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2.
Chem Biol Interact ; 327: 109164, 2020 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-32524992

RESUMO

General anaesthetics are some of the most widely used and essential therapeutic agents. However, despite over a century of research, the molecular mechanisms of general anaesthesia in the central nervous system remain elusive. Ketamine (ketamine hydrochloride) has been approved for use in general anaesthesia either alone or in combination with other medications. It is a superb drug for use in short-term medical procedures that do not require skeletal muscle relaxation, and it has approval for the induction of general anaesthesia as a pre-anaesthetic to other general anaesthetic agents. However, Several questions remain unsolved, including the exact identification of the neural substrate of consciousness and its components, the pharmacodynamic interactions between anaesthetic agents, the mechanisms of cognitive alterations that follow an anaesthetic procedure, the identification of an eventual unitary mechanism of anaesthesia-induced alteration of consciousness, the relationship between network effects and the biochemical targets of anaesthetic agents, leading to difficulties in between-studies comparisons. Thus, the glutamate and dopamine systems play distinct roles in terms of neuronal signalling, yet both have proposed to contribute significantly to the pathophysiology of neuropsychiatric diseases. Imaging of the glutamate system and other aspects of research on the dopamine system have produced less consistent findings, potentially due to methodological limitations and the heterogeneity of the disorder. In this review, we discuss the neural circuits through which the two systems interact and how their disruption may cause psychotic symptoms. We also summarize from a molecular perspective of mechanisms of action of ketamine as general anaesthetics on ligand-gated ion channels mediated modulation of dopamine in the brain region.


Assuntos
Anestésicos Dissociativos/farmacologia , Dopamina/metabolismo , Ácido Glutâmico/metabolismo , Ketamina/farmacologia , Anestesia/efeitos adversos , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Neurônios Dopaminérgicos/efeitos dos fármacos , Humanos , Transtornos Psicóticos/fisiopatologia , Receptores de N-Metil-D-Aspartato/antagonistas & inibidores , Receptores de N-Metil-D-Aspartato/metabolismo , Esquizofrenia/fisiopatologia
3.
Medicine (Baltimore) ; 99(26): e20778, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590756

RESUMO

BACKGROUND: Myxedema psychosis (MP) is a rare presentation of hypothyroidism. Although known for >70 years, a significant lack of systematic literature describing this condition exists. This limits the clinician's ability to identify and manage this entity properly. Hence, we aimed to systematically review the literature and summarize the presentation, diagnosis, management, and outcomes of this rare entity. METHODS: Systematic review following PRISMA guidance. We will perform a comprehensive search of PubMed, Medline, Embase, Google Scholar (first 300 hits), and Cochrane databases for published observational studies, case series, and case reports. We will use descriptive statistics to provide summary estimates of demographics, common presenting features, laboratory test results, imaging findings, treatment administered, and outcomes. Moreover, continuous variables will be compared by the Wilcoxon Mann Whitney test, whereas categorical variables will be assessed by the χ test. Bivariate and multivariate regression will be performed to assess risk factors associated with poor outcome. A scoping review revealed that a meta-analysis might not be feasible owing to the paucity of systematic studies describing the condition. RESULTS: This is the first systematic review examining this rare entity. Thus, the result of which will be significant. We hope that this review will help in identifying relevant predictive clinical or laboratory characteristics. Additionally, it identifies the best treatment strategies. The findings of this review will help increase our knowledge of this condition so as to recognize this condition promptly. Also, it will assist in differentiating MP from masqueraders, such as Hashimoto encephalopathy (HE). The results of this review will be published in a peer-reviewed journal. CONCLUSION: This is the first systematic review exploring MP demographics, diagnosis treatment, and outcomes. The information gathered by this review will be necessary for patients, clinicians, researchers, and guideline makers. PROSPERO REGISTRATION NUMBER: CRD42020160310.


Assuntos
Mixedema , Transtornos Psicóticos , Gerenciamento Clínico , Humanos , Mixedema/diagnóstico , Mixedema/psicologia , Mixedema/terapia , Prognóstico , Transtornos Psicóticos/sangue , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/terapia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
4.
Encephale ; 46(3S): S66-S72, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32471707

RESUMO

OBJECTIVE: The COVID-19 pandemic affected today more than 3,000,000 worldwide, and more than half of humanity has been placed in quarantine. The scientific community and the political authorities fear an epidemic of suicide secondary to this crisis. The aim of this review is to analyze the impact of the COVID-19 pandemic on the dimensions of the suicidal process and its interaction with the various risk factors. We also propose innovative strategies to manage suicidal behavior in the context of pandemic. METHODS: We carried out a narrative review of international publications dealing with major pandemics (COVID-19, SARS) and their influence on suicidal vulnerability. RESULTS: Many factors are likely to increase the emergence of suicidal ideation and suicide attempts during this crisis. Social distancing and quarantine could increase the feeling of disconnection and the perception of social pain in vulnerable individuals. Some populations at high suicidal risk could be further impacted by the current pandemic: the elderly, medical staff and individuals exposed to economic insecurity. Several innovative tools adapted to the constraints of social distancing and quarantine may prevent suicide risk: e-health, VigilanS, buddhist-derived practices and art engagement. CONCLUSIONS: This unprecedented crisis may interact with certain dimensions of the suicidal process. However, it is time to innovate. Several suicide prevention tools all have their place in new modes of care and should be tested on a large scale.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Suicídio/psicologia , Intoxicação Alcoólica/psicologia , Inteligência Artificial , Betacoronavirus/fisiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/psicologia , Efeitos Psicossociais da Doença , Intervenção na Crise/instrumentação , Recessão Econômica , França/epidemiologia , Humanos , Inflamação , Solidão/psicologia , Modelos Neurológicos , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/psicologia , Psicoterapia/métodos , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/virologia , Quarentena/psicologia , Sistema Renina-Angiotensina/fisiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/psicologia , Isolamento Social/psicologia , Estresse Psicológico/etiologia , Estresse Psicológico/terapia , Ideação Suicida , Suicídio/prevenção & controle , Suicídio/estatística & dados numéricos , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia , Telemedicina , Populações Vulneráveis
7.
Psychiatr Danub ; 32(1): 60-69, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32303031

RESUMO

BACKGROUND: Schizophrenia is a multifactorial neurodevelopmental disorder associated with cognitive dysfunction and changes in primary sensory processing. This article aims to explore the current insights into the relationship between schizophrenia and different visual disturbances. METHODS: To provide a literature review of visual impairments in schizophrenia, we performed a PubMed/MEDLINE and Scopus search to identify all articles in English on the topic up to the end of 2018. RESULTS: Multiple retinal functional and structural abnormalities are found in patients with schizophrenia. Wider retinal venules suggest chronically insufficient brain supply of oxygen and this could contribute to the occurrence of psychotic symptoms. Optical coherence tomography studies showed that retinal nerve fiber layer, macular thickness, and macular volume were significantly lowered in the chronic phase of schizophrenia. Results from electroretinogram recordings have demonstrated different declinations such as abnormalities of a - wave activity in the photoreceptors or b - wave activity in the bipolar and Muller cells. Abnormalities in eye movements, such as a notable decrease in saccades and smooth pursuit eye movements, are one of the most reliable and reproducible impairments associated with schizophrenia. Disrupted visual processing of the magnocellular pathway may result in a decrease of contrast sensitivity, sensory processing, orientation discrimination, visual integration, trajectory and spatial localization, backward masking and motion tracking. Visual perceptual abnormalities occur in more than 60% of schizophrenic patients and these are visual hallucinations, perceptual distortion of colors, shapes and light intensity, decrease in contour integration and surround suppression. Other, frequently present eye disorders include impaired visual acuity, strabismus and nystagmus. CONCLUSION: Visual impairments are one of the most important features of schizophrenia, which could help in defining the disease state and assigning appropriate treatment.


Assuntos
Oftalmopatias/complicações , Oftalmopatias/fisiopatologia , Esquizofrenia/complicações , Esquizofrenia/fisiopatologia , Oftalmopatias/patologia , Alucinações , Humanos , Transtornos Psicóticos/complicações , Transtornos Psicóticos/fisiopatologia , Acompanhamento Ocular Uniforme , Movimentos Sacádicos , Esquizofrenia/patologia , Percepção Visual
8.
Psychiatry Res Neuroimaging ; 299: 111068, 2020 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-32208349

RESUMO

The psychosis spectrum comprises heterogeneous disorders characterized by both world-related and self-related symptoms. How these symptoms may arise with similar features in spite of the different aetiologies is yet an unsolved question. In behavior narrative review, we compare three conditions characterized by psychotic experiences (schizophrenia, substance-use disorder and sensory-deprivation) searching for links between their phenomenological features and the mechanisms underlying their onset. Clinically, psychotic experiences are characterized by the reciprocal contamination of world- and self-related contents, termed 'world/self ambivalence'. Neuroimaging evidence suggests that the imbalance between stimuli-, self-, and attention-related functional networks (visual/auditory, default-mode, and salience network respectively) assumes central relevance in all the conditions considered. Phenomenology and neurobiology were thus interrelated in light of the reviewed literature, identifying two key neuronal mechanisms which may lead to world/self ambivalence. First, psychotic experiences are associated with the relative dominance of one network over the other (default-mode over auditory/visual networks, or vice-versa), prompting an excess of internal or external pressure to the experienced ambivalence between world and self. Second, an altered salience network resting-state functional connectivity could generate a dysregulation of the attentive fluctuations from self- to world-related activity, thus blurring the boundary between the environment and oneself, labelled the 'world/self boundary'.


Assuntos
Afeto , Transtornos Psicóticos/fisiopatologia , Atenção/fisiologia , Humanos , Imagem por Ressonância Magnética , Neuroimagem , Neurônios , Rotulagem de Produtos , Esquizofrenia/fisiopatologia
9.
Fortschr Neurol Psychiatr ; 88(2): 121-138, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32102104

RESUMO

Acute psychotic disorders (APS) are characterized by an acute onset as well as a wide array of symptoms including affective, psychotic, and psychomotor symptoms. They occur independently of substance use or organic disorders. In most cases, patients recover fully and without residues within a short period of time. However, APS tend to show a relapsing course, and transitions into other psychiatric disorders (schizophrenia, bipolar disorder) may occur.


Assuntos
Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/psicologia , Doença Aguda/psicologia , Transtorno Bipolar , Humanos , Transtornos Psicóticos/complicações , Recidiva , Esquizofrenia
10.
Am J Psychiatry ; 177(4): 327-334, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32046533

RESUMO

OBJECTIVE: At first hospitalization, a long duration of untreated psychosis (DUP) predicts illness severity and worse treatment outcomes. The mechanism of this association, however, remains unclear. It has been hypothesized that lengthy untreated psychosis is toxic or that it reflects a more severe form of schizophrenia. Alternatively, the association may be an artifact of lead-time bias. These hypotheses are tested in a longitudinal study of schizophrenia with 2,137 observations spanning from childhood to 20 years after first admission. METHODS: Data were from the Suffolk County Mental Health Project. The cohort included 287 individuals with schizophrenia or schizoaffective disorder. DUP was defined as days from first psychotic symptom to first psychiatric hospitalization. Psychosocial function was assessed using the Premorbid Adjustment Scale and the Global Assessment of Functioning Scale. Psychosocial function trajectories were estimated using multilevel spline regression models adjusted for gender, occupational status, race, and antipsychotic medication. RESULTS: Both long- and short-DUP patients experienced similar declines in psychosocial function, but declines occurred at different times relative to first admission. Long-DUP patients experienced most of these declines prior to first admission, while short-DUP patients experienced declines after first admission. When psychosocial function was analyzed relative to psychosis onset, DUP did not predict illness course. CONCLUSIONS: The association between DUP and psychosocial function may be an artifact of early detection, creating the illusion that early intervention is associated with improved outcomes. In other words, DUP may be better understood as an indicator of illness stage than a predictor of course.


Assuntos
Antipsicóticos/uso terapêutico , Viés , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Tempo para o Tratamento/estatística & dados numéricos , Adolescente , Adulto , Feminino , Hospitalização , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/psicologia , Esquizofrenia/fisiopatologia , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
11.
PLoS One ; 15(2): e0229221, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32097437

RESUMO

OBJECTIVES: Comorbidity is prevalent in older working ages and might affect employment exits. This study aimed to 1) assess the associations between comorbidity and different employment exit routes, and 2) examine such associations by gender. METHODS: We used data from employed adults aged 50-62 in the Stockholm Public Health Survey 2002 and 2006, linked to longitudinal administrative income records (N = 10,416). The morbidity measure combined Limiting Longstanding Illness and Common Mental Disorder-captured by the General Health Questionnaire-12 (≥4)-into a categorical variable: 1) No Limiting Longstanding Illness, no Common Mental Disorder, 2) Limiting Longstanding Illness only, 3) Common Mental Disorder only, and 4) comorbid Limiting Longstanding Illness+Common Mental Disorder. Employment status was followed up until 2010, treating early retirement, disability pension and unemployment as employment exits. Competing risk regression analysed the associations between morbidity and employment exit routes, stratifying by gender. RESULTS: Compared to No Limiting Longstanding Illness, no Common Mental Disorder, comorbid Limiting Longstanding Illness+Common Mental Disorder was associated with early retirement in men (subdistribution hazard ratio = 1.73, 95% confidence intervals: 1.08-2.76), but not in women. For men and women, strong associations for disability pension were observed with Limiting Longstanding Illness only (subdistribution hazard ratio = 11.43, 95% confidence intervals: 9.40-13.89) and Limiting Longstanding Illness+Common Mental Disorder (subdistribution hazard ratio = 14.25, 95% confidence intervals: 10.91-18.61), and to a lesser extent Common Mental Disorder only (subdistribution hazard ratio = 2.00, 95% confidence intervals: 1.31-3.05). Women were more likely to exit through disability pension than men (subdistribution hazard ratio = 1.96, 95% confidence intervals: 1.60-2.39). Common Mental Disorder only was the only morbidity category associated with unemployment (subdistribution hazard ratio = 1.70, 95% confidence intervals: 1.36-2.15). CONCLUSIONS: Strong associations were observed between specific morbidity categories with different employment exit routes, which differed by gender. Initiatives to extend working lives should consider older workers' varied health needs to prevent inequalities in older age.


Assuntos
Emprego/estatística & dados numéricos , Pensões/estatística & dados numéricos , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/fisiopatologia , Aposentadoria/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Idoso , Pessoas com Deficiência , Feminino , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Suécia/epidemiologia
12.
J Abnorm Psychol ; 129(1): 122-130, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31343182

RESUMO

Sleep disturbances are prevalent among individuals with a psychotic disorder and have been linked to symptoms of paranoia across the entire psychosis continuum. Emerging evidence suggests that rather than a secondary symptom, poor quality of sleep may contribute to elevated paranoid ideation. We investigated the temporal dynamics of sleep quality and paranoid ideation using the experience sampling method in 42 acutely paranoid individuals with a psychotic disorder, 32 nonparanoid individuals with psychotic disorder, and 41 individuals with high schizotypy traits. We applied time-lagged mixed multilevel modeling to tease apart the effect of poor sleep quality on morning paranoia and negative affect, and the impact of evening paranoid ideation and negative affect on subsequent sleep quality. In the whole sample, poor subjective sleep quality predicted elevated paranoia the following morning, a relationship that was fully mediated by morning negative affect. No significant association between evening paranoia and poor sleep the following night emerged. In the everyday lives of individuals on the paranoia continuum, low quality of sleep appears to drive paranoia through its impact on negative affect. These findings identify sleep quality as an important target of transdiagnostic interventions for psychotic and affective symptomatology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos Paranoides/complicações , Transtornos Psicóticos/complicações , Transtorno da Personalidade Esquizotípica/complicações , Transtornos do Sono-Vigília/complicações , Sono/fisiologia , Adolescente , Adulto , Avaliação Momentânea Ecológica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Paranoides/fisiopatologia , Transtornos Paranoides/psicologia , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/psicologia , Transtorno da Personalidade Esquizotípica/fisiopatologia , Transtorno da Personalidade Esquizotípica/psicologia , Transtornos do Sono-Vigília/fisiopatologia , Transtornos do Sono-Vigília/psicologia , Adulto Jovem
13.
Neuroimaging Clin N Am ; 30(1): 65-72, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31759573

RESUMO

MR imaging is a suitable instrument for the detection of incidental radiological findings in patients with early psychosis and guidance of subsequent treatment adjustments. We outline evidence showing the clinical utility of MR imaging to guide treatment selection by identifying radiological abnormalities and predicting clinical outcomes in early-stage psychosis. We argue that MR imaging is an indispensable screening tool to detect gross radiological abnormalities in early psychosis and implementation in routine clinical assessments is warranted. We highlight future key challenges and make pragmatic suggestions to exploit the potential of MR imaging to construct robust prognostic models for personalized early interventions.


Assuntos
Imagem por Ressonância Magnética/métodos , Transtornos Psicóticos/diagnóstico por imagem , Transtornos Psicóticos/terapia , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Intervenção Médica Precoce , Humanos , Achados Incidentais , Prognóstico , Transtornos Psicóticos/fisiopatologia
14.
PLoS One ; 14(12): e0226409, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31830099

RESUMO

INTRODUCTION: People with depression, anxiety, or psychosis often complain of confusion, problems concentrating or difficulties cognitively appraising contextual cues. The same applies to people with neurodegenerative diseases or brain damage such as dementia or stroke. Assessments of those cognitive difficulties often occurs in cross-sectional and controlled clinical settings. Information on daily moment-to-moment cognitive fluctuations and its relation to affect and context is lacking. The development and evaluation of a digital cognition task is presented. It enables the fine-grained mapping of cognition and its relation to mood, intrapersonal factors and context. METHODS: The momentary Digit Symbol Substitution Task is a modified digital version of the original paper-and-pencil task, with a duration of 30 seconds and implemented in an experience sampling protocol (8 semi-random assessments a day on 6 consecutive days). It was tested in the healthy population (N = 40). Descriptive statistics and multilevel regression analyses were used to determine initial feasibility and assess cognitive patterns in everyday life. Cognition outcome measures were the number of trials within the 30-second sessions and the percentage of correct trials. RESULTS: Subjects reported the task to be easy, pleasant and do-able. On average, participants completed 11 trials with 97% accuracy per 30-second session. Cognitive variation was related to mood, with an interaction between positive and negative affect for accuracy (% correct) (p = .001) and an association between positive affect and speed (number of trials) (p = .01). Specifically, cheerful, irritated and anxious seem to covary with cognition. Distraction and location are relevant contextual factors. The number of trials showed a learning effect (p < .001) and was sensitive to age (p < .001). CONCLUSION: Implementing a digital cognition task within an experience-sampling paradigm shows promise. Fine-tuning in further research and in clinical samples is needed. Gaining insight into cognitive functioning could help patients navigate and adjust the demands of daily life.


Assuntos
Afeto/fisiologia , Ansiedade/fisiopatologia , Cognição/fisiologia , Transtornos Psicóticos/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Amostragem , Adulto Jovem
15.
Rev. Asoc. Esp. Neuropsiquiatr ; 39(136): 45-58, jul.-dic. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-192347

RESUMO

El concepto de "locura" -más amplio y menos definido que el de "psicosis"- continúa siendo de uso popular, pese a haberse abandonado en medicina por su carga peyorativa. Las manifestaciones culturales y artísticas pueden reflejar las representaciones sociales de la enfermedad mental, a la vez que difundir, amplificar, matizar y/o metabolizar los sentidos circulantes. Atendiendo al estigma y la discriminación como barreras para el acceso a los tratamientos psiquiátricos, el objetivo de este trabajo es la aproximación a las visiones y valoraciones subculturales de la "locura". Para ello, se presentan y discuten los resultados del análisis de contenido de 3.653 canciones punk españolas (1981-2010). Mediante este proceso se pretende delinear un retrato subcultural del "loco" y "la locura". Hipotetizamos que una parte de las visiones estigmatizantes presentes en la población general pueden hallarse contenidas en los discursos lítero-musicales del punk español, aunque con matices valorativos que pueden diferir respecto a la cultura mayoritaria


Although the term 'madness' (a broader but less delimited concept than 'psychosis') has been abandoned in Medicine due to its pejorative connotation, it is still commonly used. The study of the social representations of mental disorders through the analysis of cultural material has previously been argued. In this way, as stigma and discrimination are barriers to psychiatric care, our aim is to identify the subcultural views about the theme of madness and value judgments associated. For this purpose, content analysis of 3,653 Spanish punk songs (1981-2010) was carried out. Through this process, we intended to delineate a subcultural portrait of the theme of madness. We hypothesized that some stigmatizing views of the general population might be present in the lyrical-musical discourses of Spanish punk, although their value dimension might differ from the dominant culture


Assuntos
Humanos , Transtornos Psicóticos/fisiopatologia , Estigma Social , Estudos Retrospectivos , Medicina nas Artes , Música , Espanha , Pesquisa Qualitativa
16.
Ir J Psychol Med ; 36(4): 239-241, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31747989

RESUMO

Psychotic disorders are central to mental health service provision and a common theme of academic research programmes in Ireland, which explore the neurobiological and psychosocial risk factors underpinning the development and progression of these illnesses. While we await the discovery of novel pharmacological treatment targets for psychotic disorders, it is important to employ our existing management strategies to optimal effect. In this special issue on psychosis, a selection of clinical research studies and reviews from Irish researchers, and often of Irish populations, are brought together which span the trajectory of psychotic illness from early intervention to treatment resistance. The topics include the characteristics and course of first episode psychosis cohorts, real-world evaluation of early intervention services, management strategies for treatment resistant schizophrenia and neurobiological research into social stress. The current editorial provides an overview of these papers and highlights the initial steps of the Irish Psychosis Research Network towards developing an integrated clinical research network focusing on the treatment and research into psychotic disorders.


Assuntos
Antipsicóticos/uso terapêutico , Clozapina/uso terapêutico , Transtornos Psicóticos/terapia , Esquizofrenia/terapia , Resistência a Medicamentos/fisiologia , Intervenção Educacional Precoce , Humanos , Irlanda/epidemiologia , Serviços de Saúde Mental/normas , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/fisiopatologia , Fatores de Risco , Resultado do Tratamento
17.
Brain Struct Funct ; 224(9): 3277-3289, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31686202

RESUMO

Our sensory systems actively predict sensory information based on previously learnt patterns, which are continuously updated with information from the actual sensory input via prediction errors. Individuals with schizophrenia consistently show reduced auditory prediction errors as well as altered fractional anisotropy (indicative of white matter changes) in the arcuate fasciculus and the auditory interhemispheric pathway, both of which are auditory white matter pathways associated with prediction errors. However, it is not clear if healthy individuals with psychotic-like experiences exhibit similar deficits. Participants underwent electroencephalography (EEG) recordings while listening to a classical two-tone duration deviant oddball paradigm (n = 103) and a stochastic oddball paradigm (n = 89). A subset of participants (n = 89) also underwent diffusion-weighted magnetic resonance imaging (MRI). Fractional anisotropy (FA), was extracted from the arcuate fasciculi and the auditory interhemispheric pathway. While prediction errors evoked by the classical oddball paradigm failed to reveal significant effects, the stochastic oddball paradigm elicited significant clusters at the typical mismatch negativity time window. Furthermore, we observed that FA of the arcuate fasciculi and auditory interhemispheric pathway significantly improved predictive models of psychotic-like experiences in healthy individuals over and above predictions made by auditory prediction error responses alone. Specifically, we observed that decreasing FA in the auditory interhemispheric pathway and reducing ability to learn stochastic irregularities are associated with increasing CAPE + scores. To the extent that these associations have previously been reported in patients with schizophrenia, the findings from this study suggest that both, auditory prediction errors and white matter changes in the auditory interhemispheric pathway, may have the potential to be translated into early screening markers for psychosis.


Assuntos
Córtex Auditivo/fisiologia , Córtex Auditivo/fisiopatologia , Percepção Auditiva/fisiologia , Transtornos Psicóticos/patologia , Transtornos Psicóticos/fisiopatologia , Substância Branca/patologia , Substância Branca/fisiopatologia , Estimulação Acústica , Adolescente , Vias Auditivas/patologia , Vias Auditivas/fisiopatologia , Imagem de Difusão por Ressonância Magnética , Eletroencefalografia , Potenciais Evocados Auditivos , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Adulto Jovem
18.
Psychiatry Res ; 282: 112623, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31685288

RESUMO

Autism traits are found at elevated rates in individuals with schizophrenia spectrum disorders, however, there is a lack of evidence regarding potential clinical impact. The current research aimed to examine potential associations between autism traits and symptoms of psychosis, social and role functioning, and quality of life. 99 individuals experiencing a first episode of psychosis took part in a cross-sectional interview and self-report questionnaire which assessed current symptoms of psychosis, autism traits, functioning, and quality of life. Participants were found to have a high level of autism traits. Higher autism traits were associated with poorer quality of life, functioning, and current psychotic symptoms. Receiver operating characteristic curve (ROC) analyses indicated that optimal AQ cut-off scores to predict severity of psychosis symptoms, functioning, and quality of life were lower than those used to suggest likely autism-spectrum diagnosis. Results suggest that autism traits are associated with poorer clinical presentation in first-episode psychosis populations, even in those whose traits fall below potentially diagnostic thresholds for autism. Psychosis services should be prepared to adequately address the needs of individuals with higher autism traits.


Assuntos
Transtorno do Espectro Autista/fisiopatologia , Transtornos Psicóticos/fisiopatologia , Qualidade de Vida , Esquizofrenia/fisiopatologia , Adulto , Transtorno do Espectro Autista/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Psicóticos/epidemiologia , Esquizofrenia/epidemiologia , Adulto Jovem
19.
Psychiatry Res ; 282: 112608, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31655405

RESUMO

OBJECTIVES: Abnormalities in insular functional connectivity have been implicated in many clinical features of schizophrenia. The aim of this study was to determine to what degree such abnormalities occur in individuals with clinical high risk for psychosis (CHR), and whether which is associated with symptom severity. METHODS: Resting-state fMRI data were collected from 47 healthy controls, 24 CHR individuals and 19 patients with first-episode schizophrenia. Using the posterior, dorsal and ventral insular subregions as separate seeds, we examined resting-state functional connectivity differences between different groups and the association between concurrent symptom severity and dysconnectivity. RESULTS: Compared with healthy controls, both CHR individuals and schizophrenia patients showed hypoconnectivity between posterior insula (PI) and somatosensory areas, and between dorsal anterior insula (dAI) and putamen. Schizophrenia patients also showed dAI and ventral anterior insula(vAI) hyperconnectivity with visual areas relative to controls and CHR individuals. Correlation analysis revealed that dAI functional connectivity with superior temporal gyrus was positively correlated with positive symptoms of CHR, and vAI connectivity with dorsolateral prefrontal cortex was negatively correlated with the severity of the symptoms of first-episode schizophrenia. CONCLUSIONS: Our findings suggest that insular functional dysconnectivity with the sensory cortex may be a system-level neural substrate preceding the onset of psychosis.


Assuntos
Córtex Cerebral/fisiopatologia , Conectoma , Rede Nervosa/fisiopatologia , Transtornos Psicóticos/fisiopatologia , Esquizofrenia/fisiopatologia , Adulto , Córtex Cerebral/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Rede Nervosa/diagnóstico por imagem , Transtornos Psicóticos/diagnóstico por imagem , Risco , Esquizofrenia/diagnóstico por imagem , Adulto Jovem
20.
Psychiatry Res ; 282: 112625, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31662188

RESUMO

Poor social connection or loneliness is a prominent feature of schizotypy and may exacerbate psychosis risk. Previous studies have examined the inter-relationships between loneliness and psychosis risk, but critically, they have largely been conducted in non-clinical samples or exclusively used laboratory questionnaires with limited consideration of the heterogeneity within schizotypy (i.e., positive, negative, disorganized factors). The present study examined links between loneliness and psychotic-like symptoms across the dimensions of schizotypy through cross-sectional, laboratory-based questionnaires (Study 1; N = 160), ambulatory assessment (Study 2; N = 118) in undergraduates, and ambulatory assessment in inpatients in a substance abuse treatment program (Study 3; N = 48). Trait positive schizotypy consistently predicted cross-sectional and state psychotic-like symptoms. Loneliness, assessed via cross-sectional and ambulatory means, was largely linked with psychotic-like symptoms. Importantly, psychotic-like symptoms were dynamic: psychotic-like symptoms largely increased with loneliness in individuals with elevated positive and disorganized schizotypal traits, though there were some inconsistency related to disorganized schizotypy and state psychotic-like symptoms. Negative schizotypy and loneliness did not significantly interact to predict psychotic-like symptoms, suggesting specificity to positive schizotypy. Ambulatory approaches provide the opportunity for ecologically valid identification of risk states across psychopathology, thus informing early intervention.


Assuntos
Alucinações/fisiopatologia , Solidão , Transtornos Psicóticos/fisiopatologia , Transtorno da Personalidade Esquizotípica/fisiopatologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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