RESUMEN
Using machine learning, we recently decomposed the neuroanatomical heterogeneity of established schizophrenia to discover two volumetric subgroups-a 'lower brain volume' subgroup (SG1) and an 'higher striatal volume' subgroup (SG2) with otherwise normal brain structure. In this study, we investigated whether the MRI signatures of these subgroups were also already present at the time of the first-episode of psychosis (FEP) and whether they were related to clinical presentation and clinical remission over 1-, 3-, and 5-years. We included 572 FEP and 424 healthy controls (HC) from 4 sites (Sao Paulo, Santander, London, Melbourne) of the PHENOM consortium. Our prior MRI subgrouping models (671 participants; USA, Germany, and China) were applied to both FEP and HC. Participants were assigned into 1 of 4 categories: subgroup 1 (SG1), subgroup 2 (SG2), no subgroup membership ('None'), and mixed SG1 + SG2 subgroups ('Mixed'). Voxel-wise analyses characterized SG1 and SG2 subgroups. Supervised machine learning analyses characterized baseline and remission signatures related to SG1 and SG2 membership. The two dominant patterns of 'lower brain volume' in SG1 and 'higher striatal volume' (with otherwise normal neuromorphology) in SG2 were identified already at the first episode of psychosis. SG1 had a significantly higher proportion of FEP (32%) vs. HC (19%) than SG2 (FEP, 21%; HC, 23%). Clinical multivariate signatures separated the SG1 and SG2 subgroups (balanced accuracy = 64%; p < 0.0001), with SG2 showing higher education but also greater positive psychosis symptoms at first presentation, and an association with symptom remission at 1-year, 5-year, and when timepoints were combined. Neuromorphological subtypes of schizophrenia are already evident at illness onset, separated by distinct clinical presentations, and differentially associated with subsequent remission. These results suggest that the subgroups may be underlying risk phenotypes that could be targeted in future treatment trials and are critical to consider when interpreting neuroimaging literature.
Asunto(s)
Trastornos Psicóticos , Esquizofrenia , Humanos , Brasil , Encéfalo/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
OBJECTIVE: To assess the effects of gestational age and birth weight on brain volumes in a population-based sample of normal developing children at the age of 9 years. STUDY DESIGN: A total of 192 children from twin births were included in the analyses. Data on gestational age and birth weight were reported shortly after birth. Total brain, cerebellum, cerebrum, gray and white matter, and lateral ventricle volumes were assessed with structural magnetic resonance imaging. The Wechsler Intelligence Scale for Children-III was administered to assess general cognitive abilities. Structural equation modeling was used to analyze the effects of gestational age and birth weight on brain volumes. RESULTS: Shorter gestational age was associated with a relatively smaller cerebellar volume (P = .002). This effect was independent of IQ scores. Lower birth weight was associated with lower IQ score (P = .03). Birth weight was not associated with brain volumes. CONCLUSION: The effect of gestational age on cerebellar volume is not limited to children with very premature birth or very low birth weight, but is also present in children born >32 weeks of gestation and with birth weight >1500 g.
Asunto(s)
Peso al Nacer/fisiología , Encéfalo/crecimiento & desarrollo , Desarrollo Infantil/fisiología , Edad Gestacional , Cerebelo/crecimiento & desarrollo , Niño , Humanos , Recién Nacido , Recien Nacido Prematuro , Imagen por Resonancia Magnética , Masculino , Tamaño de los Órganos , Nacimiento a TérminoRESUMEN
We tested the hypothesis that the increased incidence of schizophrenia among Surinamese immigrants to The Netherlands could be explained by a similarly high incidence in Surinam. We conducted a 1-year first-contact incidence study in Surinam and compared the findings with data from a similar study conducted in The Netherlands using the same inclusion criteria and instruments. The risk of developing a schizophrenic disorder was 2.4 times higher (95% CI 1.3-4.2) in Surinamese immigrants than in residents of Surinam. The increased risk is probably due to environmental factors in The Netherlands.
Asunto(s)
Aceptación de la Atención de Salud , Esquizofrenia/epidemiología , Adaptación Psicológica , Adulto , Humanos , Incidencia , Países Bajos/epidemiología , Riesgo , Suriname/etnología , Población UrbanaRESUMEN
More than one-third of the population of Surinam has migrated to The Netherlands in the 1970s and 1980s. If selective migration explains the increased incidence in these migrants, one expects to find a very low incidence of the disorder in Surinam. We examined the medical records of the sole psychiatric hospital in Surinam and found that the mean annual rate of first admissions for schizophrenia or schizophreniform disorder (DSM-III-R criteria) in 1992 and 1993 was 1.61 per 10,000 (95% Confidence interval: 1.24-1.98 per 10,000), a normal figure. These findings constitute a challenge to the hypothesis that selection explains the increased incidence in the migrants. The possibility of an increased incidence of the disorder in Surinam (which might also explain the increased incidence among migrants) has not been ruled out by the results of this study.
Asunto(s)
Trastornos Psicóticos/epidemiología , Esquizofrenia/epidemiología , Adolescente , Adulto , Emigración e Inmigración , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Riesgo , Suriname/epidemiologíaRESUMEN
OBJECTIVE: The incidence of schizophrenia among Surinamese immigrants to the Netherlands is high. The authors tested Ødegaard's hypothesis that this phenomenon is explained by selective migration. METHOD: The authors imagined that migration from Surinam to the Netherlands subsumed the entire population of Surinam and not solely individuals at risk for schizophrenia. They compared the risk of a first admission to a Dutch mental hospital for schizophrenia from 1983 to 1992 for Surinamese-born immigrants to the risk for Dutch-born individuals, using the Surinamese-born population in the Netherlands and the population of Surinam combined as the denominator for the immigrants. RESULTS: The age- and sex-adjusted relative risk of schizophrenia for the Surinamese-born immigrants was 1.46. CONCLUSIONS: Selective migration cannot solely explain the higher incidence of schizophrenia in Surinamese immigrants to the Netherlands.