Comorbidity in Schizophrenia: Conceptual Issues and Clinical Management

Abdullah, Hussain Muhammad; Shahul, Hameed Azeb; Hwang, Mei‐Yuh; Ferrando, Stephen J.

doi:10.1176/appi.focus.20200026

Cited by 13 publications

(13 citation statements)

References 60 publications

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“…Schizophrenia and depression are highly comorbid disorders ( 103 ), with both disorders sharing overlapping symptoms, such as anhedonia ( 104 ). Initial evidence also raises the possibility that cerebellar stimulation can reduce depressive symptoms in schizophrenia.…”

Section: Discussionmentioning

confidence: 99%

Cerebellar stimulation in schizophrenia: A systematic review of the evidence and an overview of the methods

2022

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BackgroundCerebellar structural and functional abnormalities underlie widespread deficits in clinical, cognitive, and motor functioning that are observed in schizophrenia. Consequently, the cerebellum is a promising target for novel schizophrenia treatments. Here we conducted an updated systematic review examining the literature on cerebellar stimulation efficacy and tolerability for mitigating symptoms of schizophrenia. We discuss the purported mechanisms of cerebellar stimulation, current methods for implementing stimulation, and future directions of cerebellar stimulation for intervention development with this population.MethodsTwo independent authors identified 20 published studies (7 randomized controlled trials, 7 open-label studies, 1 pilot study, 4 case reports, 1 preclinical study) that describe the effects of cerebellar circuitry modulation in patients with schizophrenia or animal models of psychosis. Published studies up to October 11, 2022 were identified from a search within PubMed, Scopus, and PsycInfo.ResultsMost studies stimulating the cerebellum used transcranial magnetic stimulation or transcranial direct-current stimulation, specifically targeting the cerebellar vermis/midline. Accounting for levels of methodological rigor across studies, these studies detected post-cerebellar modulation in schizophrenia as indicated by the alleviation of certain clinical symptoms (mainly negative and depressive symptoms), as well as increased frontal-cerebellar connectivity and augmentation of canonical neuro-oscillations known to be abnormal in schizophrenia. In contrast to a prior review, we did not find consistent evidence for cognitive improvements following cerebellar modulation stimulation. Modern cerebellar stimulation methods appear tolerable for individuals with schizophrenia, with only mild and temporary side effects.ConclusionCerebellar stimulation is a promising intervention for individuals with schizophrenia that may be more relevant to some symptom domains than others. Initial results highlight the need for continued research using more methodologically rigorous designs, such as additional longitudinal and randomized controlled trials.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42022346667].

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Section: Discussionmentioning

confidence: 99%

Cerebellar stimulation in schizophrenia: A systematic review of the evidence and an overview of the methods

2022

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“…In this regard, the UP offers several interesting advantages that could help to address these issues. First, the main focus of UP is on targeting the key problems of the disorder while also allowing the therapist to work on the comorbid affective symptoms (Abdullah et al, 2020). A second advantage of UP is its flexible, modular design (Sauer-Zavala et al, 2019), which allows for a highly customized intervention.…”

Section: Access and Barriers To Carementioning

confidence: 99%

Opening Treatment Windows for Treatment-Resistant Schizophrenia: Improving Emotion Regulation Strategies Using the Unified Protocol in a Case Study in Spain

Grasa

Corripio

Roldán

et al. 2023

Clinical Case Studies

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Approximately 30%-50% of people with schizophrenia worldwide have treatment-resistant schizophrenia (TRS). Currently available standard psychopharmacological and psychological treatments have proven insufficient to achieve full recovery in these patients. Alternative psychological interventions focused on improving emotion regulation, such as the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), could potentially improve treatment outcomes in this difficult to treat population. The aim of the present case study is to demonstrate how the UP can be adapted for the treatment of TRS. We decided to use UP to treat this particular patient due to the presence of intense unpleasant emotions, aversive reactions, and emotional avoidance strategies. After completing the full treatment protocol, the patient showed significant decreases in scores on the Difficulties in Emotion Regulation Scale (DERS), including total and emotional rejection, life interference, and emotional lack of control. A significant reduction was also observed in anxiety (OASIS) and depressive symptoms (ODSIS). The intervention had a positive impact on auditory hallucinations, with decreased severity, less intense anxiety, and less interference in life. The treatment led to greater control over voices and the patient reported feeling more confident in her relationship with those voices. These results provide preliminary support for the use of UP for the treatment of TRS.

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“…Obsessive‐compulsive disorder, previously thought of as a defense mechanism in response to other positive symptoms, is now regarded as a major comorbidity. It is known to hamper neurocognitive integrity and further increases the already wide spectrum of schizophrenia‐related symptomatology (Abdullah et al., 2020). Substance use disorders (SUDs) are also highly prevalent in patients with SCZ.…”

Section: Introductionmentioning

confidence: 99%

A comprehensive update on genetic inheritance, epigenetic factors, associated pathology, and recent therapeutic intervention by gene therapy in schizophrenia

Devtalla,

Rana

et al. 2023

Chem Biol Drug Des

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Schizophrenia is a severe psychological disorder in which reality is interpreted abnormally by the patient. The symptoms of the disease include delusions and hallucinations, associated with extremely disordered behavior and thinking, which may affect the daily lives of the patients. Advancements in technology have led to understanding the dynamics of the disease and the identification of the underlying causes. Multiple investigations prove that it is regulated genetically, and epigenetically, and is affected by environmental factors. The molecular and neural pathways linked to the regulation of schizophrenia have been extensively studied. Over 180 Schizophrenic risk loci have now been recognized due to several genome‐wide association studies (GWAS). It has been observed that multiple transcription factors (TF) binding‐disrupting single nucleotide polymorphisms (SNPs) have been related to gene expression responsible for the disease in cerebral complexes. Copy number variation, SNP defects, and epigenetic changes in chromosomes may cause overexpression or underexpression of certain genes responsible for the disease. Nowadays, gene therapy is being implemented for its treatment as several of these genetic defects have been identified. Scientists are trying to use viral vectors, miRNA, siRNA, and CRISPR technology. In addition, nanotechnology is also being applied to target such genes. The primary aim of such targeting was to either delete or silence such hyperactive genes or induce certain genes that inhibit the expression of these genes. There are challenges in delivering the gene/DNA to the site of action in the brain, and scientists are working to resolve the same. The present article describes the basics regarding the disease, its causes and factors responsible, and the gene therapy solutions available to treat this disease.

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Comorbidity in Schizophrenia: Conceptual Issues and Clinical Management

Cited by 13 publications

References 60 publications

Cerebellar stimulation in schizophrenia: A systematic review of the evidence and an overview of the methods

Cerebellar stimulation in schizophrenia: A systematic review of the evidence and an overview of the methods

Opening Treatment Windows for Treatment-Resistant Schizophrenia: Improving Emotion Regulation Strategies Using the Unified Protocol in a Case Study in Spain

A comprehensive update on genetic inheritance, epigenetic factors, associated pathology, and recent therapeutic intervention by gene therapy in schizophrenia

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