Agata Ando

Investigating the link between drug-naive first episode psychoses (FEPs), weight gain abnormalities and brain structural damages: Relevance and implications for therapy

ABSTRACT Evidence suggests that obesity and overweight may be associated with severe brain structural abnormalities and poor cognitive and functional outcomes in the general population. Despite these observations and the high prevalence of weight gain abnormalities in patients with psychosis spectrum disorders (PSDs), no studies have investigated the impact that these metabolic disturbances may have on brain structures and development in the earliest stages of PSDs. In the present review we shed light on the association between weight gain and brain structural abnormalities that may affect the course of illness in drug‐naïve FEPs. Given the lack of studies directly investigating this issue, we firstly identified and critically evaluated the literature assessing weight gain abnormalities and gray or white matter (GM, WM) volumes (either globally or in specific regions of interest) in otherwise healthy obese/overweight adolescents and young adults. We then compared the results of this systematic review with those of two recent meta‐analysis investigating GM and WM abnormalities in drug‐naïve FEPs. Weight gain in otherwise healthy subjects was consistently associated with frontal and temporal GM atrophy and with reduced integrity of WM in the corpus callosum. Of relevance, all these brain regions are affected in drug‐naïve FEPs, and their integrity is associated with clinical, cognitive and functional outcomes. The underlying mechanisms that may explain the association between weight gain, adiposity, and brain damage in both healthy subjects and drug‐naïve FEPs are widely discussed. On the basis of this knowledge, we tried: a) to deduce an integrative model for the development of obesity in psychosis spectrum disorders; b) to identify the key vulnerability factors underlying the association between weight gain and psychosis; c) to provide information on new potential targets of intervention. HIGHLIGHTObesity and overweight may increase the severity of brain structural abnormalities associated with FEPs.Obesity and overweight may potentially lead to a more severe course of illness and to worst prognostic outcomes in FEPs.Shared vulnerability factors may explain findings on the high rates of obesity and overweight in drug naive FEPs.In FEPs, early interventions aimed at limiting the development of obesity/overweight may result in better prognostic outcomes.

White matter and schizophrenia: A meta-analysis of voxel-based morphometry and diffusion tensor imaging studies

Voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) are the most implemented methodologies to detect alterations of both gray and white matter (WM). However, the role of WM in mental disorders is still not well defined. We aimed at clarifying the role of WM disruption in schizophrenia and at identifying the most frequently involved brain networks. A systematic literature search was conducted to identify VBM and DTI studies focusing on WM alterations in patients with schizophrenia compared to control subjects. We selected studies reporting the coordinates of WM reductions and we performed the anatomical likelihood estimation (ALE). Moreover, we labeled the WM bundles with an anatomical atlas and compared VBM and DTI ALE-scores of each significant WM tract. A total of 59 studies were eligible for the meta-analysis. WM alterations were reported in 31 and 34 foci with VBM and DTI methods, respectively. The most occurred WM bundles in both VBM and DTI studies and largely involved in schizophrenia were long projection fibers, callosal and commissural fibers, part of motor descending fibers, and fronto-temporal-limbic pathways. The meta-analysis showed a widespread WM disruption in schizophrenia involving specific cerebral circuits instead of well-defined regions.

Rorschach Performance Assessment System (R-PAS) and vulnerability to stress: A preliminary study on electrodermal activity during stress

This study investigated the predictive validity of the ten Rorschach Performance Assessment System (R-PAS) variables from the Stress and Distress domain, by testing whether they predicted increased sympathetic reactivity to a mild, laboratory-induced stress, occurred one week after Rorschach administration. A relatively small student sample (N=52) contributed to this research: During a first meeting (T1) participants were administered the Rorschach task according to R-PAS guidelines; about one week later (T2) their electrodermal activity (EDA) was recorded during exposure to a mild laboratory stress-inducing task. Based on literature indicating that exposure to stress tends to increase physiological vulnerability/reactivity to stressful situations, we anticipated that Stress and Distress R-PAS variables measured at T1 would positively correlate with increased sympathetic reactivity to stress at T2, as indicated by greater EDA changes from baseline to stress and recovery. Results partially confirmed our hypotheses: (a) the mean of and (b) the majority of the Stress and Distress R-PAS variables were significantly correlated, in the expected direction, with medium and medium to large effect sizes.

An Interrater Reliability Study of Rorschach Performance Assessment System (R–PAS) Raw and Complexity-Adjusted Scores

ABSTRACT Recently, the Rorschach Performance Assessment System (R–PAS; Meyer, Viglione, Mihura, Erard, & Erdberg, 2011) was introduced to overcome some possible limitations of the Comprehensive System (CS; Exner, 2003) while continuing its efforts to link Rorschach inferences to their evidence base. An important, technical modification to the scoring system is that R–PAS interpretations are based on both standard scores and complexity-adjusted scores. Two previous U.S. studies reported good to excellent interrater reliability (IRR) for the great majority of R–PAS variables; however, IRR of complexity-adjusted scores has never been investigated. Furthermore, no studies have yet investigated R–PAS IRR in Europe. To extend this literature, we examined R–PAS IRR of Page 1 and Page 2 raw and complexity-adjusted scores with 112 Italian Rorschach protocols. We collected a large sample of both clinical and nonclinical Rorschach protocols, each of which was coded separately by 2 independent raters. Results demonstrated a mean intraclass correlation of .78 (SD = .14) for raw scores and.74 (SD = .14) for complexity-adjusted scores. Overall, for both raw and complexity-adjusted values, most of the variables were characterized by good to excellent IRR.

Prediction of functional outcome in young patients with a recent-onset psychiatric disorder: Beyond the traditional diagnostic classification system

A critical research goal is to identify modifiable risk factors leading to functional disabilities in young psychiatric patients. The authors developed a multidimensional trans-diagnostic predictive model of functional outcome in patients with the recent-onset of a psychiatric illness. Baseline clinical, psychosis-risk status, cognitive, neurological-soft-signs measures, and dopamine-related-gene polymorphisms (DRD1-rs4532, COMT-rs165599, and DRD4-rs1800955) were collected in 138 young non-psychotic outpatients. 116 individuals underwent follow-up (mean=2.2years, SD=0.9) examination. A binary logistic model was used to predict low-functioning status at follow-up as defined by a score lower than 65 in the social occupational functioning assessment scale. A total of 54% of patients experiences low functioning at follow-up. Attention, Avolition, and Motor-Coordination subscale were significant predictors of low-functioning with an accuracy of 79.7%. A non-significant trend was found for a dopamine-related-gene polymorphism (DRD1-rs4532). The model was independent of psychotic-risk status, DSM-diagnosis, and psychotic conversion. A trans-diagnostic approach taking into account specific neurocognitive, clinical, and neurological information has the potential to identify those individuals with low-functioning independent of DSM diagnosis or the level of psychosis-risk. Specific early interventions targeting modifiable risk factors and emphasize functional recovery in young psychiatric samples, independent of DSM-diagnosis and psychosis-risk, are essential.

Effects of repetitive transcranial magnetic stimulation (rTMS) on attribution of movement to ambiguous stimuli and EEG mu suppression

Recent research suggests that attributing human movement to ambiguous and static Rorschach stimuli (M responses) is associated with EEG mu suppression, and that disrupting the left inferior gyrus (LIFG; a putative area implicated in mirroring activity) decreases the tendency to see human movement when exposed to the Rorschach ambiguous stimuli. The current study aimed to test whether disrupting the LIFG via repetitive transcranial stimulation (rTMS) would decrease both the number of human movement attributions and EEG mu suppression. Each participant was exposed to the Rorschach stimuli twice, i.e., during a baseline condition (without rTMS but with EEG recording) and soon after rTMS (TMS condition with EEG recording). Experimental group (N = 15) was stimulated over the LIFG, while the control group (N = 13) was stimulated over the Vertex. As expected, disrupting the LIFG but not Vertex, decreased the number of M attributions provided by the participants exposed to the Rorschach stimuli, with a significant interaction effect. Unexpectedly, however, rTMS did not significantly influence EEG mu suppression.

Psychological Implications of PCOS

Quality of life (QoL) is widely considered an important parameter for evaluating the quality and outcome of health care, particularly for patients suffering from chronic disorders: polycystic ovary syndrome is one of these.