to compare the efficacy of psychostimulants when added to clozapine compared to other antipsychotics. Data was obtained from a schizophrenia outpatient clinic, in a tertiary care centre in Canada.

Methods

A chart review was conducted on outpatients enrolled in the schizophrenia program at the Royal Ottawa Mental Health Centre, between 31/5/2014 - 1/6/2019. For patients who were prescribed any psychostimulants at any time point up to 3-months prior to the study end date, clinical information related to efficacy and tolerability of stimulants, psychotic symptoms and concomitant antipsychotic treatment was collected.

Results

A total number of 1300 patients were included in the chart review study. Of those, 80 patients (6.15%) were prescribed stimulants during the study period. Of the participants who prescribed stimulants, 70% were male, 17.5% had a diagnosis of ADHD, and 38.75% were on clozapine. 21.25% had more than one trial of stimulant medications. Over half of participants continued on stimulants during the study period, with an overall good response in 36.25%, and minimal or equivocal response in 20% of participants on stimulants. Stimulants were discontinued in 13.75% of patients due to lack of efficacy, and 30% due to problematic symptoms.

The data is currently being analysed; Comprehensive results to follow.

Discussion

The preliminary results indicate that the use of stimulants was associated with improvement in cognitive and/or negative symptoms in a subset of patients and resulted in worsening of psychosis in some patients. The authors will discuss the efficacy and tolerability of use of adjunctive stimulants in outpatients with schizophrenia. Potential factors associated with the observed response and side effects will be discussed further.
T212. LEVELS OF GLUTAMATERGIC NEUROMETABOLITES IN PATIENTS WITH SEVERE TREATMENT-RESISTANT SCHIZOPHRENIA: A PROTON MAGNETIC RESONANCE SPECTROSCOPY STUDY
Authors: Tarumi Ryosuke , Tsugawa Sakiko , Noda Yoshihiro , Plitman Eric , Honda Shiori , Matshusita Karin , Chavez Sofia , Sawada Kyosuke , Wada Masataka , Matsui Mie , Fujii Shinya , Miyazaki Takahiro , Chakravarty Mallar , Uchida Hiroyuki , Remington Gary , Graff-Guerrero Ariel , Mimura Masaru , Nakajima Shinichiro
Published: May 2020

Background

Approximately 30% of patients with schizophrenia do not respond to antipsychotics and are thus considered to have treatment-resistant schizophrenia (TRS). To date, only four studies have examined glutamatergic neurometabolite levels using proton magnetic resonance spectroscopy (1H-MRS) in patients with TRS, collectively suggesting that glutamatergic dysfunction may be implicated in the pathophysiology of TRS. Notably, the TRS patient population in these studies had mild to moderate illness severity, which is not entirely reflective of what is observed in clinical practice.

Methods

In this present work, we compared glutamate+glutamine (Glx) levels in the dorsal anterior cingulate cortex (dACC) and caudate among patients with TRS, patients with non-TRS, and healthy controls (HCs), using 3T 1H-MRS (PRESS, TE=35ms). TRS criteria were defined by severe positive symptoms (i.e. ≥5 on 2 Positive and Negative Syndrome Scale (PANSS) positive symptom items or ≥4 on 3 PANSS positive symptom items) despite standard antipsychotic treatment.

Results

A total of 95 participants were included (29 TRS patients [PANSS=111.2±20.4], 33 non-TRS patients [PANSS=49.8±13.7], and 33 HCs). dACC Glx levels were higher in the TRS group versus HCs (group effect: F[2,75]=4.74, p=0.011; TRS vs. HCs: p=0.012). No group differences were identified in the caudate. There were no associations between Glx levels in these regions and clinical severity in either patient group.

Discussion

Our results confirm that higher dACC Glx might be related to the pathophysiology underlying TRS, by demonstrating this phenomenon in a TRS patient population reflective of clinical practice.
T215. THE ANTIPSYCHOTIC ACTION OF HALOPERIDOL IN PSYCHOTIC-LIKE RATS REQUIRES PRESYNAPTIC VESICULAR ACCUMULATION
Authors: Müller Christian , Weiss Eva-Maria , Hellmann Jan , Dahlmanns Jana , Kalinichenko Liubov , Alzheimer Christian , Löber Stefan , Hübner Harald , Kornhuber Johannes , Gmeiner Peter , Grömer Teja , Uzuneser Taygun
Published: May 2020

Background

The therapeutic effects of antipsychotic drugs (APDs) are mainly attributed to their post synaptic inhibitory functions on the dopamine D2 receptor, which however, cannot explain the delayed onset of full therapeutic efficacy. It was previously shown that APDs accumulate in presynaptic vesicles during chronic treatment and are released like neurotransmitters in an activity-dependent manner triggering an auto-inhibitory feedback mechanism. Although closely mirroring therapeutic action onset, the functional consequence of the APD accumulation remained unclear. Here we show that the accumulation of the APD haloperidol (HAL) is required for full therapeutic action in psychotic-like rats.

Methods

We designed a haloperidol (HAL) analogue compound (HAL-F), which lacks the accumulation property of HAL, but retains its antagonist action at dopamine D2 receptors.

Results

By perfusing lysotracker fluorophore-stained cultured hippocampal neurons, we confirmed the accumulation of HAL and the non-accumulation of HAL-F. In an AMPH-hypersensitization psychosis-like model in rats, we found that subchronic i.c.v. delivered HAL, but not HAL-F attenuates psychotic-like behavior in rats in an amphetamine-induced hyperlocomotion test and the a pre-puls inhibition of an acustic startle response.

Discussion

These findings suggest the presynaptic accumulation of HAL as an essential prerequisite for its full antipsychotic action and may better explain the time course of APD action. Targeting accumulation properties of APDs may, thus, become a new strategy to improve APD action.
M103. PSYCHOLOGICAL ONLINE INTERVENTION FOR PSYCHOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Pardo Cebrián Rebeca , González-Fraile Eduardo , Sánchez-Gutiérrez Teresa , Barbeito Sara , Fernández-Castilla Belén , Calvo Ana
Published: May 2020

Background

Although the use of technological advances in psychiatric treatment is relatively recent, the availability and sophistication of technologies are growing, research on psychological interventions for patients with psychosis has incorporated the use of various electronic applications, social networks, and other similar tools to provide new methods/routes of communication between therapists and patients. This new therapeutic approach may provide patients with personalized, flexible, and evidence-based interventions in their communities and even in their own homes. The aim of this study is reviewing the scientific literature about the use of online intervention for patients with psychosis to show the current state of online intervention and asses the effectiveness of these treatments.

Methods

The review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We have identified articles from Pubmed and Medline databases. We included all randomized controlled trials designed to test the efficacy of the online intervention or web-based intervention to patients with psychosis. We excluded observational trials, non-randomised trial and protocol study. Studies with RCT design and the participants must not have more than 5 to 10 years of evolution since the diagnosis, and the papers have been published between 2010 and 2019, in English language. The researchers independently assessed the articles and the discrepancies were resolved by consensus.

Results

We presented data about all randomized controlled trials of online interventions/ e-Health interventions/ App-mobile based and/or computer based intervention programs than were specifically designed for people with first episode psychosis or psychotic symptoms that had measured changes in functioning, quality of life or positive/negative symptoms. As unique treatment or as a complementary treatment with other psychological or psychopharmacology intervention.

Discussion

Online psychological interventions can play an important role in the well-being of people with schizophrenia. The strengths and limitations of our systematic review and meta-analysis will be discussed.
M133. DISCRIMINATION PHENOMENA AND THE LEVEL OF SCHIZOTYPY
Authors: Pignon Baptiste , Schürhoff Franck , Richard Jean-Romain , Ferchiou Aziz , Szöke Andreï
Published: May 2020

Background

Several have suggested a link between discrimination phenomena and psychotic disorders. Since this is a potentially modifiable factor, it seems important to clarify the links between discrimination and psychotic disorders. In the hypothesis of the psychotic continuum, schizotypal features in the general population are intermediate phenotypes in schizophrenia studies. In this study, the aim was to study the links between discrimination and level of schizotypy in the general population. We assumed that exposure to discrimination experiences is associated with increased levels of schizotypy.

Methods

Subjects from the general population (N = 1456), without psychotic disorders, were recruited in 17 cities and 6 countries (Brazil, Spain, France, Holland, Italy, UK). Each subject completed the Community Assessment of Psychic Experiences (CAPE), a autoquestionaire considered to assess the level of psychometric schizotypy (with positive, negative and depressive dimensions) and the 20-item Perceived Discrimination Scale developed by Williams et al. Linear regression analyzes were used with discrimination as an explanatory variable and CAPE scores as variables to be explained.

Results

We show that an increase in the perceived discrimination score was associated with significantly higher levels of schizotypy, in the positive (p = 1.7.10-10), negative (p = 3.4.10-10) and the depressed dimensions (p = 2.1.10-10). In more than half of the subjects who reported discrimination experiences, the reason for the discrimination invoked was not one of the reasons given. Ethnicity remains, however, a major cause of reported discrimination.

Discussion

The stress-vulnerability model could explain the link between discrimination and schizotypy, though dysregulation of the hypothalamo-pituitary axis and cortisol secretion in subjects with schizotypy, preventing them from responding adaptively to social stress. Psychological and social factors also seem to play a role in stress management.
M138. THE STRUCTURAL AND FUNCTIONAL BRAIN IMPACT OF CLOZAPINE IN SCHIZOPHRENIC PATIENTS: REVIEW OF THE LITERATURE
Authors: Metivier Lucie , Vandevelde Anais
Published: May 2020

Background

Schizophrenia is a common and severe mental disorder. The actual treatment is neuroleptic. Clozapine (CLZ), the atypical antipsychotic leader, is the best treatment of the resistant schizophrenia. Neuroimaging studies are important to understand better the neurological effects of CLZ. The main goal of this study is to analyze actual data of anatomic imaging studies (MRI, DTI, fMRI, PET and SPECT), evaluate CLZ anatomical and functional brain effect on patients suffering resistant schizophrenia (SZ) in order to characterize the mode of action of CLZ, identify the neural bases of the CLZ treatment response and establish the link between the mode of action and CLZ and the treatment response on patients suffering resistant SZ.

Methods

We have analyzed literature using PUBMED database with the following keywords: « clozapine », « neuroimaging », »MRI », « DTI », « VBM », « functional magnetic resonnance imaging », « PET », « fMRI », « SPECT ».

Results

51 studies were included. 10 on anatomical imagery and 41 on functional imagery. From an anatomic point of view, studies suggest best cerebral integrity on patients with CLZ treatment compared to other antipsychotics, on grey nuclei, prefrontal cortex and on white matter beams belonging to the fronto sub cortical network. LEROUX et col, OCZELIK et col. From the functional point of view, studies show a functional connectivity modulation and an action on the cerebral metabolism MOLINA et col, especially in the frontal cortex of patients that respond to CLZ treatment compared to patients who have received another antipsychotic treatment. The PET and SPECT studies show the CLZ action mechanism especially on the glutamatergic system FUKUYAMA et col. Concerning CLZ-treated patients’ response, many studies have shown a larger perfusion on the frontal cortex and thalamic region on patient responding to CLZ compared non-responders. MOLINA et col, ERTUGUL et col. About clinical evolution, the longitudinal studies show an amelioration of the psychotic symptoms (positive symptoms, negative symptoms, suicidal risk and cognitive alteration) on CLZ-treated patients compared than the ones who have been treated with another antispychotic. ARANGO et col, MOLINA et col. CLZ treatment allows a decrease of craving on patients who suffer cannabis usage disorders compared with patients who are treated with risperidone. MACHIELSEN et col.

Discussion

These results bring a new light on SZ psychopathological, on CLZ cerebral mechanism and open the debate of actual prescription recommendations. However, we won’t conclude with certainly due heterogeneity of the experimental design, as other studies are necessary to complete knowledge of this subject.
M152. IS MEDICAL SERVICES UTILISATION A MODERATING FACTOR OF EARLY EXCESS MORTALITY IN PATIENTS WITH SCHIZOPHRENIA
Authors: Krivoy Amir , Hoshen Moshe , Weiser Mark , Balicer Ran , Weizman Abraham
Published: May 2020

Background

Unlike the general population, patients with schizophrenia have an excess of chronic physical morbidities such as diabetes, cardiovascular and respiratory disorders. In addition, they do no gain from primary and secondary medical services due to gaps in the accessibility and quality of those services. The result is a shorter life expectancy of about 20 years mostly due to preventable physical illnesses, of otherwise people with an exclusive brain disorder.In this study, we aimed to explore how does utilization of medical services moderate the association between physical morbidity and early mortality in schizophrenia patients

Methods

A retrospective cohort study derived from Clalit Health Services electronic database (the largest health provider in Israel, covers 53% of the national population). A three years follow-up (2012–2014) of 24,679 individuals with a diagnosis of schizophrenia (ICD 10 Code: F.20) and control general population (N=2,295,579), up to 75 years old age.

Results

Schizophrenia was associated with HR 3.52 (95% CI 3.35–3.72) for mortality, adjusted for age, sex and socioeconomic status. Patients’ mortality rate was 5.6% with about half dying from physical illnesses (cardiovascular, neoplasms, respiratory, and digestive disorders). Metabolic syndrome parameters were more prevalent in the schizophrenia population, with the exception of hypertension. While the adjusted Odd Ratio (OR) for primary physician (GP) contact was 0.42 for schizophrenia patients, the OR for hospitalization was 1.25 with more than double mean length of hospitalization. A higher number of contacts with GP or specialists was associated with lower mortality in patients with metabolic disturbances

Discussion

Patients with schizophrenia tend to die earlier, mostly from preventable physical illnesses also in Israel. Utilizing primary and secondary medical services was associated with better survival rates when having metabolic dysregulation. The main health policy implication of the study results is a call to establish a national system to detect and manage physical morbidity by increasing the accessibility of primary and secondary medical services for this high-risk population
M158. ASSOCIATIONS OF NEUROLOGICAL SOFT SIGNS AND CEREBELLAR-CEREBRAL FUNCTIONAL CONNECTIVITY IN PATIENTS WITH FIRST-EPISODE SCHIZOPHRENIA AND THEIR UNAFFECTED SIBLINGS
Authors: Cai Xinlu , Wang Yongming , Zhou Hanyu , Huang Jia , Lui Simon S Y , Møller Arne , Mak Henry K F , Cheung Eric F C , Chan Raymond C K
Published: May 2020

Background

Neurological softs signs (NSS) are defined as subtle neurological abnormalities with manifestations of motor coordination, sensory integration and disinhibition. Evidence has suggested NSS as one of the most promising endophenotypes for schizophrenia spectrum disorders. Moreover, accumulating evidence also suggest that NSS may be associated with specific functional connectivity. The present study aimed to examine the cerebellar-cerebral resting-state functional connectivity (rsFC) of NSS in patients with first-episode schizophrenia (FES) and their unaffected siblings (SB).

Methods

We administered the abridge version of the Cambridge Neurological Inventory (CNI) to 51 FES patients, 20 unaffected SB, and 50 healthy controls (HC) to assess the severity of NSS. All the participants also underwent a resting-state functional magnetic resonance imaging (MRI) scan. Ten regions of interest (ROIs) in the cerebellum were selected to represent cerebellar motor network (MN) and cerebellar executive control network (EN), which corresponded to the “sensorimotor-cognitive” dichotomy of NSS. rsFC between each ROI and the whole brain voxels were constructed, and the linear regression analysis was conducted to examine the cerebellar-cerebral rsFC patterns of NSS in each group.

Results

Regarding the cerebellar MN, there were positive correlations observed between the rsFC of the cerebellar MN with the default mode network (DMN) and NSS in FES patients group (CNI total score and the motor coordination subscale) and the SB group (CNI total score and the motor coordination and sensory integration subscales). The rsFC of the cerebellar MN and the sensorimotor network were significantly and positively correlated with NSS (CNI total score and the motor coordination and sensory integration subscales) in the SB group.

Regarding the cerebellar EN, we found that both the FES and the SB groups exhibited significantly negative correlations between NSS (CNI total score and the motor coordination subscale) and the rsFC of the cerebellar EN with the DMN. Moreover, the rsFC between the cerebellar EN and the sensorimotor network was positively correlated with NSS (CNI total score and the motor coordination and disinhibition subscales) in the SB group.

Discussion

We found inverse correlations between NSS and the rsFC of the cerebellar EN/MN and the DMN in both FES patients and their unaffected SB, suggesting that altered cerebellar-cerebral rsFC between these networks is correlated with the NSS. Moreover, the SB group exhibited a unique correlational pattern that NSS were correlated with the cerebellar-sensorimotor network rsFC, suggesting that such a network connectivity may serve as a potential biomarker for schizophrenia.