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What is the Impact of Neighbourhood Change & Psychotic Experiences?

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Research Paper Title

Neighborhood change and psychotic experiences in a general population sample.

Background

Social stress caused by the neighbourhood environment may be a risk factor for psychotic experiences (PEs).

However, little information is available on the effect of the perception of the neighbourhood in relation to PEs.

Methods

In a general population study in the United States (N = 974), the researchers examined the relationship between PEs and neighborhood disruption/gentrification.

Results

When adjusted for age, sex, race, income, nativity, city, marital status, and common mental disorders, higher disruption scores were significantly associated with higher odds for any PE (odds ratio = 1.09, 95% CI = 1.05-1.12).

The same pattern of associations was observed for individual PEs including delusional mood, delusion of reference and persecution, delusion of control, and hallucination.

Conclusions

This study suggests that subjectively perceived neighbourhood change may be a factor contributing to the occurrence of PEs.

There was no significant relationship between PE and gentrification.

Having a low income and racial minority status did not modify this association.

Future studies can employ comparative longitudinal analyses of individuals/neighbourhoods/cities, geographical information systems, and ethnography, to examine the impact of neighbourhood change on mental health.

Reference

Narita, Z., Knowles, K., Fedina, L., Oh, H., Stickley, A., Kelleher, I. & DeVylder, J. (2019) Neighborhood change and psychotic experiences in a general population sample. Schizophrenia Research. pii: S0920-9964(19)30543-2. doi: 10.1016/j.schres.2019.11.036. [Epub ahead of print].

What are the Comorbidity Rates of Depression & Anxiety in First Episode Psychosis?

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Research Paper Title

Comorbidity rates of depression and anxiety in first episode psychosis: A systematic review and meta-analysis.

Background

Anxiety and depression symptoms are frequently experienced by individuals with psychosis, although prevalence rates have not been reviewed in first-episode psychosis (FEP).

The aim of this systematic review was to focus on the prevalence rates for both anxiety and depression, comparing the rates within the same study population.

Methods

A systematic review and meta-analysis was completed for all studies measuring both anxiety and depression in FEP at baseline.

The search identified 6040 citations, of which n = 10 met inclusion criteria.

These reported 1265 patients (age 28.3 ± 9.1, females: 39.9%) with diagnosed FEP.

Studies which used diagnosis to define comorbidity count were included in separate meta-analyses for anxiety and depression, although the heterogeneity was high limiting interpretation of separate prevalence rates.

A random-effects meta-analysis also compared the mean difference between anxiety and depression within the same studies.

Results

The researchers show that anxiety and depression co-occur at a similar rate within FEP, although the exact rates are not reliable due to the heterogeneity between the small number of studies.

Conclusions

Future research in FEP should consider routinely measuring anxiety and depression using continuous self-report measures of symptoms.

Clinically, the researchers recommend that both anxiety and depression are equally targeted during psychological intervention in FEP, together with the psychotic symptoms.

Reference

Wilson, R.S., Yung, A.R. & Morrison, A.P. (2019) Comorbidity rates of depression and anxiety in first episode psychosis: A systematic review and meta-analysis. Schizophrenia Research. pii: S0920-9964(19)30542-0. doi: 10.1016/j.schres.2019.11.035. [Epub ahead of print].

Can Brain Changes Reflected by Alterations in Functional Connectivity be a Useful for Outcome Prediction in the Prodromal Stage?

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Research Paper Title

Brain functional connectivity data enhance prediction of clinical outcome in youth at risk for psychosis.

Background

The first episode of psychosis is typically preceded by a prodromal phase with subthreshold symptoms and functional decline.

Improved outcome prediction in this stage is needed to allow targeted early intervention.

This study assesses a combined clinical and resting-state fMRI prediction model in 137 adolescents and young adults at Clinical High Risk (CHR) for psychosis from the Shanghai At Risk for Psychosis (SHARP) programme.

Methods

Based on outcome at one-year follow-up, participants were separated into three outcome categories including:

  • Good outcome (symptom remission, N = 71);
  • Intermediate outcome (ongoing CHR symptoms, N = 30); and
  • Poor outcome (conversion to psychosis or treatment-refractory, N = 36).

Validated clinical predictors from the psychosis-risk calculator were combined with measures of resting-state functional connectivity.

Results

Using multinomial logistic regression analysis and leave-one-out cross-validation, a clinical-only prediction model did not achieve a significant level of outcome prediction (F1 = 0.32, p = .154).

An imaging-only model yielded a significant prediction model (F1 = 0.41, p = .016), but a combined model including both clinical and connectivity measures showed the best performance (F1 = 0.46, p < .001).

Influential predictors in this model included functional decline, verbal learning performance, a family history of psychosis, default-mode and frontoparietal within-network connectivity, and between-network connectivity among language, salience, dorsal attention, sensorimotor, and cerebellar networks.

Conclusions

These findings suggest that brain changes reflected by alterations in functional connectivity may be useful for outcome prediction in the prodromal stage.

Reference

Collin, G., Nieto-Castanon, A., Shenton, M.E., Pasternak, O., Kelly, S., Keshavan, M.S., Seidman, L.J., McCarley, R.W., Niznikiewicz, M.A., Li, H., Zhang, T., Tang, Y., Stone, W.S., Wang, J. & Whitfield-Gabrieli, S. (2019) Brain functional connectivity data enhance prediction of clinical outcome in youth at risk for psychosis. NeuroImage Clinical. doi: 10.1016/j.nicl.2019.102108. [Epub ahead of print].

What are the Effects from Perinatal Period to Adulthood on Psychosocial Stress & Adversity?

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Research Paper Title

Psychosocial Stress and Adversity: Effects from the Perinatal Period to Adulthood.

Abstract

Early exposure to stress and adversity can have both immediate and lasting effects on physical and psychological health.

Critical periods have been identified in infancy, during which the presence or absence of experiences can alter developmental trajectories.

There are multiple explanations for how exposure to psychosocial stress, before conception or early in life, has an impact on later increased risk for developmental delays, mental health, and chronic metabolic diseases.

Through both epidemiologic and animal models, the mechanisms by which experiences are transmitted across generations are being identified.

Because psychosocial stress has multiple components that can act as stress mediators, a comprehensive understanding of the complex interactions between multiple adverse or beneficial experiences and their ultimate effects on health is essential to best identify interventions that will improve health and outcomes.

This review outlines what is known about the biology, transfer, and effects of psychosocial stress and early life adversity from the perinatal period to adulthood.

This information can be used to identify potential areas in which clinicians in neonatal medicine could intervene to improve outcomes.

Reference

Barrero-Castillero, A., Morton, S.U., Nelson, C.A. & Smith, V.C. (2019) Psychosocial Stress and Adversity: Effects from the Perinatal Period to Adulthood. NeoReviews. 20(12):e686-e696. doi: 10.1542/neo.20-12-e686.

Schizophrenia & the Dopamine Transporter

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Research Paper Title

Altered levels of dopamine transporter in the frontal pole and dorsal striatum in schizophrenia.

Background

The dopamine hypothesis proposes that there is a hypodopaminergic state in the prefrontal cortex and a hyperdopaminergic state in the striatum of patients with schizophrenia.

Evidence suggests the hyperdopaminergic state in the striatum is due to synaptic dopamine elevation, particularly in the dorsal striatum.

However, the molecular mechanisms causing disrupted dopaminergic function in schizophrenia remains unclear.

The researchers postulated that the dopamine transporter (DAT), which regulates intra-synaptic dopamine concentrations by transporting dopamine from the synaptic cleft into the pre-synaptic neuron, could be involved in dopaminergic dysfunction in schizophrenia.

Methods

Therefore, they measured levels of DAT in the cortex and striatum from patients with schizophrenia and controls using postmortem human brain tissue. Levels of desmethylimipramine-insensitive mazindol-sensitive [3H]mazindol binding to DAT were measured using in situ radioligand binding and autoradiography in gray matter from Brodmann’s area (BA) 10, BA 17, the dorsal striatum, and nucleus accumbens from 15 patients with schizophrenia and 15 controls.

Results

Levels of desmethylimipramine-insensitive mazindol-sensitive [3H]mazindol binding were significantly higher in BA 10 from patients with schizophrenia (p = 0.004) and significantly lower in the dorsal striatum (dorsal putamen p = 0.005; dorsal caudate p = 0.007) from those with the disorder.

There were no differences in levels of desmethylimipramine-insensitive [3H]mazindol binding in BA 17 or nucleus accumbens.

Conclusions

These data raise the possibility that high levels of DAT in BA 10 could be contributing to lower synaptic cortical dopamine, whereas lower levels of DAT could be contributing to a hyperdopaminergic state in the dorsal striatum.

Reference

Sekiguchi, H., Pavey, G. & Dean, B. (2019) Altered levels of dopamine transporter in the frontal pole and dorsal striatum in schizophrenia. NPJ Schizophrenia. 5(1), pp.20. doi: 10.1038/s41537-019-0087-7.

Is Skin Fairness a Better Predictor for Impaired Physical & Mental Health than Hair Redness?

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Research Paper Title

Skin fairness is a better predictor for impaired physical and mental health than hair redness.

Background

About 1-2% of people of European origin have red hair.

Especially female redheads are known to suffer higher pain sensitivity and higher incidence of some disorders, including skin cancer, Parkinson’s disease and endometriosis.

Methods

Recently, an explorative study performed on 7,000 subjects showed that both male and female redheads score worse on many health-related variables and express a higher incidence of cancer.

Here, the researchers ran the preregistered study on a population of 4,117 subjects who took part in an anonymous electronic survey.

Results

They confirmed that the intensity of hair redness negatively correlated with physical health, mental health, fecundity and sexual desire, and positively with the number of kinds of drugs prescribed by a doctor currently taken, and with reported symptoms of impaired mental health.

It also positively correlated with certain neuropsychiatric disorders, most strongly with learning disabilities disorder and phobic disorder in men and general anxiety disorder in women.

However, most of these associations disappeared when the darkness of skin was included in the models, suggesting that skin fairness, not hair redness, is responsible for the associations.

Conclusions

The researchers discussed two possible explanations for the observed pattern, the first based on vitamin D deficiency due to the avoidance of sunbathing by subjects with sensitive skin, including some redheads, and second based on folic acid depletion in fair skinned subjects, again including some (a different subpopulation of) redheads.

It must be emphasised, however, that both of these explanations are only hypothetical as no data on the concentration of vitamin D or folic acid are available for the subjects.

The results, as well as the conclusions of current reviews, suggest that the new empirical studies on the concentration of vitamin D and folic acids in relation to skin and hair pigmentation are urgently needed.

Reference

Flegr, J. & Sýkorová, K. (2019) Skin fairness is a better predictor for impaired physical and mental health than hair redness. Scientific Reports. 9(1):18138. doi: 10.1038/s41598-019-54662-5.

Overview of Trauma- & Stress-Related Disorders

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Trauma- and stress-related disorders result from exposure to a traumatic or stressful event.

Specific disorders include acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). These disorders cause similar symptoms but differ in how long they last.

  • ASD:
    • Typically begins immediately after the event.
    • Lasts from 3 days to 1 month.
  • PTSD:
    • Lasts for more than 1 month.
    • It may develop as a continuation of acute stress disorder or develop separately up to 6 months after the event.

Although depression and anxiety are often prominent, individuals with trauma-related disorders often have a wide variety of symptoms that may not obviously seem related to the traumatic event.

For example, individuals may:

  • Act aggressively;
  • Be unable to experience pleasure; and/or
  • Feel restless, discontented, angry, numb, or disconnected from themselves and others.

Treatment of Anxiety Disorders

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When treating anxiety disorders, there are a number of things to consider:

  • Treatment of the cause if appropriate;
  • Psychotherapy;
  • Drug therapy; and/or
  • Treatment of other active disorders.

Accurate diagnosis is important because treatment varies from one anxiety disorder to another.

Additionally, anxiety disorders must be distinguished from anxiety that occurs in many other mental health disorders, which involve different treatment approaches.

If the cause is another medical disorder or a drug, medical professionals aim to correct the cause rather than treat the symptoms of anxiety.

Anxiety should subside after the physical disorder is treated or the drug has been stopped long enough for any withdrawal symptoms to abate.

If anxiety remains, anti-anxiety drugs or psychotherapy (such as behavioural therapy) is used.

For individuals who are dying, certain strong pain relievers, such as morphine, may relieve both pain and anxiety.

If an anxiety disorder is diagnosed, drug therapy or psychotherapy (such as behavioral therapy), alone or in combination, can significantly relieve the distress and dysfunction for most individuals.

Benzodiazepines (such as diazepam) are commonly prescribed for acute anxiety.

For many individuals, antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), work as well for anxiety disorders as they do for depression.

Specific treatments depend on which anxiety disorder is diagnosed.

All of the anxiety disorders can occur along with other psychiatric conditions.

For example, anxiety disorders often occur along with an alcohol use disorder.

It is important to treat all of these conditions as soon as possible.

Treating the alcohol use disorder without treating the anxiety is unlikely to be effective since the individual may be using alcohol to treat the anxiety.

On the other hand, treating the anxiety without addressing the alcohol disorder may be unsuccessful because daily changes in the amount of alcohol in the blood can cause levels of anxiety to fluctuate.

Diagnosis of Anxiety Disorders

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A diagnosis of anxiety disorder is via a medical professional’s evaluation, based on specific criteria.

Deciding when anxiety is severe enough to be considered a disorder can be complicated.

Individual ability to tolerate anxiety varies, and determining what constitutes abnormal anxiety can be difficult.

Medical professionals usually use the following specific established criteria:

  • Anxiety is very distressing.
  • Anxiety interferes with functioning.
  • Anxiety is long-lasting or keeps coming back

Medical professionals look for other disorders that may be causing anxiety, such as depression or a sleep disturbance.

They may also ask whether relatives have had similar symptoms, because anxiety disorders tend to run in families.

Medical professionals also do a physical examination. Blood and other tests may be done to check for other medical disorders that can cause anxiety.

Symptoms of Anxiety Disorders

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Anxiety can arise suddenly, as in panic, or gradually over minutes, hours, or days.

Anxiety can last for any length of time, from a few seconds to years.

It ranges in intensity from barely noticeable qualms to a full-blown panic attack, which may cause shortness of breath, dizziness, an increased heart rate, and trembling (tremor).

Anxiety disorders can be so distressing and interfere so much with an individual’s life that they can lead to depression.

Individuals may develop a substance use disorder.

Individuals who have an anxiety disorder (except for certain very specific phobias, such as fear of spiders) are at least twice as likely to have depression as those without an anxiety disorder.

Sometimes individuals with depression develop an anxiety disorder.