The Role of Premorbid Adjustment in Predicting Post-Illness Psychosocial Functioning in the Early Stages of Psychosis

Schizophrenia is a chronic, debilitating illness with significant heterogeneity of onset, illness course, and outcome. Although affecting 1% of the population, disability costs ranked 11th of all health disorders internationally. Efforts to best understand how this disease process causes poor outcomes are imperative. Premorbid functioning, social and academic adjustment throughout development before illness onset, may inform long-term outcomes in psychosis. Chapter I details a systematic review of this relationship in early psychosis patients. Findings were supportive of a robust relationship between premorbid functioning and post-illness psychosocial functioning, particularly when social or academic premorbid domain approaches were used. No identified study used a domain by developmental period approach to predict psychosocial outcomes. To address this gap and improve on identified methodological concerns in previous literature, two studies were conducted using primary data in a sample of early psychosis patients. Using a comprehensive domain by trajectory approach, the first study examined associations between premorbid social and academic patterns and post-onset psychosocial functioning in early psychosis patients at study entry. The second study examined these same relationships for distal outcomes longitudinally at two-year follow-up. Study entry results, reported in Chapter II, illustrated significant relationships between trajectories of premorbid functioning and global and social functioning. Specifically, global psychosocial functioning was predicted by the change of social adjustment over development and initial academic performance. Study entry social functioning was associated with initial social performance and change of social performance over development. The two-year follow-up study, Chapter III, illustrated these relationships hold up over time. Two-year global functioning was predicted by academic premorbid patterns. Two-year social functioning was associated with social premorbid patterns and initial academic performance. Occupational functioning was associated with academic premorbid patterns. These findings demonstrate the importance of premorbid functioning to inform longitudinal post-illness psychosocial functioning. Findings from these studies suggest that using premorbid data is a fruitful endeavor to inform psychosocial recovery interventions, which can be specifically tailored to individual patients’ strengths. Future studies should continue to assess these patterns at further follow-up throughout the course of illness and design causal model investigations with these variables

Variations in entomological indices in relation to weather patterns and malaria incidence in East African highlands: implications for epidemic prevention and control

<p>Abstract</p> <p>Background</p> <p>Malaria epidemics remain a significant public health issue in the East African highlands. The aim of this study was to monitor temporal variations in vector densities in relation to changes in meteorological factors and malaria incidence at four highland sites in Kenya and Uganda and to evaluate the implications of these relationships for epidemic prediction and control.</p> <p>Methods</p> <p>Mosquitoes were collected weekly over a period of 47 months while meteorological variables and morbidity data were monitored concurrently. Mixed-effects Poisson regression was used to study the temporal associations of meteorological variables to vector densities and of the latter to incidence rates of <it>Plasmodium falciparum</it>.</p> <p>Results</p> <p><it>Anopheles gambiae </it>s.s. was the predominant vector followed by <it>Anopheles arabiensis</it>. <it>Anopheles funestus </it>was also found in low densities. Vector densities remained low even during periods of malaria outbreaks. Average temperature in previous month and rainfall in previous two months had a quadratic and linear relationship with <it>An. gambiae </it>s.s. density, respectively. A significant statistical interaction was also observed between average temperature and rainfall in the previous month. Increases in densities of this vector in previous two months showed a linear relationship with increased malaria incidence.</p> <p>Conclusion</p> <p>Although epidemics in highlands often appear to follow abnormal weather patterns, interactions between meteorological, entomological and morbidity variables are complex and need to be modelled mathematically to better elucidate the system. This study showed that routine entomological surveillance is not feasible for epidemic monitoring or prediction in areas with low endemicity. However, information on unusual increases in temperature and rainfall should be used to initiate rapid vector surveys to assess transmission risk.</p

INTERPLAY BETWEEN CHILDHOOD TRAUMA, BODILY SELF-DISTURBANCES, AND CLINICAL PHENOMENA IN SCHIZOPHRENIA: A NETWORK ANALYSIS

Background: Bodily self-disturbances have long been considered central to schizophrenia. Exposure to childhood trauma has been linked to the development of both psychosis and bodily self-disturbances, yet little work has examined the role of bodily self-disturbances in the relationship between childhood trauma and schizophrenia symptomatology. This study uses network analysis to bridge this gap. Methods: Networks were constructed to examine relationships between schizophrenia symptoms (Positive and Negative Symptom Scale; PANSS), bodily self-disturbances (Perceptual Aberration Scale; PAS), and self-reported exposure to childhood trauma (Childhood Trauma Questionnaire, Short-Form; CTQ-SF) in 152 people with a schizophrenia-spectrum disorder. Shortest path and bridge analyses were conducted to assess the role of bodily self-disturbances in linking childhood trauma to schizophrenia symptomatology. Three networks were constructed: 1) PAS, childhood trauma, and PANSS sub-scale composites (positive, negative, general); 2) PAS, childhood trauma, and positive symptoms, 3) PAS, childhood trauma, and distress symptoms. Results: Shortest path analysis revealed that bodily self-disturbances were on the shortest path between childhood trauma and positive and general symptoms (network 1), between trauma and hallucinations (network 2), and between trauma and depression (network 3). Bodily self-disturbances were also found to serve as a bridge between childhood trauma and positive symptoms of schizophrenia, particularly delusions and hallucinations. Conclusions: Using a novel, data-driven approach, we showed that bodily self-disturbances play a key role in linking childhood trauma to positive and co-morbid affective symptoms of schizophrenia. Threat experiences (i.e., abuse) specifically relate to bodily self-disturbances and psychotic symptoms

Cognitive motor impairments and brain structure in schizophrenia spectrum disorder patients with a history of catatonia.

There is growing interest in understanding the behavioral and neural mechanisms of catatonia. Here, we examine cognition and brain structure in schizophrenia spectrum disorder (SSD) patients with a history of catatonia. A total of 172 subjects were selected from a data repository; these included SSD patients with (n = 43) and without (n = 43) a history of catatonia and healthy control subjects (n = 86). Cognitive functioning was assessed using the Screen for Cognitive Impairment in Psychiatry (SCIP) and brain structure was assessed using voxel-based morphometry (VBM) in the CAT12 toolbox. SSD patients with a history of catatonia showed worse performance on tests of verbal fluency and processing speed compared to SSD patients without such a history, even after controlling for current antipsychotic and benzodiazepine use. No differences were found between patients with and without a history of catatonia in terms of brain structure. Both patient groups combined showed significantly smaller grey matter volumes compared to healthy control subjects in brain regions consistent with prior studies, including the anterior cingulate, insular, temporal, and medial frontal cortices. The results highlight a cognitive-motor impairment in SSD patients with a history of catatonia. Challenges and limitations of examining brain structure in patients with a history of catatonia are discussed

Regionally specific volume deficits along the hippocampal long axis in early and chronic psychosis

Previous studies in psychosis patients have shown hippocampal volume deficits across anterior and posterior regions or across subfields, but subfield specific changes in volume along the hippocampal long axis have not been examined. Here, we tested the hypothesis that volume changes exist across the hippocampus in chronic psychosis but only the anterior CA region is affected in early psychosis patients. We analyzed structural MRI data from 179 patients with a non-affective psychotic disorder (94 chronic psychosis; 85 early psychosis) and 167 heathy individuals demographically matched to the chronic and early psychosis samples respectively (82 matched to chronic patients; 85 matched to early patients). We measured hippocampal volumes using Freesurfer 6-derived automated segmentation of both anterior and posterior regions and the CA, dentate gyrus, and subiculum subfields. We found a hippocampal volume deficit in both anterior and posterior regions in chronic psychosis, but this deficit was limited to the anterior hippocampus in early psychosis patients. This volume change was more pronounced in the anterior CA subfield of early psychosis patients than in the dentate gyrus or subiculum. Our findings support existing models of psychosis implicating initial CA dysfunction with later progression to other hippocampal regions and suggest that the anterior hippocampus may be an important target for early interventions. Keywords: Schizophrenia, Hippocampus, First episode psychosis, Volume, Subfields

Smaller anterior hippocampal subfields in the early stage of psychosis

Abstract Hippocampal volume is smaller in schizophrenia, but it is unclear when in the illness the changes appear and whether specific regions (anterior, posterior) and subfields (CA1, CA2/3, dentate gyrus, subiculum) are affected. Here, we used a high-resolution T2-weighted sequence specialized for imaging hippocampal subfields to test the hypothesis that anterior CA1 volume is lower in early psychosis. We measured subfield volumes across hippocampal regions in a group of 90 individuals in the early stage of a non-affective psychotic disorder and 70 demographically similar healthy individuals. We observed smaller volume in the anterior CA1 and dentate gyrus subfields in the early psychosis group. Our findings support models that implicate anterior CA1 and dentate gyrus subfield deficits in the mechanism of psychosis