Neuroimaging auditory verbal hallucinations in schizophrenia patient and healthy populations

BACKGROUND: Auditory verbal hallucinations (AVH) are a cardinal feature of schizophrenia, but they can also appear in otherwise healthy individuals. Imaging studies implicate language networks in the generation of AVH; however, it remains unclear if alterations reflect biologic substrates of AVH, irrespective of diagnostic status, age, or illness-related factors. We applied multimodal imaging to identify AVH-specific pathology, evidenced by overlapping gray or white matter deficits between schizophrenia patients and healthy voice-hearers. METHODS: Diffusion-weighted and T1-weighted magnetic resonance images were acquired in 35 schizophrenia patients with AVH (SCZ-AVH), 32 healthy voice-hearers (H-AVH), and 40 age- and sex-matched controls without AVH. White matter fractional anisotropy (FA) and gray matter thickness (GMT) were computed for each region comprising ICBM-DTI and Desikan-Killiany atlases, respectively. Regions were tested for significant alterations affecting both SCZ-AVH and H-AVH groups, relative to controls. RESULTS: Compared with controls, the SCZ-AVH showed widespread FA and GMT reductions; but no significant differences emerged between H-AVH and control groups. While no overlapping pathology appeared in the overall study groups, younger (<40 years) H-AVH and SCZ-AVH subjects displayed overlapping FA deficits across four regions (p < 0.05): the genu and splenium of the corpus callosum, as well as the anterior limbs of the internal capsule. Analyzing these regions with free-water imaging ascribed overlapping FA abnormalities to tissue-specific anisotropy changes. CONCLUSIONS: We identified white matter pathology associated with the presence of AVH, independent of diagnostic status. However, commonalities were constrained to younger and more homogenous groups, after reducing pathologic variance associated with advancing age and chronicity effects

Effectiveness of holistic assessment-based interventions in improving outcomes in adults with multiple long-term conditions and/or frailty:an umbrella review protocol

Objective: This umbrella review aims to synthesize evidence on the effectiveness of holistic assessment-based interventions (HABIs) in improving health outcomes in adults (aged ≥ 18) with multiple long-term conditions (MLTCs) and/or frailty in community and hospital settings.Introduction: Health systems need evidence-based, effective interventions to improve health outcomes for adults with MLTCs. Holistic assessment-based interventions are effective in older people admitted to the hospital (usually called Comprehensive Geriatric Assessment in that context) but the evidence that similar interventions are effective in the community is inconclusive.Inclusion criteria: We will include systematic reviews published since 2010 in English which examine the effectiveness of community and/or hospital HABIs in improving health outcomes among community-dwelling and hospitalized adults aged ≥ 18 with MLTCs and/or frailty. Methods: We will perform systematic searches in MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Scopus, ASSIA, Cochrane Library, and TRIP Medical Database and manually search reference lists of included reviews for additional eligible reviews. Two reviewers will independently screen titles and abstracts for eligibility, and then screen potentially eligible full-texts against selection criteria. We will assess the methodological quality of included reviews using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses tool and extract data using an adapted and piloted JBI data extraction tool. The summary of findings will be presented in tabular form, with narrative descriptions and visual indications accompanying the tabulated results. The citation matrix will be generated and the corrected covered area calculated to analyze the overlap in primary studies included in reviews.<br/

Cannabis use and risk of schizophrenia: a Mendelian randomization study.

Cannabis use is observationally associated with an increased risk of schizophrenia, but whether the relationship is causal is not known. Using a genetic approach, we took 10 independent genetic variants previously identified to associate with cannabis use in 32 330 individuals to determine the nature of the association between cannabis use and risk of schizophrenia. Genetic variants were employed as instruments to recapitulate a randomized controlled trial involving two groups (cannabis users vs nonusers) to estimate the causal effect of cannabis use on risk of schizophrenia in 34 241 cases and 45 604 controls from predominantly European descent. Genetically-derived estimates were compared with a meta-analysis of observational studies reporting ever use of cannabis and risk of schizophrenia or related disorders. Based on the genetic approach, use of cannabis was associated with increased risk of schizophrenia (odds ratio (OR) of schizophrenia for users vs nonusers of cannabis: 1.37; 95% confidence interval (CI), 1.09-1.67; P-value=0.007). The corresponding estimate from observational analysis was 1.43 (95% CI, 1.19-1.67; P-value for heterogeneity =0.76). The genetic markers did not show evidence of pleiotropic effects and accounting for tobacco exposure did not alter the association (OR of schizophrenia for users vs nonusers of cannabis, adjusted for ever vs never smoker: 1.41; 95% CI, 1.09-1.83). This adds to the substantial evidence base that has previously identified cannabis use to associate with increased risk of schizophrenia, by suggesting that the relationship is causal. Such robust evidence may inform public health messages about cannabis use, especially regarding its potential mental health consequences