Progressive Brain Changes in Children and Adolescents With First-Episode Psychosis

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CONTEXT: Progressive loss of brain gray matter (GM) has been reported in childhood-onset schizophrenia; however, it is uncertain whether these changes are shared by pediatric patients with different psychoses.

OBJECTIVE: To examine the progression of brain changes in first-episode early-onset psychosis and their relationship to diagnosis and prognosis at 2-year follow-up.

DESIGN: Prospective, multicenter, naturalistic, 2-year follow-up study.

SETTING: Six child and adolescent psychiatric units in Spain.

PARTICIPANTS: A total of 110 patients and 98 healthy controls were recruited between March 1, 2003, and November 31, 2005. Magnetic resonance imaging of the brain was performed for 61 patients with schizophrenia (n = 25), bipolar disorder (n = 16), or other psychoses (n = 20) and 70 controls (both at baseline and after 2 years of follow-up). Mean age at baseline was 15.5 years (patients) and 15.3 years (controls).

MAIN OUTCOME MEASURES: The GM and cerebrospinal fluid (CSF) volumes in the total brain and frontal, parietal, and temporal lobes.

RESULTS: Compared with controls, patients with schizophrenia showed greater GM volume loss in the frontal lobe during the 2-year follow-up (left: -3.3 vs -0.6 cm(3), P = .004; right: -3.7 vs -0.8 cm(3), P = .005) and left frontal CSF volume increase (left: 6.7 vs 2.4 cm(3), P = .006). In addition to frontal volume, changes for total GM (-37.1 vs -14.5 cm(3), P = .001) and left parietal GM (-4.3 vs -2.2 cm(3), P = .04) were significantly different in schizophrenic patients compared with controls. No significant differences emerged for patients with bipolar disease. Greater left frontal GM volume loss was related to more weeks of hospitalization, whereas severity of negative symptoms correlated with CSF increase in patients with schizophrenia.

CONCLUSIONS: Patients with schizophrenia or other psychoses showed greater loss of GM volume and increase of CSF in the frontal lobe relative to controls. Progressive changes were more evident in patients with schizophrenia than those with bipolar disorder. These changes in specific brain volumes after onset of psychotic symptoms may be related to markers of poorer prognosis.

Arch Gen Psychiatry. 2012; 69(1):16-26 (ISSN: 1538-3636)

Arango C; Rapado-Castro M; Reig S; Castro-Fornieles J; González-Pinto A; Otero S; Baeza I; Moreno C; Graell M; Janssen J; Parellada M; Moreno D; Bargalló N; Desco M
Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain. carango@hggm.es

Factors in Treatment Adherence for Schizophrenia

Factors such as problems with sticking to routines and gaps in the service system may predict non-adherence, but “poor insight” – anosognosia – may be the biggest predictor of all. All the same, one writer says care givers may have more influence over medication adherence than they know.

When the medical condition under treatment is a severe mental illness like schizophrenia, however, the consequences of non-treatment can be devastating and lasting: worsening symptoms, cognitive damage, hospitalization, not to mention arrest, incarceration, homelessness and other outcomes of disordered thinking.

Treatment Advocacy Center

http://www.treatmentadvocacycenter.org/about-us/our-blog/69-no-state/2064-factors-in-treatment-adherence-for-schizophrenia-

Molecular and Genetic Evidence for Abnormalities in the Nodes of Ranvier in Schizophrenia

Arch Gen Psychiatry. 2012; 69(1):7-15 (ISSN: 1538-3636)

Roussos P ; Katsel P ; Davis KL ; Bitsios P ; Giakoumaki SG ; Jogia J ; Rozsnyai K ; Collier D ; Frangou S ; Siever LJ ; Haroutunian V
Department of Psychiatry, The Mount Sinai School of Medicine, Bronx, NY 10468, USA.

CONTEXT: Genetic, neuroimaging, and molecular neurobiological evidence support the hypothesis that the disconnectivity syndrome in schizophrenia (SZ) could arise from failures of saltatory conduction and abnormalities at the nodes of Ranvier (NOR) interface where myelin and axons interact.

OBJECTIVE: To identify abnormalities in the expression of oligodendroglial genes and proteins that participate in the formation, maintenance, and integrity of the NOR in SZ.

DESIGN: The messenger RNA (mRNA) expression levels of multiple NOR genes were quantified in 2 independent postmortem brain cohorts of individuals with SZ, and generalizability to protein expression was confirmed. The effect of the ANK3 genotype on the mRNA expression level was tested in postmortem human brain. Case-control analysis tested the association of the ANK3 genotype with SZ. The ANK3 genotype’s influence on cognitive task performance and functional magnetic resonance imaging activation was tested in 2 independent cohorts of healthy individuals.

SETTING: Research hospital. Patients Postmortem samples from patients with SZ and healthy controls were used for the brain expression study (n = 46) and the case-control analysis (n = 272). Healthy white men and women participated in the cognitive (n = 513) and neuroimaging (n = 52) studies.

MAIN OUTCOME MEASURES: The mRNA and protein levels in postmortem brain samples, genetic association with schizophrenia, cognitive performance, and blood oxygenation level-dependent functional magnetic resonance imaging.

RESULTS: The mRNA expression of multiple NOR genes was decreased in schizophrenia. The ANK3 rs9804190 C allele was associated with lower ANK3 mRNA expression levels, higher risk for SZ in the case-control cohort, and poorer working memory and executive function performance and increased prefrontal activation during a working memory task in healthy individuals.

CONCLUSIONS: These results point to abnormalities in the expression of genes and protein associated with the integrity of the NOR and suggest them as substrates for the disconnectivity syndrome in SZ. The association of ANK3 with lower brain mRNA expression levels implicates a molecular mechanism for its genetic, clinical, and cognitive associations with SZ.

PreMedline Identifier:21893642

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

Pilot Program Demonstrates Measureable Benefits for People with Schizophrenia

Evidence-Based Tools Help Improve Daily Functioning and Increase Treatment Transparency and Accountability

March 8, 2012 – Washington, D.C. – People with schizophrenia report improved functioning after participating in a new, evidence-based clinical program, according to results announced today from a six-month pilot. The program, Advancing Standards of Care for People with Schizophrenia, was spearheaded by the National Council for Community Behavioral Healthcare (National Council) and administered at 10 community behavioral health organizations across the country. The program significantly improved communication, social interaction and coping skills for persons recovering from schizophrenia.

“Although society’s understanding of schizophrenia has progressed over the decades, we can do more to help people with the illness recover,” said Linda Rosenberg, President and CEO of the National Council. “This program promotes practitioner and consumer partnerships. Together they measure progress and reinforce what works. It’s a true step forward for people with schizophrenia and the organizations that serve them.”

The program revolved around two evidence-based tools: a group curriculum to help adults better understand and self-manage their mental health condition; and a functional assessment tool, which tracks a person’s ability to independently carry out everyday tasks. The tools encourage participants to take control of their mental illness, discuss it with others, and monitor progress. Participants said they found this helpful in addressing the misconceptions others may have about them.

According to one 49-year-old treated at Hill Country Mental Health in Kerrville, Texas, participating in the program gave her confidence to face her diagnosis and fears.“I was frightened, isolated and sometimes in denial about my illness,” she said. “After participating in this program, I’m much more confident discussing things openly with my mental health provider and even sharing what I’ve learned with people around me.”

Health care providers that participated in the program said that the measurement tool gave them accurate and reliable data that supported increased transparency and accountability.
“We are all adapting to health care system changes that recognize the value of care over volume of care,” said Linda Werlein, CEO of Hill Country Mental Health. “This program provided both an effective curriculum, and a way to demonstrate progress.”

Rosenberg also notes that the program’s success holds great potential for replication. She emphasizes, “the participating behavioral health centers found the interventions to be effective, easy to administer and results-oriented, and many of them plan to spread the program throughout their organizations.”

Christopher, a client at AltaPointe Health Systems in Mobile, Alabama, says the program encouraged him to think about and solve problems in new ways. “I learned valuable life skills, how to stay healthy, manage my anger, and prevent a relapse,” he explained.

Key Results:

  • The 10 pilot sites started with a total of 568 clients in December, 2010.
  • The average age of participants was 45.7 years, many of whom had already been in treatment for years
  • 20 percent of participants scored an “inability to function in all areas” on the pre-interventional functional assessment
  • 50 percent of participants scored “major impairment” in at least five critical areas of functioning in daily activities
  • The average cumulative functional score from all participants rose from an initial 37.76 to 41.07 over the course of six months.
  • Overall, there was a statistically significant gain in three sub-scales: communications, interaction with one’s social network, and coping skills.
  • There was an overall attrition rate of 48 percent, consistent with community based treatment protocols.

A full list of pilot sites in the Advancing Standards of Care for People with Schizophrenia program and a copy of the outcomes report program can be found at www.thenationalcouncil.org.

Funding for the Advancing Standards of Care for People with Schizophrenia program was made possible through a grant from Sunovion Pharmaceuticals Inc.

About Schizophrenia

Schizophrenia is a brain disorder that can impair a person’s ability to think clearly and relate to others. People with schizophrenia may become withdrawn or have difficulty in everyday situations. Schizophrenia typically develops in adolescence or early adulthood, although it may occur later in life. Schizophrenia varies in severity, can be treated and recovery is possible.

About the National Council

The National Council is a not-for-profit, 501(c) (3) association of 1,950 community healthcare organizations that provide treatment and rehabilitation for mental illnesses and addiction disorders to nearly 6 million adults, children and families in communities across the country. Learn more at www.The NationalCouncil.org.

About Sunovion

Sunovion is a leading pharmaceutical company dedicated to discovering, developing and commercializing therapeutic products that advance the science of medicine in the central nervous system (CNS) and respiratory disease areas and improve the lives of patients and their families. Sunovion is an indirect, wholly-owned subsidiary of Dainippon Sumitomo Pharma Co., Ltd. More information is available at www.sunovion.com

 

Contact Communications@thenationalcouncil.org

Successful Smoking Cessation With Electronic Cigarettes

 

Smoking cessation programs are useful in helping smokers to quit, but smoking is a very difficult addiction to break and the need for novel and effective approaches to smoking cessation interventions is unquestionable. The E-cigarette is a battery-powered electronic nicotine delivery device that may help smokers to remain abstinent during their quit attempt. We report for the first time objective measures of smoking cessation in smokers who experimented with the E-cigarette.

By Pasquale Caponnetto; Riccardo Polosa; Cristina Russo; Carmelo Leotta; Davide Campagna from Journal of Medical Case Report

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Waiting For Mental Health Parity

Every day across the United States, families struggle with the challenges of mental illness or substance abuse. The 68 million Americans with these issues include people of all income levels, all races and all political affiliations. Mental illness does not discriminate.

Often, the difference between being overwhelmed as a family or meeting the challenges head-on and making progress against the illness can be just one factor: access to meaningful health insurance. Even those who think they have quality health coverage can be overwhelmed when a loved one receives a diagnosis of mental illness or is a substance abuser. They discover that their health insurance does not cover needed services or that the out-of-pocket expenses are prohibitive and significantly more than what is charged for physical ailments.

By Pete Domenici and Gordon H. Smith at the Washington Post

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