Study Finds Patients With First-Episode Schizophrenia Disorders Show Greater Body Fat, Cardiovascular Risk

Research Folders Laptop Mean Investigation Gathering Data And An

Christoph Correll, M.D., a professor of psychiatry and molecular medicine at the Zucker Hillside Hospital in New York, and colleagues studied approximately 400 patients with FES. Photo Credit: Stuart Miles | DPC

From Psychiatric News Alert: The duration of psychiatric illness and treatment for patients after first-episode schizophrenia spectrum disorders (FES) appears to be associated with weight gain and having other cardiometabolic abnormalities, according to a study published in JAMA Psychiatry.

Data showed that when evaluated after experiencing FES, nearly 50% were obese or overweight, 40% had prehypertension, 10% had hypertension, and 13.2% had some form of metabolic syndrome. Longer psychiatric illness duration correlated significantly with higher body mass index, fat percentage, and waist circumference. Treatment with antipsychotic medications, such as olanzapine and quetiapine, was associated with higher triglyceride levels in the blood.

“In patients with FES, cardiometabolic risk factors and abnormalities are present early in the illness and likely related to the underlying illness, unhealthy lifestyle, and [use of] antipsychotic medications, which interact with each other. Prevention of and early interventions for psychiatric illness and treatment with lower-risk agents, routine antipsychotic adverse effect monitoring, and smoking-cessation interventions are needed from the earliest illness phases.”

To read more about research into cardiovascular risk associated with psychiatric illness and use of psychotropic medications, see the Psychiatric News articles

For more on this topic, see the study

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Genomic Analysis: Eight Distinct Types of Schizophrenia

From Psychiatric News Alert. Schizophrenia appears to be “heterogenous”—that is, comprising a group of related disorders each of which present with distinct clinical syndromes; and those syndromes now appear to be associated with eight separate networks of genetic mutations.

That’s the finding from a remarkable genetic analysis titled “Uncovering the Hidden Risk Architecture of the Schizophrenias: Confirmation in Three Independent Genome-Wide Association Studies,” appearing in AJP in Advance.

Schizophrenia (Sepultura album)

Schizophrenia (Sepultura album) (Photo credit: Wikipedia)

In a large genome-wide association study of cases with schizophrenia and controls, researchers with the Molecular Genetics of Schizophrenia Consortium (an international group of researchers) examined single nucleotide polymorphisms (SNPs) that grouped or clustered together and assessed the risk for schizophrenia by comparing the cases and noncases. They then looked at relationships between the SNP clusters and various ways that patients present symptomatically across three separate studies.

The authors identified 42 SNP sets associated with a 70 percent or greater risk of schizophrenia and confirmed 34 (81 percent) or more with similar high risk of schizophrenia in two independent samples. These SNP sets or genotypic networks were linked to the different ways that patients present with schizophrenia, yielding eight distinct clinical syndromes varying in symptoms and severity.

“We found that some genetic pathways increasing susceptibility involved deficient control of healthy brain development, and other pathways involved increased susceptibility to brain injury and toxicity,”

Claude Robert Cloninger, M.D., a study coauthor and a professor of psychiatry at Washington University School of Medicine, told Psychiatric News. “Regulation of the plasticity of glutamate receptors was important in some classes of schizophrenia and not others.

A Single Nucleotide Polymorphism is a change o...

“The main take home message is that there are many pathways to schizophrenia, which converge on eight classes of the disorder,” he said.

Full coverage of this study will appear in a future issue of Psychiatric News. For more information on psychiatric genetics, see the Psychiatric News article, “Revolution in Psychiatric Genetics Rapidly Gains Steam.

Some of the “Other” Common Symptoms in Schizophrenia

Schizophrenia is most easily recognized by the symptoms that define it, such as visual and auditory hallucinations (e.g., “seeing things” and “hearing voices”) and delusions, including paranoia. But other symptoms are also extremely common.

Apathy, for instance, is often observed. If a person is experiencing auditory or visual delusions and paranoia – “psychosis” – they they are less likely to engage in day to day activities because the voices and suspicions are controlling the majority of their life. A Person living with schizophrenia can still experience depression even when they are not having other symptoms, the person will show signs of apathy, which can be attributed to the depression. Excessive doses of antipsychotics can also sometimes contribute to apathy.

Negative Symptoms Associated with Schizophrenia

Between 40% and 50% of people living with schizophrenia who have been treated and are recovering

will show evidence of negative symptoms. Negative symptoms include:

• Emotional flatness or lack of expressiveness.
• Inability to start and follow through with activities.
• Lack of pleasure or interest in life.

One distinction of some people living with schizophrenia is they do not expect enjoyable activities to give them pleasure, which likely causes them to not engage in pleasure-seeking behaviors.

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Reprograming Skin Cells Into Brain Cells

Using skin cells from patients with mental disorders, scientists are creating brain cells that are now providing extraordinary insights into schizophrenia and Parkinson’s disease.

For many poorly understood mental disorders, such as schizophrenia or autism, scientists often wish they could turn back the clock to uncover what has gone wrong in the brain. Now thanks to recent developments in the lab, this is coming true.

Salk Institute for Biological Studies, La Joll...

Salk Institute for Biological Studies, La Jolla, California (Photo credit: Wikipedia)

Researchers are using genetic engineering and growth factors to reprogram the skin cells of patients and grow them into brain cells. In the lab under careful watch, investigators can detect inherent defects in how neurons develop or function, or see what environmental toxins or other factors prod them to misbehave in the Petri dish. With these “diseases in a dish” they can also test the effectiveness of drugs that can right missteps in development, or counter the harm of environmental insults.

“It’s quite amazing that we can replicate a psychiatric disease in a petri dish,” says neuroscientist Fred Gage, a professor of genetics at the Salk Institute of Biological Studies. “This allows us to identify subtle changes in the functioning of neuronal circuits that we never had access to before.”

Anderson Cooper’s Empathy Exercise for Schizophrenia

In case you haven’t seen it yet, below is Anderson Cooper’s segment in June 2014 in which he dons earphones and attempts ordinary activities while experiencing voices in an exercise designed by clinical psychologist, Pat Deegan.

Visit Anderson Cooper’s blog by CLICKING HERE to see what he has to say about the experience and to see his interview of Dr. Deegan.

Patricia E. Deegan, Ph.D., is an independent consultant who specializes in researching and lecturing on the topic of recovery and the empowerment of people diagnosed with mental illness. She is an activist in the disability rights movement and has lived her own journey of recovery after being diagnosed with schizophrenia as a teenager. She is the creator of the CommonGround Approach, which includes CommonGround – a web application to support shared decision making in the psychopharmacology consultation, and RECOVERYlibrary – a collection of recovery oriented resources aimed at providing the tools, the hope, and the inspiration to recovery after a diagnosis of mental illness.

You can learn more about Pat Deegan at HER WEBSITE.

Study on Vets With Schizophrenia, Comorbid Anxiety

FROM Psychiatric News Alert: Veterans with schizophrenia and a comorbid anxiety disorder have increased rates of other disorders, higher psychiatric and medical hospitalization, and increased utilization of outpatient mental health services, according to the study, “Service Utilization Among Veterans With Schizophrenia and a Comorbid Anxiety Disorder,” published in the APA journal Psychiatric Services in Advance.

Researchers from the Department of Veterans Affairs’ Serious Mental Illness Treatment Resource and Evaluation Center in Ann Arbor, Mich., examined diagnostic, utilization, and medication records included in the Veterans Health Administration (VHA) National Psychosis Registry. Relationships between schizophrenia and anxiety disorders were evaluated along demographic and service utilization dimensions.

During Fiscal 2011, 23.8% of 87,006 VHA patients with schizophrenia were diagnosed with a comorbid anxiety disorder; 15.2% of the sample had a posttraumatic stress disorder (PTSD) diagnosis and 8.6% a non-PTSD anxiety disorder. The researchers found that patients without a comorbid anxiety disorder had significantly lower rates of other comorbid mental disorders than did patients with comorbid anxiety disorders. Specifically, 20.6% of patients with no anxiety disorder had depression, compared with 47.7% of those with PTSD and 46.8% of those with non-PTSD anxiety disorders. Only 3.7% of patients with no anxiety disorder had a personality disorder, compared with 11.2% of those with PTSD and 10.8% of those with non-PTSD anxiety.

“Anxiety disorders are common among individuals with schizophrenia within the VHA and appeared in this study to convey additional disability in terms of psychiatric comorbidity and the need for increased psychiatric care,” the researchers pointed out. “Future research should investigate ways to improve detection and enhance treatment provided to this population.”

For more on care of veterans with psychiatric disorders, see the Psychiatric Newsarticles, “APA Calls for Better Training to Treat Chronic Pain, Addiction Among Vets” and “Knowledge of Military Life Facilitates Vets’ MH Care.”

Study Finds Immune Molecule Levels Linked to Schizophrenia Onset

From Psychiatric News Alert: The levels of certain immune-related molecules in the cerebrospinal fluid appear to differ in individuals with schizophrenia and at risk for schizophrenia compared with healthy control subjects, scientists report in Schizophrenia Bulletin. The study was headed by Lindsay Hayes, Ph.D., a postdoctoral fellow at the Johns Hopkins Schizophrenia Center, and Akira Sawa, M.D., Ph.D., director of the center. 

Another potentially important finding the researchers reported was that the levels of these molecules in schizophrenia-risk subjects were “exacerbated” compared with the levels in subjects who already had been diagnosed with schizophrenia. Thus the levels of these molecules might serve as predictive biomarkers for the onset of schizophrenia, the researchers believe. “However, this data is very preliminary and needs to be validated with additional large cohorts and in longitudinal studies to confirm their predictive impact,” Hayes toldPsychiatric News. 

Alan Brown, M.D., a professor of psychiatry and epidemiology at Columbia University and an expert on infectious agents that have been linked to schizophrenia, said in an interview that since “the abnormalities appeared to be greater in those with at-risk mental states than in those with schizophrenia suggests that a longitudinal study with cerebrospinal fluid immunologic biomarkers in the same individuals tested at different time points could be very promising.” 

More information about the immune system’s possible links to schizophrenia can be found in the Psychiatric News article, “Immune System Protein Could Give Clue to Late-Onset Schizophrenia.” To read about the value of early schizophrenia detection and treatment, see “Early Detection of Schizophrenia: The Time Is Now,” a column by then-APA President Jeffrey Lieberman, M.D. 

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