Browsing by Author "Crossley Karmelic, Nicolas Andres"

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    Differences of affective and non-affective psychoses in early intervention services from Latin America
    (2022) Cerqueira, Raphael O.; Ziebold, Carolina; Cavalcante, Daniel; Oliveira, Giovany; Vasquez Nuñez, Javiera Eugenia; Undurraga, Juan; Gonzalez-Valderrama, Alfonso; Nachar, Ruben; Lopez-Jaramillo, Carlos; Noto, Cristiano; Crossley Karmelic, Nicolas Andres; Gadelha, Ary
    Background: Psychosis presentation can be affected by genetic and environmental factors. Differentiating be-tween affective and non-affective psychosis (A-FEP and NA-FEP, respectively) may influence treatment decisions and clinical outcomes. The objective of this paper is to examine differences between patients with A-FEP or NA-FEP in a Latin American sample.Methods: Patients from two cohorts of patients with a FEP recruited from Brazil and Chile. Subjects included were aged between 15 and 30 years, with an A-FEP or NA-FEP (schizophrenia-spectrum disorders) according to DSM-IV-TR. Sociodemographic data, duration of untreated psychosis and psychotic/mood symptoms were assessed. Generalized estimating equation models were used to assess clinical changes between baseline-follow-up ac-cording to diagnosis status.Results: A total of 265 subjects were included. Most of the subjects were male (70.9 %), mean age was 21.36 years. A-FEP and NA-FEP groups were similar in almost all sociodemographic variables, but A-FEP patients had a higher probability of being female. At baseline, the A-FEP group had more manic symptoms and a steeper reduction in manic symptoms scores during the follow-up. The NA-FEP group had more negative symptoms at baseline and a higher improvement during follow-up. All domains of The Positive and Negative Syndrome Scale improved for both groups. No difference for DUP and depression z-scores at baseline and follow-up. Limitations: The sample was recruited at tertiary hospitals, which may bias the sample towards more severe cases.Conclusions: This is the largest cohort comparing A-FEP and NA-FEP in Latin America. We found that features in FEP patients could be used to improve diagnosis and support treatment decisions.
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    Difficulties during delivery, brain ventricle enlargement and cognitive impairment in first episode psychosis
    (2023) Costas-Carrera, A.; Verdolini, N.; Garcia-Rizo, C.; Mezquida, G.; Janssen, J.; Valli, I.; Corripio, I.; Sanchez-Torres, A.M.; Bioque, M.; Lobo, A.; Gonzalez-Pinto, A.; Rapado-Castro, M.; Vieta, E.; De La Serna, H.; Mane, A.; Roldan, A.; Crossley Karmelic, Nicolas Andres; Penades, R.; Cuesta, M.J.; Parellada, M.; PEPs group
    Published by Cambridge University Press.Background Patients with a first episode of psychosis (FEP) display clinical, cognitive, and structural brain abnormalities at illness onset. Ventricular enlargement has been identified in schizophrenia since the initial development of neuroimaging techniques. Obstetric abnormalities have been associated with an increased risk of developing psychosis but also with cognitive impairment and brain structure abnormalities. Difficulties during delivery are associated with a higher risk of birth asphyxia leading to brain structural abnormalities, such as ventriculomegaly, which has been related to cognitive disturbances. Methods We examined differences in ventricular size between 142 FEP patients and 123 healthy control participants using magnetic resonance imaging. Obstetric complications were evaluated using the Lewis-Murray scale. We examined the impact of obstetric difficulties during delivery on ventricle size as well as the possible relationship between ventricle size and cognitive impairment in both groups. Results FEP patients displayed significantly larger third ventricle size compared with healthy controls. Third ventricle enlargement was associated with diagnosis (higher volume in patients), with difficulties during delivery (higher volume in subjects with difficulties), and was highest in patients with difficulties during delivery. Verbal memory was significantly associated with third ventricle to brain ratio. Conclusions Our results suggest that difficulties during delivery might be significant contributors to the ventricular enlargement historically described in schizophrenia. Thus, obstetric complications may contribute to the development of psychosis through changes in brain architecture.
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    Imaging social and environmental factors as modulators of brain dysfunction: time to focus on developing, non-Western societies
    (2019) Crossley Karmelic, Nicolas Andres; Alliende Serra, Luz Maria; Ossandón Valdés, Tomás; Castañeda, Carmen Paz; González-Valderrama, Alfonso; Undurraga, Juan; Castro, Mariana; Guinjoan, Salvador; Diaz-Zuluanga, Ana María; Pineda Zapata, Julian A.; Lopez-Jaramillo, Carlos; Reyes-Madrigal, Francisco; De la fuente Sandoval, Camilo; León-Ortíz, Pablo; Sanguinetti Czepielewski, Leticia; Gama, Clarissa S.; Zugman, Andre; Gadelha, Ary; Jackowski, Andrea; Bressan, Rodrigo
    Social and environmental factors are known risk factors and modulators of mental health disorders. We here conducted a nonsystematic review of the neuroimaging literature studying the effects of poverty, urbanicity, and community violence, highlighting the opportunities of studying non-Western developing societies such as those in Latin America. Social and environmental factors in these communities are widespread and have a large magnitude, as well as an unequal distribution, providing a good opportunity for their characterization. Studying the effect of poverty in these settings could help to explore the brain effect of economic improvements, disentangle the effect of absolute and relative poverty, and characterize the modulating impact of poverty on the underlying biology of mental health disorders. Exploring urbanicity effects in highly unequal cities could help identify the specific factors that modulate this effect as well as examine a possible dose-response effect by studying megacities. Studying brain changes in those living among violence, which is particularly high in places such as Latin America, could help to characterize the interplay between brain predisposition and exposure to violence. Furthermore, exploring the brain in an adverse environment should shed light on the mechanisms underlying resilience. We finally provide examples of two methodological approaches that could contribute to this field, namely a big cohort study in the developing world and a consortium-based meta-analytic approach, and argue about the potential translational value of this research on the development of effective social policies and successful personalized medicine in disadvantaged societies.
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    Interactions between hippocampal activity and striatal dopamine in people at clinical high risk for psychosis: relationship to adverse outcomes
    (Springer Nature, 2021) Modinos, Gemma; Richter, Anja; Egerton, Alice; Bonoldi. Ilaria; Azis, Matilda; Antoniades, Mathilde; Bossong, Matthijs; Crossley Karmelic, Nicolas Andres; Perez, Jesus; Stone, James M.; Veronese, Mattia; Zelaya, Fernando; Grace, Anthony A.; Howes, Oliver D.; Allen, Paul; McGuire, Phillip
    Preclinical models propose that increased hippocampal activity drives subcortical dopaminergic dysfunction and leads to psychosis-like symptoms and behaviors. Here, we used multimodal neuroimaging to examine the relationship between hippocampal regional cerebral blood flow (rCBF) and striatal dopamine synthesis capacity in people at clinical high risk (CHR) for psychosis and investigated its association with subsequent clinical and functional outcomes. Ninety-five participants (67 CHR and 28 healthy controls) underwent arterial spin labeling MRI and 18F-DOPA PET imaging at baseline. CHR participants were followed up for a median of 15 months to determine functional outcomes with the global assessment of function (GAF) scale and clinical outcomes using the comprehensive assessment of at-risk mental states (CAARMS). CHR participants with poor functional outcomes (follow-up GAF < 65, n = 25) showed higher rCBF in the right hippocampus compared to CHRs with good functional outcomes (GAF ≥ 65, n = 25) (pfwe = 0.026). The relationship between rCBF in this right hippocampal region and striatal dopamine synthesis capacity was also significantly different between groups (pfwe = 0.035); the association was negative in CHR with poor outcomes (pfwe = 0.012), but non-significant in CHR with good outcomes. Furthermore, the correlation between right hippocampal rCBF and striatal dopamine function predicted a longitudinal increase in the severity of positive psychotic symptoms within the total CHR group (p = 0.041). There were no differences in rCBF, dopamine, or their associations in the total CHR group relative to controls. These findings indicate that altered interactions between the hippocampus and the subcortical dopamine system are implicated in the pathophysiology of adverse outcomes in the CHR state.