Machine Learning Can Help Identify First Episodes of Schizophrenia, As Well As Treatment Response

MedicalResearch.com Interview with:

Bo Cao, Ph.D. Assistant Professor Department of Psychiatry Faculty of Medicine & Dentistry University of Alberta Edmonton

Dr. Bo Cao

Bo Cao, Ph.D.
Assistant Professor
Department of Psychiatry
Faculty of Medicine & Dentistry
University of Alberta
Edmonton

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Schizophrenia is a severe psychiatric disorder that comes with delusions, hallucinations, poor motivation, cognitive impairments.

The economic burden of schizophrenia was estimated at $155.7 billion in 2013 alone in the United States. Schizophrenia usually emerges early in life and can potentially become a lifetime burden for some patients. Repeated untreated psychotic episodes may be associated with irreversible alterations of the brain. Thus, it is crucial to identify schizophrenia early and provide effective treatment. However, identifying biomarkers in schizophrenia during the first episode without the confounding effects of treatment has been challenging. Limited progress has been made in leveraging these biomarkers to establish diagnosis and make individualized predictions of future treatment responses to antipsychotics.

In a recent study by Dr. Cao and his colleagues, they successfully identified the first-episode drug-naïve schizophrenia patients (accuracy 78.6%) and predict their responses to antipsychotic treatment (accuracy 82.5%) at an individual level by using a machine learning algorithm and the functional connections of a brain region called the superior temporal cortex.  Continue reading

Perinatal Folic Acid May Protect Against Serious Mental Illness in Young People

MedicalResearch.com Interview with:

Joshua L. Roffman, MD Department of Psychiatry Mass General Hospital

Dr. Roffman

Joshua L. Roffman, MD
Department of Psychiatry
Mass General Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Autism, schizophrenia, and other serious mental illness affecting young people are chronic, debilitating, and incurable at present.  Recent public health studies have associated prenatal exposure to folic acid, a B-vitamin, with reduced subsequent risk of these illnesses.  However, until this point, biological evidence supporting a causal relationship between prenatal folic acid exposure and reduced psychiatric risk has remained elusive.

We leveraged the rollout of government-mandated folic acid fortification of grain products in the U.S. from 1996-98 as a “natural experiment” to determine whether increased prenatal folic acid exposure influenced subsequent brain development.  This intervention, implemented to reduce risk of spina bifida and other disabling neural tube defects in infants, rapidly doubled blood folate levels among women of childbearing age in surveillance studies.

Across two large, independent cohorts of youths age 8 to 18 who received MRI scans, we observed increased cortical thickness, and a delay in age-related cortical thinning, in brain regions associated with schizophrenia risk among individuals who were born during or after the fortification rollout, compared to those born just before it.  Further, delayed cortical thinning also predicted reduced risk of psychosis spectrum symptoms, a finding that suggests biological plausibility in light of previous work demonstrating early and accelerated cortical thinning among school-aged individuals with autism or psychosis.

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Study finds Cannabis Use Not Associated With Increased Suicide Risk in Patients with Psychiatric Disorders

MedicalResearch.com Interview with:

“Cannabis sativa” by Manuel is licensed under CC BY 2.0

Leen Naji, BHSc, MD
Family Medicine Resident
McMaster University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cannabis use has consistently been linked to suicide attempt in the general population, but little data exists linking the association between cannabis use and suicide attempt amongst patients with psychiatric disorders. This is important data as we know that patients with psychiatric disorders are both more likely to use cannabis and to attempt suicide. Therefore, our goal was to study the association between cannabis use and suicide attempt amongst patients with psychiatric disorders. Additionally, since we know that women are more likely to suffer from mental health disorders, are more likely to attempt suicide and are more likely to incur the deleterious consequences of drug use at lower doses, we sought to compare the association between cannabis use and suicide attempt in men and women amongst our study population.

We conducted our analysis on a large sample of over 900 adults with psychiatric disorders (465 men, 444 women), of whom 112 men and 158 women had attempted suicide. The average age of our study sample was 40 years.

We found that cannabis use is not associated with an increased risk of suicide in patients with psychiatric disorders, though this association may vary when looking at specific subpopulations and/or amount of cannabis use. For instance, we found that heavier cannabis use is associated with an increased risk of suicide attempt amongst men with psychiatric disorders. Specifically, there was a 3% increased risk of suicide attempt for every day of cannabis use per month in men with psychiatric disorders. We also found that amongst those with psychiatric conditions, women, unemployed individuals and those with a mood disorder were at increased risk of suicide attempt.   Continue reading

Short-Term Prolonged Exposure Therapy Found Effective in PTSD Trial

MedicalResearch.com Interview with:
“Man’s best friend helps NC Guardsman with PTSD [Image 1 of 8]” by DVIDSHUB is licensed under CC BY 2.0, PhD

Professor of Psychiatry
Director, Center for the Treatment and Study of Anxiety
University of Pennsylvania
Philadelphia, Pa 19104

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As much as 10 to 20 percent of military members deployed to Iraq and Afghanistan following the September 11th attacks suffer from PTSD, which is often chronic and incapacitating. A constant increase in the number of individuals suffering from PTSD as a result of massive natural disasters, terror attacks, and the wars in Iraq and Afghanistan, has prompted an urgent need for effective and efficient evidence-based treatments for PTSD.

Prolong exposure (PE) is a form of cognitive-behavioral therapy that involves exposure to trauma memories and daily life trauma reminders. Previous studies have proven PE is quite effective for treating civilians and veterans with PTSD. In this five-year study, the researchers sought to determine whether PE could have similar success with active-duty military personnel. The researchers examined the benefit of various methods for delivering PE including Massed-PE, (10 therapy sessions administered over two weeks) and Spaced-PE (10 sessions administered over 8 weeks), as well as Present Centered Therapy (PCT), a non-trauma-focused therapy that involves identifying and discussing daily stressors in 10 sessions over eight weeks, and Minimal Contact Control (MCC), which included supportive phone calls from therapists once weekly for four weeks.

Patients who received Massed-PE therapy, delivered over two weeks, saw a greater reduction in PTSD symptoms than those who received MCC. Importantly, Massed-PE therapy was found to be equally effective to Spaced-PE in reducing PTSD symptom severity. The researchers also found that PCT might be an effective treatment option for PTSD in active military personnel although it was less effective than PE in veteran and civilian PTSD sufferers.  Continue reading

Deep Brain Stimulation Helpful For Some Visual Hallucinations

MedicalResearch.com Interview with:

Dr. Foltynie

Dr. Foltynie

Thomas Foltynie MD PhD
Senior Lecturer and Honorary Consultant Neurologist
Unit of Functional Neurosurgery Institute of Neurology and
National Hospital for Neurology and Neurosurgery
University College London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Stimulation of the Nucleus Basalis of Meynert can enhance cholinergic innervation of the cortex in animal models and has been previously reported to have beneficial cognitive effects in a single patient with Parkinson’s Disease dementia.

In this double blind crossover trial, six patients with Parkinson’s Disease underwent low frequency stimulation to the NBM bilaterally.  While there were no consistent objective improvements in cognitive performance, there was a marked reduction in visual hallucinations in two of the participants. .

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Consequences of Interpersonal Violence Against Child Athletes Persist into Adulthood

MedicalResearch.com Interview with:

Tine Vertommen, Criminologist Faculty of Medicine and Health Sciences Universiteitsplein 1 Antwerp, Belgium

Tine Vertommen

Tine Vertommen, Criminologist
Faculty of Medicine and Health Sciences
Universiteitsplein 1
Antwerp, Belgium

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: A recent prevalence study into interpersonal violence against child athletes in the Netherlands and Belgium showed that 6% experienced severe sexual violence, 8% experienced severe physical violence, and 9% of respondents experienced severe psychological violence in sport (Vertommen et al., 2016). While general literature has repeatedly shown that exposure to interpersonal violence during childhood is associated with mental health problems in adulthood, this relationship has not yet been demonstrated in (former) athletes. Thus, the objective of the current study is to assess the long-term consequences of these experiences on adult mental health and quality of life.

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Intermittent Explosive Disorder Linked To Higher Risk of Substance Abuse

MedicalResearch.com Interview with:

Emil F. Coccaro, M.D. Ellen C. Manning Professor Department of Psychiatry and Behavioral Neuroscience The University of Chicago Chicago, Illinois 60637

Dr. Emil Coccaro

Emil F. Coccaro, M.D.
Ellen C. Manning Professor
Department of Psychiatry and Behavioral Neuroscience
The University of Chicago
Chicago, Illinois 60637

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Aggressive behavior and drug use have been related for years but this study shows people with problematic aggression (Intermittent Explosive Disorder: IED) are in fact at risk for developing alcohol, tobacco, and cannabis use disorders and that the onset of problematic aggression (IED) begins before the onset of the drug use.

The increased risk for alcohol use disorder was nearly six-fold higher, the increased risk for cannabis use disorder was seven-fold higher, and the increased risk for tobacco use disorder  was four-fold higher. In addition, the presence of IED increased the severity of the substance use disorder.

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Is Depression in Mild Cognitive Impairment a Precursor to Dementia?

MedicalResearch.com Interview with:
Zahinoor Ismail MD FRCPC

Clinical Associate Professor,
Hotchkiss Brain Institute
University of Calgary

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Depression and depressive symptoms are common in mild cognitive impairment (MCI). Evidence suggests that depression in MCI increases the likelihood of progression from MCI to dementia, compared to non-depressed people with MCI. In the newer construct of mild behavioural impairment (MBI), which describes the relationship between later life onset of sustained and impactful neuropsychiatric symptoms and the risk of cognitive decline and dementia, depression is an important subdomain (in addition to apathy, impulse control, social cognition and psychotic symptoms). Thus, depression and depressive symptoms are a significant risk factor for cognitive, behavioural and functional outcomes in older adults who have at most mild cognitive impairment. As the importance of neuropsychiatric symptoms in older adults emerges, good prevalence estimates are required to inform clinicians and researchers as well as public health policy and decision makers.

We performed a systematic review and meta-analysis to determine the best estimate of prevalence of depression in  mild cognitive impairment. We included 57 studies, representing 20,892 participants in the analysis. While we determined that the omnibus prevalence estimate was 32%, there was significant heterogeneity in this sample based on setting. In community samples, the rate was 25%, but in clinical samples this was higher at 40%. Additionally, different case ascertainment methods for depression (self report, clinician administered or caregiver report) and different MCI criteria didn’t change the prevalence estimates.

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Auditory Perceptual Abnormalities As High Risk Indictor of Progression to Psychosis

MedicalResearch.com Interview with:
Guillermo Horga, MD, PhD

Assistant Professor of Clinical Psychiatry
Columbia University Medical Center

MedicalResearch.com: What is the background for this study?

Response: Some people who eventually develop schizophrenia or other psychotic disorders have early “prodromal” symptoms such as subtle perceptual abnormalities and unusual thoughts that precede the onset of these disorders by months or even years. These subtle symptoms are typically not fully formed or met with full conviction, which distinguishes them from full-blown symptoms of psychosis.

The “prodromal” phase has been the subject of intense study as researchers believe it can provide an invaluable window into the neurobiological processes that cause psychotic disorders as well as an opportunity to develop early preventive interventions. Persons who experience “prodromal” symptoms (known as “clinical high-risk” individuals) tend to report a variety of relatively subtle perceptual abnormalities (e.g., heightened sensitivity to sounds, distortions in how objects are perceived, momentarily hearing voices of speakers who are not present), unusual thoughts, and disorganized speech, some of which have been shown to be particularly informative in distinguishing who among these persons will eventually develop a full-blown psychotic disorder, a prediction that is clinically important as it may indicate the need for close monitoring of individuals who are at the greatest risk. Even though subtle perceptual abnormalities are common in this population, the available research indicates that they are as a whole uninformative for clinical prediction purposes. However, previous research in this area had never examined in detail whether assessing perceptual abnormalities in different sensory domains (such as visual versus auditory abnormalities) separately could be more informative than assessing them as a whole.

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Psychotic Experiences and Cognitive Deficits Affects Large Proportion of Population

Josephine Mollon MSc Department of Psychosis Studies Institute of Psychiatry, Psychology, and Neuroscience King’s College London London, England

Josephine Mollon

MedicalResearch.com Interview with:
Josephine Mollon MSc

Department of Psychosis Studies
Institute of Psychiatry, Psychology, and Neuroscience
King’s College London
London, England

 Medical Research: What is the background for this study? What are the main findings?

Dr. Mollon: Psychotic symptoms, such as hallucinations and delusions, are core features of psychotic disorders. A significant minority of the general population also reports subclinical psychotic experiences. Evidence suggests that these experiences may lie on a continuum with clinically significant psychotic symptoms. For example, cognitive deficits, which are a hallmark of psychotic disorders, are also seen in people with subclinical psychotic experiences. We used population-based survey data to characterize cognitive functioning in adults with psychotic experiences while adjusting for important sociodemographic characteristics and investigating the effect of age.

The 171 (9.7%) adults with psychotic experiences showed significant memory and verbal deficits, but not IQ or processing speed deficits. Only participants 50 years and older with psychotic experiences showed medium to large impairments in general IQ, verbal knowledge, working memory and memory after adjusting for socioeconomic status, cannabis use, and common mental disorders.

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Adverse Childhood Experiences Common in Military Men

John Blosnich, Ph.D., M.P.H., Post-doctoral fellow at the Center for Health Equity Research and Promotion Veterans Affairs Pittsburgh Healthcare System.
MedicalResearch.com Interview with:
John Blosnich, Ph.D., M.P.H.,
Post-doctoral fellow at the Center for Health Equity Research and Promotion
Veterans Affairs Pittsburgh Healthcare System.

Medical Research: What are the main findings of the study?

Dr. Blosnich: I think there are two main findings from our study:

First, since the beginning of the All-Volunteer U.S. military in 1973, there has been a shift in childhood experiences among men who have served in the military.

Second, the childhood experiences of women who have served in the military have been largely similar across the Draft and All-Volunteer Eras.
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