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Network Analysis Reveals Which Negative Symptom Domains Are Most Central in Schizophrenia vs Bipolar Disorder.

ABSTRACT: Network analysis was used to examine how densely interconnected individual negative symptom domains are, whether some domains are more central than others, and whether sex influenced network structure. Participants included outpatients with schizophrenia (SZ; n = 201), a bipolar disorder (BD; n = 46) clinical comparison group, and healthy controls (CN; n = 27) who were rated on the Brief Negative Symptom Scale. The mutual information measure was used to construct negative symptom networks. Groups were compared on macroscopic network properties to evaluate overall network connectedness, and microscopic properties to determine which domains were most central. Macroscopic analyses indicated that patients with SZ had a less densely connected negative symptom network than BD or CN groups, and that males with SZ had less densely connected networks than females. Microscopic analyses indicated that alogia and avolition were most central in the SZ group, whereas anhedonia was most central in BD and CN groups. In addition, blunted affect, alogia, and asociality were most central in females with SZ, and alogia and avolition were most central in males with SZ. These findings suggest that negative symptoms may be highly treatment resistant in SZ because they are not very densely connected. Less densely connected networks may make treatments less likely to achieve global reductions in negative symptoms because individual domains function in isolation with little interaction. Sex differences in centralities suggest that the search for pathophysiological mechanisms and targeted treatment development should be focused on different sets of symptoms in males and females.

SUBMITTER: Strauss GP

PROVIDER: S-EPMC6811832 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Network Analysis Reveals Which Negative Symptom Domains Are Most Central in Schizophrenia vs Bipolar Disorder.

Strauss Gregory Paul GP Esfahlani Farnaz Zamani FZ Kirkpatrick Brian B Allen Daniel N DN Gold James M JM Visser Katherine Frost KF Sayama Hiroki H

Schizophrenia bulletin 20191001 6

Network analysis was used to examine how densely interconnected individual negative symptom domains are, whether some domains are more central than others, and whether sex influenced network structure. Participants included outpatients with schizophrenia (SZ; n = 201), a bipolar disorder (BD; n = 46) clinical comparison group, and healthy controls (CN; n = 27) who were rated on the Brief Negative Symptom Scale. The mutual information measure was used to construct negative symptom networks. Group ...[more]

PMID: 30649527

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Project description:BackgroundAcross clinical settings, black individuals are disproportionately less likely to be diagnosed with bipolar disorder compared to schizophrenia, a traditionally more severe and chronic disorder with lower expectations for remission. The causes of this disparity are likely multifactorial, ranging from the effects of implicit bias, to developmental and lifelong effects of structural racism, to differing cultural manifestations of psychiatric symptoms and distress. While prior studies examining differences have found a greater preponderance of specific psychotic symptoms (such as persecutory delusions and hallucinations) and a more dysphoric/mixed mania presentation in Black individuals, these studies have been limited by a lack of systematic phenotypic assessment and small sample sizes. In the current report, we have combined data from two large multi-ethnic studies of bipolar disorder with comparable semi-structured interviews to investigate differences in symptoms presentation across the major clinical symptom domains of bipolar disorder.ResultsIn the combined meta-analysis, there were 4423 patients diagnosed with bipolar disorder type I, including 775 of self-reported as Black race. When symptom presentations were compared in Black versus White individuals, differences were found across all the major clinical symptom domains of bipolar disorder. Psychotic symptoms, particularly persecutory hallucinations and both persecutory and mood-incongruent delusions, were more prevalent in Black individuals with bipolar disorder type I (ORs = 1.26 to 2.45). In contrast, Black individuals endorsed fewer prototypical manic symptoms, with a notably decreased likelihood of endorsing abnormally elevated mood (OR = 0.44). Within depression associated symptoms, we found similar rates of mood or cognitive related mood symptoms but higher rates of decreased appetite (OR = 1.32) and weight loss (OR = 1.40), as well as increased endorsement of initial, middle, and early-morning insomnia (ORs = 1.73 to 1.82). Concurrently, we found that black individuals with BP-1 were much less likely to be treated with mood stabilizers, such as lithium (OR = 0.45), carbamazepine (OR = 0.37) and lamotrigine (OR = 0.34), and moderately more likely to be on antipsychotic medications (OR = 1.25).ConclusionsIn two large studies spanning over a decade, we found highly consistent and enduring differences in symptoms across the major clinical symptom domains of bipolar disorder. These differences were marked by a greater burden of mood-incongruent psychotic symptoms, insomnia and irritability, and fewer prototypical symptoms of mania. While such symptoms warrant better recognition to reduce diagnostic disparities, they may also represent potential targets of treatment that can be addressed to mitigate persistent disparities in outcome.

Project description:BackgroundThe network approach to psychopathology has become increasingly popular. Little research has examined the dynamic network structure of mental disorders, and, to date, no study has investigated the network dynamics of positive affect, negative affect, and physical activity in bipolar disorder. This represents the first study to estimate the dynamic network structure of affect and physical activity in individuals with and without bipolar I disorder.MethodsAn intensive longitudinal design was used to assess positive affect, negative affect, and actigraphy-based estimates of physical activity. The overall sample consisted of 32 adults with bipolar I disorder and 36 healthy control participants. Eligible participants underwent an 8-week assessment period, in which once-per-day ratings of affect and actigraphy estimates were obtained. Participants were re-assessed on baseline measures afterwards. Dynamic network analysis was used to examine the network structure of affect and physical activity over time. Multilevel models were used to examine the relationship between autocorrelation and changes in depression symptoms among participants with bipolar disorder.LimitationsThe network analyses assume stationarity. Future research should consider time-varying multilevel network models to better account for time trends.ResultsThe results of the temporal networks indicated that the directed edges between positive and negative affect were mostly positive among individuals with bipolar I disorder. Among healthy control participants, the directed edges between positive and negative affect were mostly negative in direction. Physical activity, as assessed by daily actigraphy indices, was more densely connected in the healthy control network than the bipolar disorder network. Furthermore, the results indicated that critical slowing down predicted worsening of mood symptoms in the bipolar I disorder group.ConclusionsThis study suggests that certain dynamic patterns of affect may be an underlying process that contributes to the maintenance of bipolar disorder. These results have both theoretical and practical implications.

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Network Analysis Reveals Which Negative Symptom Domains Are Most Central in Schizophrenia vs Bipolar Disorder.

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Network Analysis Reveals Which Negative Symptom Domains Are Most Central in Schizophrenia vs Bipolar Disorder.

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