Preliminary evidence that fatigue contributes to anhedonia in stable individuals diagnosed with schizophrenia

ObjectivesAnhedonia and fatigue are trans-diagnostic symptoms commonly observed in schizophrenia. Anhedonia is a core negative symptom with a strong relationship with depression and is associated with diminished global functioning. Similarly, fatigue is also associated to depression and research across psychiatric illnesses indicate that fatigue may persist even when primary symptoms are treated. Although fatigue is common in people diagnosed with schizophrenia, it is under studied within this population. The objective of this exploratory study was to investigate the association of fatigue and anhedonia by controlling for depression in a sample of individuals diagnosed with schizophrenia.MethodFifty-one stable individuals diagnosed with schizophrenia from the University Department of Adult Psychiatry in Montpellier took part in this study. Participants completed questionnaires on fatigue impact and depression, and were assessed for symptom severity. Following data collection, statistical analyses were conducted in order to explore associations between clinical variables and fatigue impact. Based on the results obtained, a hierarchical linear regression was conducted in order to investigate whether fatigue impact contributed to the variance of negative symptoms.ResultsThe hierarchical linear regression indicated that when controlling for depression, fatigue impact contributes to ~20% of the variance of anhedonia. Together the social impact of fatigue and depression contribute to 24% of the variation of anhedonia.ConclusionTo the best of our knowledge, this exploratory study is the first to investigate and show that fatigue impact may contribute to anhedonia. We recommend further research to investigate fatigue, its impact on symptomatology, and better categorization of negative symptoms in hopes of developing targeted fatigue treatment interventions

Unravelling socio-motor biomarkers in schizophrenia

We present novel, low-cost and non-invasive potential diagnostic biomarkers of schizophrenia. They are based on the ‘mirror-game’, a coordination task in which two partners are asked to mimic each other’s hand movements. In particular, we use the patient’s solo movement, recorded in the absence of a partner, and motion recorded during interaction with an artificial agent, a computer avatar or a humanoid robot. In order to discriminate between the patients and controls, we employ statistical learning techniques, which we apply to nonverbal synchrony and neuromotor features derived from the participants’ movement data. The proposed classifier has 93% accuracy and 100% specificity. Our results provide evidence that statistical learning techniques, nonverbal movement coordination and neuromotor characteristics could form the foundation of decision support tools aiding clinicians in cases of diagnostic uncertainty

Hypovitaminosis D is associated with depression and anxiety in schizophrenia: results from the national FACE-SZ cohort. Running title: hypovitaminosis D, depression and anxiety in schizophrenia

International audienceBackground. Guidelines have been edited for the treatment of schizophrenia (SZ) and bipola

Effects of Facial Emotions on Social-motor Coordination in Schizophrenia

Schizophrenia patients are known to be impaired in their ability to process social information and to engage in social interactions. To understand better social cognition in schizophrenia, we investigate the links between these impairments. In this paper, we focus primarily on the influence of social feedback, such as facial emotions, on motor coordination during joint action. To investigate and quantify this influence, we exploited systematically-controlled social and nonsocial feedback provided by a humanoid robot. Humanoid robotics technology offers interactive designs and can precisely control the properties of the feedback provided during the interaction. In this work, a joint-action task with a robot is performed to investigate how social cognition is affected by cognitive capabilities and symptomatology. Results show that positive social feedback has a facilitatory effect on social-motor coordination in the control participants compared to nonsocial positive feedback. This facilitation effect is not present in schizophrenia patients, whose social-motor coordination is similar in social and nonsocial feedback conditions. This result is strongly correlated with performances in the Trail Making Test (TMT), which highlights the link between cognitive deficits and social-motor coordination in schizophrenia

Overlap and Mutual Distinctions between Clinical Recovery and Personal Recovery in People with Schizophrenia in a One-Year Study

Recovery is a multidimensional construct that can be defined either from a clinical perspective or from a consumer-focused one, as a self-broadening process aimed at living a meaningful life beyond mental illness. We aimed to longitudinally examine the overlap and mutual distinctions between clinical and personal recovery. Of 1239 people with schizophrenia consecutively recruited from the FondaMental Advanced Centers of Expertise for SZ network, the 507 present at one-year did not differ from those lost to follow-up. Clinical recovery was defined as the combination of clinical remission and functional remission. Personal recovery was defined as being in the rebuilding or in the growth stage of the Stages of Recovery Instrument (STORI). Full recovery was defined as the combination of clinical recovery and personal recovery. First, we examined the factors at baseline associated with each aspect of recovery. Then, we conducted multivariable models on the correlates of stable clinical recovery, stable personal recovery, and stable full recovery after one year. At baseline, clinical recovery and personal recovery were characterized by distinct patterns of outcome (i.e. better objective outcomes but no difference in subjective outcomes for clinical recovery, the opposite pattern for personal recovery, and better overall outcomes for full recovery). We found that clinical recovery and personal recovery predicted each other over time (baseline personal recovery for stable clinical recovery at one year; P =. 026, OR = 4.94 [1.30-23.0]; baseline clinical recovery for stable personal recovery at one year; P =. 016, OR = 3.64 [1.31-11.2]). In short, given the interaction but also the degree of difference between clinical recovery and personal recovery, psychosocial treatment should target, beyond clinical recovery, subjective aspects such as personal recovery and depression to reach full recovery. © 2021 The Author(s). Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved.Sorbonne Universités à Paris pour l'Enseignement et la RechercheFondaMental-Cohorte

Schizophrenia Bulletin Open

Treatment-resistant schizophrenia (TRS) affects around 30% of patients with schizophrenia (SZ) resulting in poor functioning, relapses, and reduced quality of life. Convergent findings show that inflammation could contribute to resistance. We thus search for immune signatures of patients with TRS/ultra TRS (UTRS) in a sample of community-dwelling outpatients with SZ. In total, 195 stabilized SZ patients (mean age = 31.2 years, 73% male gender) were consecutively included in the network of the FondaMental Expert Centers for Schizophrenia in France and received a thorough clinical assessment. At inclusion, psychotic symptomatology was evaluated by the Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Circulating serum/plasma levels of a large panel of markers reflecting the main inflammatory pathways were evaluated. TRS was defined by current treatment by clozapine (CLZ) and UTRS by current CLZ treatment + PANSS total score ≥ 70. The frequency of TRS and UTRS patients was, respectively, 20% and 7.7% and was defined using multivariable analysis elevated by high levels of interleukin (IL)-12/IL-23p40, IL-17A, IL-10, and beta 2 microglobulin (B2M) and IL-12/IL-23p40, IL-17A, IL-6, IL-10, IFNγ, and B2M, respectively. These observations suggest that resistance and ultra resistance to CLZ treatment are underpinned by pro-inflammatory molecules mainly belonging to the T helper 17 pathway, a finding making sense given the interplay between inflammation and antipsychotic treatment responses. If confirmed, our findings may allow us to consider IL-23/IL-17 pathway as a therapeutic target for patients with resistance to antipsychotics.Sorbonne Universités à Paris pour l'Enseignement et la RechercheFondaMental-Cohorte

Immuno-metabolic profile of patients with psychotic disorders and metabolic syndrome. Results from the FACE-SZ cohort

Background: Metabolic syndrome (MetS) is a highly prevalent and harmful medical disorder often comorbid with psychosis where it can contribute to cardiovascular complications. As immune dysfunction is a key shared component of both MetS and schizophrenia (SZ), this study investigated the relationship between immune alterations and MetS in patients with SZ, whilst controlling the impact of confounding clinical characteristics including psychiatric symptoms and comorbidities, history of childhood maltreatment and psychotropic treatments. Method: A total of 310 patients meeting DSM-IV criteria for SZ or schizoaffective disorders (SZA), with or without MetS, were systematically assessed and included in the FondaMental Advanced Centers of Expertise for Schizophrenia (FACE-SZ) cohort. Detailed clinical characteristics of patients, including psychotic symptomatology, psychiatric comorbidities and history of childhood maltreatment were recorded and the serum levels of 18 cytokines were measured. A penalized regression method was performed to analyze associations between inflammation and MetS, whilst controlling for confounding factors. Results: Of the total sample, 25% of patients had MetS. Eight cytokines were above the lower limit of detection (LLOD) in more than 90% of the samples and retained in downstream analysis. Using a conservative Variable Inclusion Probability (VIP) of 75%, we found that elevated levels of interleukin (IL)-6, IL-7, IL-12/23 p40 and IL-16 and lower levels of tumor necrosis factor (TNF)-α were associated with MetS. As for clinical variables, age, sex, body mass index (BMI), diagnosis of SZ (not SZA), age at the first episode of psychosis (FEP), alcohol abuse, current tobacco smoking, and treatment with antidepressants and anxiolytics were all associated with MetS. Conclusion: We have identified five cytokines associated with MetS in SZ suggesting that patients with psychotic disorders and MetS are characterized by a specific “immuno-metabolic” profile. This may help to design tailored treatments for this subgroup of patients with both psychotic disorders and MetS, taking one more step towards precision medicine in psychiatry. © 2022 The AuthorsImmuno-Génétique, Inflammation, retro-Virus, Environnement : de l'étiopathogénie des troubles psychotiques aux modèles animauxRéseau d'Innovation sur les Voies de Signalisation en Sciences de la Vi

Length of hospitalisation in first episode psychosis : determinants and clinical and organizational consequences

Depuis 30 ans a été mise en place, dans la plupart des pays européens, une politique de réduction des durées d'hospitalisation. Beaucoup d'études ont été conduites sur les conséquences de ce raccourcissement des durées d'hospitalisation mais par contre peu se sont intéressées aux caractéristiques cliniques et sociodémographiques des patients à l'admission qui pourraient influer sur ces durées. Une meilleure connaissance de ces facteurs permettrait d'adapter ces durées aux besoins spécifiques des patients et ainsi réduire les conséquences négative s de sorties prématurées. De plus, cela pourrait permettre une meilleure planification de la disponibilité en lit. L'objectif de notre étude est de mettre en évidence les déterminants cliniques et sociaux des durées d'hospitalisation et les conséquences de celles ci sur l'organisation des soins grâce à une étude prospective portant sur 121 patients hospitalisés pour un premier épisode psychotiques. A l'admission il n'est retrouvé aucun facteur prédictif des durées d'hospitalisation. Par contre la réponse au traitement et la symptomatologie à la sortie de l'hospitalisation sont significativement associés aux durées d'hospitalisation. Mais le facteur le plus prédictif est la préférence du psychiatre traitant pour une durée courte ou longue d'hospitalisation. Lors du suivi les courtes hospitalisations n'ont pas été compensées par plus de suivi par les services extra-hospitaliers de psychiatrie ou par les médecins généralistes. Ces résultats suggèrent la nécessité de développer des soins plus rationnels et standardisés pour la prise en charge des premiers épisodes psychotiques pour améliorer notamment le suivi post hospitalisation.Since the middle of last century, there has been a transition in almost all western countries towards a policy of reduced periods of hospitalization. Although many studies have been carried out on the consequences of short versus long length of stay (LOS), less is known about the socio-demographic and clinical characteristics of patients on admission, which could influence LOS. A better knowledge of these factors could help adapt LOS to patients' specific needs and perhaps reduce the negative consequences of early discharge. Furthermore, predicting LOS could be helpful for planning bed availability. First-episode psychosis is a key moment to study with the importance of cares on prognosis. The aim of our study is to evaluate clinical and social determinants of LOS at admission and discharge in relation to 121 hospitalisations for first episode psychosis using standardized assessment measures and their consequences on care organisation. None of the clinical factors at admission were significant predictors of longer hospital stay. However, response to treatment and symptomatology at discharge were significantly associated with longer LOS as was the head psychiatrist's general preference for long or short hospitalisation. Furthermore our findings, during the one-year follow up, suggest that a shortening of hospital stay for first episode psychotic patients has not been compensated by an increased role of the general practitioner (GP) in providing post-discharge care or by psychiatric community care. This suggests a need for greater evidence-based rationalization of practice for the care of first psychosis episode with more interactions between hospital and community car

Conscience des troubles dans la schizophrénie (l'insight des patients est-il influencé par l'insight des parents?)

L'altération de la conscience des troubles (insight) affecte jusqu'à 80% des personnes souffrant de schizophrénie. Le défaut d'insight est associé à des facteurs psychologiques et cognitifs dont un dysfonctionnement du cortex préfrontal (CPF); il est prédictif d'une évolution plus péjorative de la pathologie. Les facteurs parentaux pouvant l'influencer sont très peu explorés. Méthode: l'objectif principal était d'étudier l'association entre l'insight de patients souffrant de schizophrénie (n=39) et celui de leurs parents biologiques, avec l'échelle multidimensionnelle de l'insight, la SUMD. L'objectif secondaire était d'identifier les facteurs influençant l'insight dans chaque groupe (sociodémographiques, cliniques et cognitifs (mémoire de travail et fonctions exécutives)). Résultats : L'analyse appariée a mise en évidence un niveau d'insight significativement meilleur chez les parents que chez les patients et une absence de corrélation entre les deux, réfutant notre hypothèse d'une association entre l'insight des deux groupes. Une meilleure connaissance parentale au sujet de la schizophrénie était associée à un meilleur insight dans les deux groupes. Chez les patients, de meilleures performances en mémoire de travail et chez les parents, de meilleures capacités de résolution de problème étaient associées à un meilleur insight. Conclusion: Comme chez les patients, la connaissance parentale au sujet de la schizophrénie et le CPF joueraient un rôle dans l'insight des parents. Les interventions familiales doivent être proposées aux familles de patients afin d'améliorer leurs connaissances au sujet de la schizophrénie et ainsi améliorer leur insight et celui des patientsLack of insight in schizophrenia affects up to 80% of patients and is linked to poorer disease outcome. In patients, poor insight is associated with psychological and cognitive factors such as prefrontal cortex (PFC) malfunctioning. Parental factors influencing patients' insight have rarely been explored. Methods: Our main objective was to study the association between patients' (n=39) and their parents' insight in schizophrenia, assessed by the multidimensional insight scale, the SUMD. Secondary objectives were to identify in cach group the sociodemographic, clinical and cognitive factors (working memory and executive functioning) associaled with insight. Results: Paired tests found significantly higher levels of insight among parents and a lack of correlation between parent and patient insight in all dimensions, refuting our hypothesis of an association between the two. Better knowledge of schizophrenia among parents was associatcd with better insight in both groups. Better working memory among patients and better problem solving abilities among parents were also associated with higher insight levels. Conclusion: Like in patients, parental knowledge about schizophrenia and PFC functioning could be implicated in parents' insight into their children's illness. Falllily interventions should systelllatically be offered to patients' families in order to increase parents' knowledge of schizophrenia and thus improve thcir insight and their child'sMONTPELLIER-BU Médecine UPM (341722108) / SudocSudocFranceF

La consommation de cannabis facteur pronostique un an après un premier épisode psychotique? (étude prospective sur un an portant sur 121 patients hospitalisés pour un premier épisode psychotique)

Contexte: l.'usage de cannabis concerne en moyenne, dans les populations qui souffrent de schizophrénie. un patient sur deux. Une abondante littérature suggère qu'à long terme, le cannabis peut constituer un élément déclenchant de troubles psychotiques, tout au moins chez les consommateurs vulnérables. En revanche, peu de recherches ont évalué l'impact de la consommation sur la progression d'une psychose d'éclosion récente. Objectifs: l'objectif de notre étude vise à déterminer si l'usage de cannabis avant la survenue d'un premier épisode psychotique, constitue un facteur prédictif de son évolution. Nous avons réalisé une étude prospective sur une période d'un an, auprès de 121 patients, hospitalisés au CHU de Montpellier pour un premier épisode psychotique. Résultats: à l'admission, près de la moitié des sujets a déclaré un usage de cannabis. Ces patients sont significativement plus souvent des hommes (p = 0.0127), plus jeunes (p = 0.0408) que les non-consommateurs. Les taux de rémission à un an, de l'ordre de 60%, sont comparables, selon que les patients faisaient ou non usage de cannabis avant l'hospitalisation. De même, la consommation ne semble pas assombrir le pronostic, en termes de symptomatologie psychotique, conscience des troubles, qualité de vie ni fonctionnement cognitif. Conclusion: l'ambiguïté des données publiées à ce jour requiert la réalisation d'études complémentaires à grande échelle, afin de déterminer si la consommation de cannabis doit devenir une cible prioritaire en termes de santé publique et, si tel est le cas, de mettre en oeuvre des stratégies d'intervention précoces, déterminantes dans le cadre d'un premier épisode psychotiqueBackground: Cannabis use affects, in people who suffer from schizophrenia, about one in two patients. Many articles suggest that long-term cannabis use may induce psychosis, at least among vulnerable users. Nevertheless, few research did assess the impact of consumption on recent-onset psychosis outcome. Aims : our study aims to ascertain whether cannabis use, before a first- episod e psychosis, predicts its evolution. A one year prospective study was realized among 121 patients, admitted ln the CHU de Montpellier for a first-episode psychosis. Results: when admitted, nearly haIf subjects reported a cannabis consumption. These patients are more often men (p = 0.0127), younger (p = 0.0408) than non-users. Remission rates after one year, about 60%, are similar, depending on whether the patients did or didn't use cannabis before hospitalization. Likewise, consumption doesn't appear to worsen the prognosis, concerning psychotic symptoms, awareness of the disorder, quality of life or cognitive functioning. Conclusion: The ambigulty of publlshed data requires further, large-scale studies, to determine whether cannabis use has to become a public health concern and, in this case, to Implement early intervention strategies, essential in first-episode psychosisMONTPELLIER-BU Médecine UPM (341722108) / SudocSudocFranceF