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Paul, E. R. (2023). Immunological Changes and Brain Function over a Psychotic-Depressive Spectrum. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Immunological Changes and Brain Function over a Psychotic-Depressive Spectrum
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Psychotic and depressive disorders are severe psychiatric disorders that contribute significantly to the global burden of disease. They are distinct disorders with different symptom profiles according to both the Diagnostic and Statistical Manual and the International Classification of Diseases. However, these disorders share commonalities in various aspects, such as high comorbidity, prevalence of subclinical symptoms, and shared genetics. Furthermore, both disorders have been associated with a dysregulated immune system functioning.

In this thesis, we aimed to identify common biological dimensions of both depression and psychosis by first investigating proteins related to immune system activation in depression and psychosis separately, and then identifying biological underpinnings of psychotic-like symptoms in depression.Specifically, we first assessed in major depressive disorder central nervous system levels of metabolites along the kynurenine pathway, a pathway that is regulated by the immune system and implicated in depressive and psychotic disorders (paper I). We found an imbalance between neuroprotective versus neurotoxic metabolites in blood and decreased levels of a neuroprotective metabolite in cerebrospinal fluid of patients with depression.

Next, we assessed patterns of proteins implicated in immune-system function that distinguish first episode psychosis and healthy controls (paper II). Results indicate prominent changes in patients compared to controls, partially replicating previous findings and partially highlighting proteins that have not previously been assessed in psychosis.

Lastly, we investigated psychotic-like symptoms in patients with major depressive disorder, finding a relation to immune system markers (paper III) and changes in connectivity between brain structures that integrate information about the physical body and autobiographic information into a sense of self (paper IV).

In summary, the results from this thesis suggest that both in major depressive disorder and first episode psychosis there might be a dysregulation of the immune system and closely related systems such as the kynurenine pathway. These commonalities could further underlie the prevalence of subclinical psychotic-like symptoms in major depressive disorder. Ultimately, a better understanding of the underlying biological mechanisms of psychiatric disorders and, transdiagnostically, their symptoms will help formulate empiricallyinformed frameworks to guide clinical diagnostic processes and treatments.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2023. p. 87
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1867
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-198464 (URN)10.3384/9789180753098 (DOI)9789180753081 (ISBN)9789180753098 (ISBN)
Public defence
2023-11-24, Berzeliussalen, Building 463, Campus US, Linköping, 09:00 (English)
Opponent
Supervisors
Note

Funding agencies: Drottning Silvias Jubileumsfond, Fonden för Psykisk Hälsa, Swedish Research Council, Region Östergötland (ALF), Medical Research Council of Southeast Sweden (ALF), Horizon 2020, Warren Foundation, Johnson & Johnson Innovation, National Institutes of Health, MD Anderson Cancer Support Grant, The Finnish Society of Sciences, Hjärnfonden, Liv and Hälsa Foundation, Finska Läkarsällskapet, Magnus Ehrnrooth Foundation, Sigrid Jusélius Foundation, Minerva Foundation, European Regional Development Fund, Estonian Research Foundation

Available from: 2023-10-13 Created: 2023-10-13 Last updated: 2023-12-28Bibliographically approved
Korhonen, L., Paul, E., Wåhlén, K., Haring, L., Vasar, E., Vaheri, A. & Lindholm, D. (2023). Multivariate analyses of immune markers reveal increases in plasma EN-RAGE in first-episode psychosis patients. Translational Psychiatry, 13(1), Article ID 326.
Open this publication in new window or tab >>Multivariate analyses of immune markers reveal increases in plasma EN-RAGE in first-episode psychosis patients
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2023 (English)In: Translational Psychiatry, E-ISSN 2158-3188, Vol. 13, no 1, article id 326Article in journal (Refereed) Published
Abstract [en]

Immune cells and cytokines are largely recognized as significant factors in the pathophysiology of neuropsychiatric disorders. The possible role of other blood cells such as leukocytes in events of acute psychosis is in contrast only emerging. To study blood-born markers in acute psychosis we here evaluated plasma proteins in drug-naive first-episode psychosis (FEP) patients and healthy controls using a multiplex proximity extension assay technique. We analyzed a panel of 92 immune markers and plasma samples from 60 FEP patients and 50 controls and evaluated the changes obtained using multivariate statistical methods followed by protein pathway analyses. Data showed that 11 proteins are significantly different between FEP patients and healthy controls We observed increases in pro-inflammatory proteins such as interleukin-6, oncostatin-M, and transforming growth factor-alpha in FEP patients compared with controls. Likewise, the extracellular newly identified RAGE-binding protein (EN-RAGE) that regulates the expression of various cytokines was also elevated in the plasma of FEP patients. The results indicate that neutrophil-derived EN-RAGE could play an important role during the early phase of acute psychosis by stimulating cytokines and the immune response targeting thereby likely also the brain vasculature.

Place, publisher, year, edition, pages
Springer, 2023
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-198695 (URN)10.1038/s41398-023-02627-8 (DOI)001088122700001 ()
Funder
Swedish Research CouncilEuropean Regional Development Fund (ERDF)
Note

Funding agencies: Supported by H2020-MSCA-RISE-2016 (EU Grant no: 73479), The Finnish Society of Sciences and Letters, The Swedish Research Council (2018-02623, 2019-05820), Region Östergötland (LIO-795611, LIO-897641), Region South-East Sweden (FORSS807001, FORSS-849051, Swedish Brain Foundation (Hjärnfonden), Liv and Hälsa Foundation, Finska Läkaresällskapet, Magnus Ehrnrooth Foundation, Sigrid Jusélius Foundation, Minerva Foundation, European Regional Development Fund (Project No.2014-2020.4.01.15-0012), and Estonian Research Foundation (PUT PRG685). Open access funding provided by Linköping University. 

Available from: 2023-10-23 Created: 2023-10-23 Last updated: 2024-01-17
Paul, E., Schwieler, L., Erhardt, S., Boda, S., Trepci, A., Kämpe, R., . . . Samuelsson, M. (2022). Peripheral and central kynurenine pathway abnormalities in major depression. Brain, behavior, and immunity, 101, 136-145
Open this publication in new window or tab >>Peripheral and central kynurenine pathway abnormalities in major depression
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2022 (English)In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 101, p. 136-145Article in journal (Refereed) Published
Abstract [en]

Considerable data relate major depressive disorder (MDD) with aberrant immune system functioning. Pro inflammatory cytokines facilitate metabolism of tryptophan along the kynurenine pathway (KP) putatively resulting in reduced neuroprotective and increased neurotoxic KP metabolites in MDD, in addition to modulating metabolic and immune function. This central nervous system hypothesis has, however, only been tested in the periphery. Here, we measured KP-metabolite levels in both plasma and cerebrospinal fluid (CSF) of depressed patients (n = 63/36 respectively) and healthy controls (n = 48/33). Further, we assessed the relation between KP abnormalities and brain-structure volumes, as well as body mass index (BMI), an index of metabolic disturbance associated with atypical depression. Plasma levels of picolinic acid (PIC), the kynurenic/quinolinic acid ratio (KYNA/QUIN), and PIC/QUIN were lower in MDD, but QUIN levels were increased. In the CSF, we found lower PIC in MDD. Confirming previous work, MDD patients had lower hippocampal, and amygdalar volumes. Hippocampal and amygdalar volumes were correlated positively with plasma KYNA/QUIN ratio in MDD patients. BMI was increased in the MDD group relative to the control group. Moreover, BMI was inversely correlated with plasma and CSF PIC and PIC/QUIN, and positively correlated with plasma QUIN levels in MDD. Our results partially confirm previous peripheral KP findings and extend them to the CSF in MDD. We present the novel finding that abnormalities in KP metabolites are related to metabolic disturbances in depression, but the relation between KP metabolites and depression-associated brain atrophy might not be as direct as previously hypothesized.

Place, publisher, year, edition, pages
Academic Press Inc - Elsevier Science, 2022
Keywords
Major depressive disorder; Kynurenine pathway; Inflammation; Central nervous system; Brain volumetry; Structural magnetic resonance imaging; Cerebrospinal fluid
National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-183765 (URN)10.1016/j.bbi.2022.01.002 (DOI)000761260700005 ()34999196 (PubMedID)
Note

Funding Agencies|Johnson & Johnson Innovation; Swedish Medical Research CouncilSwedish Medical Research Council (SMRC)European Commission [2017-00875, 2013-07434, 2019-01138]; ALF Grants, Region Ostergotland; National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R01 CA193522, R01 NS073939]; MD Anderson Cancer Support Grant [P30 CA016672]

Available from: 2022-03-24 Created: 2022-03-24 Last updated: 2023-10-13
Trostheim, M., Eikemo, M., Meir, R., Hansen, I., Paul, E., Kroll, S., . . . Leknes, S. (2020). Assessment of Anhedonia in Adults With and Without Mental Illness A Systematic Review and Meta-analysis. JAMA Network Open, 3(8)
Open this publication in new window or tab >>Assessment of Anhedonia in Adults With and Without Mental Illness A Systematic Review and Meta-analysis
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2020 (English)In: JAMA Network Open, E-ISSN 2574-3805, Vol. 3, no 8Article, review/survey (Refereed) Published
Abstract [en]

This systematic review and meta-analysis assesses levels of anhedonia in healthy individuals and patients with mental illness according to the Snaith-Hamilton Pleasure Scale. Question Does anhedonia severity differ among patients with different types of mental illness typically associated with this symptom, and what is considered healthy hedonic functioning? Findings In this systematic review and meta-analysis of 168 studies including more than 16000 participants, anhedonia as measured by the Snaith-Hamilton Pleasure Scale was significantly elevated in patients with major depressive disorder, schizophrenia, substance use disorders, Parkinson disease, and chronic pain. Compared with ongoing major depressive disorder, all other patient groups displayed significantly lower anhedonia. Meaning The findings of this meta-analysis provide a possible set of reference values for anhedonia severity across healthy populations and those with mental illness; these results may have utility for researchers and clinicians evaluating new and existing treatments for anhedonia. Importance Anhedonia, a reduced capacity for pleasure, is described for many psychiatric and neurologic conditions. However, a decade after the Research Domain Criteria launch, whether anhedonia severity differs between diagnoses is still unclear. Reference values for hedonic capacity in healthy humans are also needed. Objective To generate and compare reference values for anhedonia levels in adults with and without mental illness. Data Sources Web of Science, Scopus, PubMed, and Google Scholar were used to list all articles from January 1, 1995 to July 2, 2019, citing the scale development report of a widely used anhedonia questionnaire, the Snaith-Hamilton Pleasure Scale (SHAPS). Searches were conducted from April 5 to 11, 2018, and on July 2, 2019. Study Selection Studies including healthy patients and those with a verified diagnosis, assessed at baseline or in a no-treatment condition with the complete 14-item SHAPS, were included in this preregistered meta-analysis. Data Extraction and Synthesis Random-effects models were used to calculate mean SHAPS scores and 95% CIs separately for healthy participants and patients with current major depressive disorder (MDD), past/remitted MDD, bipolar disorder, schizophrenia, substance use disorders, Parkinson disease, and chronic pain. SHAPS scores were compared between groups using meta-regression, and traditional effect size meta-analyses were conducted to estimate differences in SHAPS scores between healthy and patient samples. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Main Outcomes and Measures Self-reported anhedonia as measured by 2 different formats of the SHAPS (possible ranges, 0-14 and 14-56 points), with higher values on both scales indicating greater anhedonia symptoms. Results In the available literature (168 articles; 16494 participants; 8058 [49%] female participants; aged 13-72 years), patients with current MDD, schizophrenia, substance use disorder, Parkinson disease, and chronic pain scored higher on the SHAPS than healthy participants. Within the patient groups, those with current MDD scored considerably higher than all other groups. Patients with remitted MDD scored within the healthy range (g = 0.1). This pattern replicated across SHAPS scoring methods and was consistent across point estimate and effect size analyses. Conclusions and Relevance The findings of this meta-analysis indicate that the severity of anhedonia may differ across disorders associated with anhedonia. Whereas anhedonia in MDD affects multiple pleasure domains, patients with other conditions may experience decreased enjoyment of only a minority of lifes many rewards. These findings have implications for psychiatric taxonomy development, where dimensional approaches are gaining attention. Moreover, the SHAPS reference values presented herein may be useful for researchers and clinicians assessing the efficacy of anhedonia treatments.

Place, publisher, year, edition, pages
Chicago, IL, United States: American Medical Association, 2020
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-169228 (URN)10.1001/jamanetworkopen.2020.13233 (DOI)000562847800002 ()32789515 (PubMedID)2-s2.0-85089615438 (Scopus ID)
Note

Funding Agencies|South-Eastern Norway Regional Health Authority [2018035]; European Research Council under the European UnionEuropean Research Council (ERC) [802885]

Available from: 2020-09-12 Created: 2020-09-12 Last updated: 2023-12-28Bibliographically approved
Paul, E. R., Farmer, M., Kämpe, R., Cremers, H. R. & Hamilton, P. J. (2019). Functional Connectivity Between Extrastriate Body Area and Default Mode Network Predicts Depersonalization Symptoms in Major Depression: Findings From an A Priori Specified Multinetwork Comparison. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 4(7), 627-635
Open this publication in new window or tab >>Functional Connectivity Between Extrastriate Body Area and Default Mode Network Predicts Depersonalization Symptoms in Major Depression: Findings From an A Priori Specified Multinetwork Comparison
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2019 (English)In: Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, ISSN 2451-9022, Vol. 4, no 7, p. 627-635Article in journal (Refereed) Published
Abstract [en]

Background

Depersonalization/derealization disorder is a dissociative disorder characterized by feelings of unreality and detachment from the self and surroundings. Depersonalization/derealization disorder is classified as a primary disorder, but depersonalization symptoms are frequently observed in mood and anxiety disorders. In the context of major depressive disorder (MDD), depersonalization symptoms are associated with greater depressive severity as indexed by treatment resistance, inpatient visits, and duration of depressive episodes. In the current investigation, we tested four network-based, neural-functional hypotheses of depersonalization in MDD. These hypotheses were framed in terms of functional relationships between 1) extrastriate body area and default mode network (DMN); 2) hippocampus and DMN; 3) medial prefrontal cortex and ventral striatum; and 4) posterior and anterior insular cortex.

Methods

We conducted functional magnetic resonance imaging during resting state on 28 female patients with MDD and 27 control subjects with no history of a psychiatric disorder. Functional connectivity between seed and target regions as specified by our network-level hypotheses was computed and correlated with scores on the Cambridge Depersonalization Scale. We used a conservative, unbiased bootstrapping procedure to test the significance of neural-behavioral correlations observed under each of the four models tested.

Results

Of the four neural-functional models of depersonalization symptoms tested, only the model proposing that reduced connectivity between the extrastriate body area and DMN predicts higher levels of depersonalization symptoms in MDD was confirmed.

Conclusions

Our results indicate that depersonalization/derealization disorder symptoms in patients with depression are related to reduced functional connectivity between brain regions that are proposed to support processing of body-related (extrastriate body area) and autobiographical (DMN) information.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Default mode network; Depersonalization/derealization disorder; Extrastriate body area; Functional connectivity; Major depressive disorder
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-162355 (URN)10.1016/j.bpsc.2019.03.007 (DOI)000494424200006 ()31103548 (PubMedID)2-s2.0-85065575555 (Scopus ID)
Note

Funding Agencies|Warren Foundation; Swedish Research CouncilSwedish Research Council; Region Ostergotland

Available from: 2019-11-28 Created: 2019-11-28 Last updated: 2023-10-13Bibliographically approved
Mayo, L. M., Paul, E., De Arcangelis, J., Van Hedger, K. & de Wit, H. (2019). Gender differences in the behavioral and subjective effects of methamphetamine in healthy humans. Psychopharmacology, 236(8), 2413-2423
Open this publication in new window or tab >>Gender differences in the behavioral and subjective effects of methamphetamine in healthy humans
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2019 (English)In: Psychopharmacology, ISSN 0033-3158, E-ISSN 1432-2072, Vol. 236, no 8, p. 2413-2423Article in journal (Refereed) Published
Abstract [en]

Rationale

Methamphetamine (MA) use is steadily increasing and thus constitutes a major public health concern. Women seem to be particularly vulnerable to developing MA use disorder, as they initiate use at a younger age and transition more quickly to problematic use. Initial drug responses may predict subsequent use, but little information exists on potential gender differences in the acute effects of MA prior to dependence.

Objective

We examined gender differences in the acute effects of MA on subjective mood and reward-related behavior in healthy, non-dependent humans.

Methods

Men (n = 44) and women (n = 29) completed 4 sessions in which they received placebo or MA under double-blind conditions twice each. During peak drug effect, participants completed the monetary incentive delay task to assess reaction times to cues signaling potential monetary losses or gains, in an effort to determine if MA would potentiate reward-motivated behavior. Cardiovascular and subjective drug effects were assessed throughout sessions.

Results

Overall, participants responded more quickly to cues predicting incentivized trials, particularly large-magnitude incentives, than to cues predicting no incentive. MA produced faster reaction times in women, but not in men. MA produced typical stimulant-like subjective and cardiovascular effects in all participants, but subjective ratings of vigor and (reduced) sedation were greater in women than in men.

Conclusions

Women appear to be more sensitive to the psychomotor-related behavioral and subjective effects of MA. These findings provide initial insight into gender differences in acute effects of MA that may contribute to gender differences in problematic MA use.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Methamphetamine; Monetary incentive delay; Gender differences; Sex differences; Subjective effects; Psychomotor activation
National Category
Substance Abuse
Identifiers
urn:nbn:se:liu:diva-160170 (URN)10.1007/s00213-019-05276-2 (DOI)000481767900010 ()31165207 (PubMedID)2-s2.0-85067253149 (Scopus ID)
Note

Funding Agencies|NIDA [DA02812]; [DA32015]

Available from: 2019-09-09 Created: 2019-09-09 Last updated: 2022-05-02Bibliographically approved
Bergamino, M., Farmer, M., Yeh, H.-W., Paul, E. & Hamilton, P. J. (2017). Statistical differences in the white matter tracts in subjects with depression by using different skeletonized voxel-wise analysis approaches and DTI fitting procedures. Brain Research, 1669, 131-140
Open this publication in new window or tab >>Statistical differences in the white matter tracts in subjects with depression by using different skeletonized voxel-wise analysis approaches and DTI fitting procedures
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2017 (English)In: Brain Research, ISSN 0006-8993, E-ISSN 1872-6240, Vol. 1669, p. 131-140Article in journal (Refereed) Published
Abstract [en]

Major depressive disorder (MDD) is one of the most significant contributors to the global burden of illness. Diffusion tensor imaging (DTI) is a procedure that has been used in several studies to characterize abnormalities in white matter (WM) microstructural integrity in MDD. These studies, however, have provided divergent findings, potentially due to the large variety of methodological alternatives available in conducting DTI research. In order to determine the importance of different approaches to coregistration of DTI-derived metrics to a standard space, we compared results from two different skeletonized voxel-wise analysis approaches: the standard TBBS pipeline and the Advanced Normalization Tools (ANTs) approach incorporating a symmetric image normalization (SyN) algorithm and a group-wise template (ANTs TBSS). We also assessed effects of applying twelve different fitting procedures for the diffusion tensor. For our dataset, lower fractional anisotropy (FA) and axial diffusivity (AD) in depressed subjects compared with healthy controls were found for both methods and for all fitting procedures. No group differences were found for radial and mean diffusivity indices. Importantly, for the AD metric, the normalization methods and fitting procedures showed reliable differences, both in the volume and in the number of significant between-groups difference clusters detected. Additionally, a significant voxel-based correlation, in the left inferior fronto-occipital fasciculus, between AD and self-reported stress was found only for one of the normalization procedure (ANTs TBSS). In conclusion, the sensitivity to detect group-level effects on DTI metrics might depend on the DTI normalization and/or tensor fitting procedures used.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
ANTs; DTI fitting algorithms; Diffusion tensor imaging; Major depressive disorder; TBSS
National Category
Bioinformatics and Systems Biology
Identifiers
urn:nbn:se:liu:diva-146289 (URN)10.1016/j.brainres.2017.06.013 (DOI)000406729700016 ()28629742 (PubMedID)
Available from: 2018-04-07 Created: 2018-04-07 Last updated: 2022-05-02
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0201-273X

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