Retinal structure analysis in psychosis spectrum disorders

Uvod: Spektar psihoza čini grupa poremećaja čija je centralna karakteristika poremećaj testa realnosti. Sa fenomenološke tačke gledišta, osnovnu iskustvenu determinantu psihoze čini poremećaj u doživljaju sopstva (“kako je to biti ja?”). Savremeno razumevanje psihotičnih poremećaja podrazumeva konceptualizaciju u vidu dimenzije koja obuhvata nozološke entitete poput shizofrenije, akutnog prolaznog duševnog oboljenja sa ili bez simptoma shizofrenije, shizoafektivnog poremećaja, i neorganskog psihotičnog poremećaja. Od konceptualizacije bolesti, shizofrenija se smatrala progresivnim oboljenjem koje se karakteriše strukturnim promenama u mozgu. Dosadašnji nalazi neuro-vizuelizacionih istraživanja ukazuju da osobe sa dijagnozom poremećaja iz spektra psihoza imaju značajne promene u raznorodnim regionima centralnog nervnog sistema (CNS) u odnosu na zdrave ispitanike. Takođe, uočeno je i prisustvo polnog dimorfizma u pojedinim strukturama CNS-a čiji je odnos izmenjen kod pacijenata sa dijagnozom poremećaja iz spektra psihoza. Retina čini integrativni deo CNS-a i predstavlja jedinu strukturu ovog sistema u okviru koje se nervno tkivo može vizuelizovati direktno, in vivo. Aksoni retine nisu mijelinizovani, niti su zaklonjeni kostima lobanje, te predstavljaju jedinstven model za direktnu opservaciju neuronskih struktura. Opservaciju retine i njenih slojeva omogućavaju skeneri nove generacije koji funkcionišu na principu optičke koherentne tomografije (OCT). OCT je imidžing tehnika koja proizvodi slike preseka tkiva sa aksijalnom rezolucijom od 4-7 μm. Upotreba OCT skenera omogućava vizuelizaciju pojedinih slojeva retine, poput vlakana retinalnog živca (RNFL), sloja ganglijskih ćelija i unutrašnjeg pleksiformnog sloja (GC-IPL), kao i volumena i debljine makule. Nalazi dosadašnjih OCT studija u shizofreniji i srodnim poremećajima nisu sasvim konzistentni. Većina istraživanja ukazuje da su promene u strukturi retine prisutne kod pacijenata sa poremećajem iz sepktra psihoza. Međutim, stepen izraženosti strukturnih promena, kao i zahvaćenost retinalnih slojeva značajno varira između istraživanja. Ciljevi: Primarni ciljevi istraživanja podrazumevali su: (1) ispitivanje postojanja razlika između zdravih ispitanika i pacijenata sa dijagnozom poremećaja iz spektra psihoza (F20.x-F29 prema Međunarodnoj klasifikaciji bolesti, deseta revizija) u sledećim parametrima retine – RNFL, GC-IPL, debljina i volumen makule i odnos optičke ekskavacije i diska; (2) ispitivanje povezanosti debljine/volumena pojedinih parametara retine sa dnevnom dozom antipsihotične terapije, dužinom trajanja bolesti i merama premorbidnog prilagođavanja kod pacijenata sa dijagnozom poremećaja iz spektra psihoza...discrete nosological categories such as: schizophrenia, acute and transient psychotic disorders, schizoaffective disorder and other and unspecified nonorganic psychosis. The main element of these disorders, by current nosological standards is disturbance of reality testing. From a phenomenological point of view, the main subjective determinant in psychosis is self-disturbance (“what is it like to be me?”). Since its conceptualization, schizophrenia has been considered a progressive disorder which is marked by structural brain disturbance. Methods of neurovisualization have indicated that heterogeneous brain areas are affected. Moreover, a sexual dimorphism in healthy humans seems to be disturbed in psychosis spectrum disorders. Retina is an integral part of the central nervous system (CNS). It is the only nervous structure that can be visualized directly, in vivo. Retinal axons are non-myelinized, nor are they concealed by the cranium. This makes retinal tissue a unique model for direct observation of neural structure. Observation of retinal structures is made possible by recent advances in imaging, most notably with the appearance of scanners functioning on the principles of optical coherence tomography (OCT). OCT imaging is a non-contact technique which produces retinal scans with an axial resolution of 4-7 μm. Owing to this, visualization of particular retinal layers is possible, such as: retinal nerve fiber layer (RNFL), ganglionic cell layer and inner plexiform layer (GC-IPL), as well as macular thickness and volume. Up until now, OCT imaging studies in schizophrenia and related disorders have yielded conflicting data. Most of recent research in this area indicates that structural retinal disturbance is present in psychosis spectrum disorders. However, the extent and degree of aberrations in retinal layers varies significantly between studies. Aims: Primary aims of this study were to: (1) investigate differences between healthy participants and patients with a psychosis spectrum diagnosis (F20.x-F29 according to International Classification of Diseases, tenth revision) in the following retinal parameters – RNFL, GC-IPL, macular thickness and volume, cup-to-disk ratio; (2) to evaluate for potential associations between thickness/volume of particular retinal parameters with total daily dosage of antipsychotic therapy, duration of illness and measures of premorbid adjustment in patients with a psychosis spectrum diagnosis.

Fenomenologija i psihijatrija: oblikovanje dijagnoze

Fenomenologija je filozofska disciplina koja ima za cilj analizu i ispitivanje struktura subjektivnog iskustva. Od formulisanja osnovnih principa ove tradicije, fenomenologija je usko povezana sa psihijatrijom. Imajući u vidu da je osoba koja doživljava psihopatološke pojave predmet psihijatrije, fenomenologija pruža adekvatan okvir za razumevanje ovih doživljaja. U radu pokazujemo na koji način fenomenologija može pojmovno i metodološki unaprediti dijagnozu u psihijatriji. U kliničkom radu, fenomenologija može se primeniti u okviru procesa dijagnostičkog rezonovanja, dajući značajniju dubinu i nijanse psihopatologiji u okviru dijagnoze psihijatrijskog poremećaja. Fenomenologija može unaprediti metodu psihijatrijskog intervjua, tako što ukazuje na značaj psihopatološkog geštalta i ejdetsku redukciju sa otklonom od različitih predra- suda prilikom istraživanja psihopatološkog iskustva. Kao što pokazujemo u radu, polu- strukturisani intervju posebno je značajna, mada ne i jedina fenomenološka metoda, koja kliničarima može biti od pomoći pri opisu i prepoznavanju psihijatrijskih geštaltova

Testing the domain of working memory and executive function in the context of cognitive functioning in patients with schizophrenia: A pilot study

Shizofrenija je teško mentalno oboljenje koje podrazumeva poremećaje gotovo svih psihičkih funkcija. Mnoga ispitivanja kognitivnog funkcionisanja pokazala su da se kod obolelih javlja generalizovana kognitivna disfunkcija. Kognitivni deficiti se odnose na pažnju, egzekutivne funkcije, radnu i vizuospacijalnu memoriju. Ciljevi ove studije obuhvatali su procenu egzekutivne funkcije i radne memorije pacijenata sa shizofrenijom, kao i ispitivanje potencijalne povezanost i sa postojećom simptomatologijom. Metod: U istraživanju je učestvovalo 18 pacijenata sa dijagnozom shizofrenije, prema MKB-10 kriterijumima. Instrumenti procene kognicije bili su testovi koji su merili egzekutivne funkcije: premeštanja (zadatak 'broj-slovo'), inhibicije (zadatak 'kontinuirano izvođenje') i ažuriranja, odnosno radnu memoriju ('prostorni zadatak 2-unazad' i 'budi u toku'). Skala pozitivnog i negativnog sindroma (PANSS) korišćena je za procenu težine simptoma bolesti. Postignuća pacijenata sa shizofrenijom upoređena su sa postignućima 132 zdrava ispitanika. Rezultati: Utvrđena je pozitivna korelacija za odnos između ukupnog skora PANSS i postignuća na testu 'prostorni zadatak 2-unazad' (r=0,62), kao i između negativnog PANSS klastera i postignuća na istom testu (r=0,53). Negativna korelacija je pokazana između negativnog PANSS klastera i niskog postignuća na testu 'kontinuirano izvođenje' (r=-0,77). Pacijenti oboleli od shizofrenije su imali značajno slabije postignuće u odnosu na kontrolnu grupu u testovima 'budi u toku' (M=17,89, SD=4,70 prema M=24,17 SD=4,18; p=0.000) i 'prostorni zadatak 2-unazad' (M=7,93, SD=3,97 prema M=10,67 SD=4,48; p=0.025). Diskusija i zaključak: Danas se smatra da su kognitivna oštećenja podjednako značajna u proceni stanja ali i tretmana pacijenta kao i klasični pozitivni ili negativni simptomi. Neke studije pokazuju da čak i do 98% obolelih pokazuje slabija postignuća na kognitivnim testovima u odnosu na očekivane vrednosti. Sumarno, naše istraživanje pokazuje da pacijente sa dijagnozom shizofrenije odlikuje značajna deterioracija radne memorije. Postignuća na ispitivanim kognitivnim funkcijama pacijenata obolelih od shizofrenije treba posmatrati kao krajnji produkt složene međuigre premorbidnog kognitivnog funkcionisanja ali i opisane kognitivne deterioracije tokom same bolesti. Na taj način kognitivni simptomi obolelih od shizofrenije se mogu posmatrati kao jedan od pokazatelj postojanja i poremećaja ranog razvoja (neurorazvojna komponenta) ali i kasnijeg neuroprogresivnog procesa (neuroprogresivna komponenta) u shizofreniji.Introduction: Schizophrenia is a severe mental disorder that includes alterations of almost all mental functions. Numerous tests of cognitive functioning have demonstrated that generalized cognitive dysfunction exists in patients with schizophrenia. These deficits are related to attention, executive functions, working memory and visouspatial memory. The aim of the study was to assess executive functioning and working memory of people with schizophrenia, as well as to examine the potential link between congition and existing simptomatology. Method: The study included 18 patients diagnosed with schizophrenia, according to the ICD-10 criteria. Instruments of cognitive assessment were tests that measured the executive functions: shifting (number-letter task), inhibition (continuous performance task), updating and working memory (N-back and keep track). Positive and Negative Syndrome Scale (PANSS) was used to assess the severity of symptoms. Data was statistically analyzed and the correlation coefficients were determined between PANSS scores and achievements on cognitive tests. Achivements of the patients were compared with those of the healthy control group. Results: Positive correlation has been determined between the total PANSS score and achievements on the N-back test (r=0,62), as well as between the negative PANSS cluster and achievements on the Nback (r=0,53). Negative correlation was determined between the negative PANSS cluster and achievements on the continuous performance test (r=-0,77). Patients suffering from schizophrenia had significantly lower achievement in comparison to the control group in tests keep track (M=17,89, SD=4,70 corresponding to M=24,17 SD=4,18; p=0.000) and N-back (M=7,93, SD=3,97 corresponding to M=10,67 SD=4,48; p=0.025). Discussion and conclusion: Today, cognitive dysfunction in schizophrenia has the same importance as classical positive or negative symptoms in assessment of disease severity as well as in efficacy of treatment. Some studies estimate that almost 98% of patients demonstrates poor achievements on various cognitive tests compared to healthy subjects. In summary, our study has found that schizophrenic patients show strong deterioration of working memory. Correlation between cognitive functioning and schizophrenia is likely to be understood in the context of premorbid cognitive functioning and subsequent cognitive decline and thus schizophrenia can be understood as both neurodevelopmental and neuroprogessive disorder

Uloga krvno-moždane barijere u psihijatrijskim oboljenjima

The blood-brain barrier (BBB) is formed by continuous, closely connected endothelial cells, enveloped in the basal lamina, pericytes, and foot extensions of astrocytes. BBB has a vital role in brain metabolism and protects the brain parenchyma from harmful agents present in the systemic circulation. Damage to the BBB and an increase in its permeability have an important role in many neurodegenerative diseases. This paper aims to review the literature on the impact of the BBB damage on psychiatric illness, a largely neglected and under researched area. Links between BBB impairment and specific neuropsychiatric disorders are described including schizophrenia, affective disorders, dementias with behavioral disorders, and alcohol use disorder, with comparison to typical hereditary small vessel diseases affecting the BBB such as cerebral autosomal dominant arteriopathy with subcortical infarction and leukoencephalopathy (CADASIL) and mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). The authors critically summarize possible pathogenic mechanisms linking BBB damage and these common disorders.Крвно-мождана баријера (КМБ) се састоји од континураних, тесно спојених ендотелних ћелија омотаних базалном ламином, перицитима и сто-паластим продужецима астроцита. КМБ има виталну функцију и можданом метаболизму и штити мождани паренхим од штетних фактора присутних у системској циркулацији. Показано је да оштећење КМБ и повећање њене пропустљи-вости има значајну улогу у многим неуродегене-ративним обољењима. Циљ овога рада је преглед литературе о значају оштећења КМБ код психијатријских обољења, до сада занемареној и недовољно истраженој облас-ти. Повезаност измедју поремећаја КМБ и неуро-психијатријских поремећаја је посебно анализи-рана за схизофренију, афективне поремећаје, де-менције са бихевиоралним изменама, поремећај употребе алкохола, са посебним освртом на на-следне болести малих крвних судова мозга са оштећењем КМБ као што су церебрална аутозо-мално доминантна артериопатија са супкортика-ним инфарктима и леукоенцефалопатијом (CADASIL) и митохондријска енцефаломиопатија са лактатном ацидозом и епизодама налик можда-ном удару (MELAS). Аутори критички сумирају могуће патогенетске механизме који повезују оштећења КМБ са овим честим обољењима

A Comparative Study on Mental Disorder Conceptualization: A Cross-Disciplinary Analysis

The conceptualization of mental disorders varies among professionals, impacting diagnosis, treatment, and research. This cross-disciplinary study aimed to understand how various professionals, including psychiatrists, psychologists, medical students, philosophers, and social sciences experts, perceive mental disorders, their attitudes towards the disease status of certain mental states, and their emphasis on biological versus social explanatory attributions. A survey of 371 participants assessed their agreement on a variety of conceptual statements and the relative influence of biological or social explanatory attribution for different mental states. Our findings revealed a consensus on the need for multiple explanatory perspectives in understanding psychiatric conditions and the influence of social, cultural, moral, and political values on diagnosis and classification. Psychiatrists demonstrated balanced bio-social explanatory attributions for various mental conditions, indicating a potential shift from the biological attribution predominantly observed among medical students and residents in psychiatry. Further research into factors influencing these differing perspectives is necessar

Retinal structure analysis in psychosis spectrum disorders

Uvod: Spektar psihoza čini grupa poremećaja čija je centralna karakteristika poremećaj testa realnosti. Sa fenomenološke tačke gledišta, osnovnu iskustvenu determinantu psihoze čini poremećaj u doživljaju sopstva (“kako je to biti ja?”). Savremeno razumevanje psihotičnih poremećaja podrazumeva konceptualizaciju u vidu dimenzije koja obuhvata nozološke entitete poput shizofrenije, akutnog prolaznog duševnog oboljenja sa ili bez simptoma shizofrenije, shizoafektivnog poremećaja, i neorganskog psihotičnog poremećaja. Od konceptualizacije bolesti, shizofrenija se smatrala progresivnim oboljenjem koje se karakteriše strukturnim promenama u mozgu. Dosadašnji nalazi neuro-vizuelizacionih istraživanja ukazuju da osobe sa dijagnozom poremećaja iz spektra psihoza imaju značajne promene u raznorodnim regionima centralnog nervnog sistema (CNS) u odnosu na zdrave ispitanike. Takođe, uočeno je i prisustvo polnog dimorfizma u pojedinim strukturama CNS-a čiji je odnos izmenjen kod pacijenata sa dijagnozom poremećaja iz spektra psihoza. Retina čini integrativni deo CNS-a i predstavlja jedinu strukturu ovog sistema u okviru koje se nervno tkivo može vizuelizovati direktno, in vivo. Aksoni retine nisu mijelinizovani, niti su zaklonjeni kostima lobanje, te predstavljaju jedinstven model za direktnu opservaciju neuronskih struktura. Opservaciju retine i njenih slojeva omogućavaju skeneri nove generacije koji funkcionišu na principu optičke koherentne tomografije (OCT). OCT je imidžing tehnika koja proizvodi slike preseka tkiva sa aksijalnom rezolucijom od 4-7 μm. Upotreba OCT skenera omogućava vizuelizaciju pojedinih slojeva retine, poput vlakana retinalnog živca (RNFL), sloja ganglijskih ćelija i unutrašnjeg pleksiformnog sloja (GC-IPL), kao i volumena i debljine makule. Nalazi dosadašnjih OCT studija u shizofreniji i srodnim poremećajima nisu sasvim konzistentni. Većina istraživanja ukazuje da su promene u strukturi retine prisutne kod pacijenata sa poremećajem iz sepktra psihoza. Međutim, stepen izraženosti strukturnih promena, kao i zahvaćenost retinalnih slojeva značajno varira između istraživanja. Ciljevi: Primarni ciljevi istraživanja podrazumevali su: (1) ispitivanje postojanja razlika između zdravih ispitanika i pacijenata sa dijagnozom poremećaja iz spektra psihoza (F20.x-F29 prema Međunarodnoj klasifikaciji bolesti, deseta revizija) u sledećim parametrima retine – RNFL, GC-IPL, debljina i volumen makule i odnos optičke ekskavacije i diska; (2) ispitivanje povezanosti debljine/volumena pojedinih parametara retine sa dnevnom dozom antipsihotične terapije, dužinom trajanja bolesti i merama premorbidnog prilagođavanja kod pacijenata sa dijagnozom poremećaja iz spektra psihoza...discrete nosological categories such as: schizophrenia, acute and transient psychotic disorders, schizoaffective disorder and other and unspecified nonorganic psychosis. The main element of these disorders, by current nosological standards is disturbance of reality testing. From a phenomenological point of view, the main subjective determinant in psychosis is self-disturbance (“what is it like to be me?”). Since its conceptualization, schizophrenia has been considered a progressive disorder which is marked by structural brain disturbance. Methods of neurovisualization have indicated that heterogeneous brain areas are affected. Moreover, a sexual dimorphism in healthy humans seems to be disturbed in psychosis spectrum disorders. Retina is an integral part of the central nervous system (CNS). It is the only nervous structure that can be visualized directly, in vivo. Retinal axons are non-myelinized, nor are they concealed by the cranium. This makes retinal tissue a unique model for direct observation of neural structure. Observation of retinal structures is made possible by recent advances in imaging, most notably with the appearance of scanners functioning on the principles of optical coherence tomography (OCT). OCT imaging is a non-contact technique which produces retinal scans with an axial resolution of 4-7 μm. Owing to this, visualization of particular retinal layers is possible, such as: retinal nerve fiber layer (RNFL), ganglionic cell layer and inner plexiform layer (GC-IPL), as well as macular thickness and volume. Up until now, OCT imaging studies in schizophrenia and related disorders have yielded conflicting data. Most of recent research in this area indicates that structural retinal disturbance is present in psychosis spectrum disorders. However, the extent and degree of aberrations in retinal layers varies significantly between studies. Aims: Primary aims of this study were to: (1) investigate differences between healthy participants and patients with a psychosis spectrum diagnosis (F20.x-F29 according to International Classification of Diseases, tenth revision) in the following retinal parameters – RNFL, GC-IPL, macular thickness and volume, cup-to-disk ratio; (2) to evaluate for potential associations between thickness/volume of particular retinal parameters with total daily dosage of antipsychotic therapy, duration of illness and measures of premorbid adjustment in patients with a psychosis spectrum diagnosis.

Testing the domain of working memory and executive function in the context of cognitive functioning in patients with schizophrenia: A pilot study

Introduction: Schizophrenia is a severe mental disorder that includes alterations of almost all mental functions. Numerous tests of cognitive functioning have demonstrated that generalized cognitive dysfunction exists in patients with schizophrenia. These deficits are related to attention, executive functions, working memory and visouspatial memory. The aim of the study was to assess executive functioning and working memory of people with schizophrenia, as well as to examine the potential link between congition and existing simptomatology. Method: The study included 18 patients diagnosed with schizophrenia, according to the ICD-10 criteria. Instruments of cognitive assessment were tests that measured the executive functions: shifting (number-letter task), inhibition (continuous performance task), updating and working memory (N-back and keep track). Positive and Negative Syndrome Scale (PANSS) was used to assess the severity of symptoms. Data was statistically analyzed and the correlation coefficients were determined between PANSS scores and achievements on cognitive tests. Achivements of the patients were compared with those of the healthy control group. Results: Positive correlation has been determined between the total PANSS score and achievements on the N-back test (r=0,62), as well as between the negative PANSS cluster and achievements on the Nback (r=0,53). Negative correlation was determined between the negative PANSS cluster and achievements on the continuous performance test (r=-0,77). Patients suffering from schizophrenia had significantly lower achievement in comparison to the control group in tests keep track (M=17,89, SD=4,70 corresponding to M=24,17 SD=4,18; p=0.000) and N-back (M=7,93, SD=3,97 corresponding to M=10,67 SD=4,48; p=0.025). Discussion and conclusion: Today, cognitive dysfunction in schizophrenia has the same importance as classical positive or negative symptoms in assessment of disease severity as well as in efficacy of treatment. Some studies estimate that almost 98% of patients demonstrates poor achievements on various cognitive tests compared to healthy subjects. In summary, our study has found that schizophrenic patients show strong deterioration of working memory. Correlation between cognitive functioning and schizophrenia is likely to be understood in the context of premorbid cognitive functioning and subsequent cognitive decline and thus schizophrenia can be understood as both neurodevelopmental and neuroprogessive disorder

How to measure the impact of the COVID-19 pandemic on quality of life: COV19-QoL – the development, reliability and validity of a new scale

Objective: The primary objective of this paper is to present a short measure of perceptions on the impact of the COVID-19 pandemic on quality of life, along with analysis of its reliability and validity in non-clinical and clinical samples. Methods: The scale was named The COV19 – Impact on Quality of Life (COV19-QoL) and it consists of six items presented in the form of a 5-point Likert scale. The items (i.e. statements) cover main areas of quality of life with regard to mental health. The scale was administered to 1346 participants from the general population in Croatia (the non-clinical sample) and 201 patients with severe mental illness recruited from four European countries (Bosnia and Herzegovina, Montenegro, North Macedonia and Serbia), constituting the clinical sample. The clinical sample was part of the randomised controlled trial IMPULSE funded by the European Commission. Data on age and gender were collected for both samples, along with psychiatric diagnoses collected for the clinical sample.Results: Main findings included a high internal consistency of the scale and a moderate to strong positive correlation among participants’ scores on different items. Principal component analysis yielded one latent component. The correlation between participants’ age and their results on COV19-QoL was negligible. Participants’ perceived quality of life was the most impacted domain, whereas mental health, personal safety and levels of depression were the least impacted domains by the pandemic.Discussion: The COV19-QoL is a reliable and valid scale which can be used to explore the impact of COVID-19 on quality of life. The scale can be successfully used by researchers and clinicians interested in the impact of the pandemic on people experiencing various pre- existing mental health issues (e.g. anxiety, mood and personality disorders) as well as those without such issues