The Frequency of Symptom-Based Phenotypes of Mental Disorders is Long-Tailed | The heterogeneity of symptoms among individuals diagnosed with the same mental disorder has been blamed to hinder research in mental health and the development of effective treatments. Although widely acknowledged as problematic, the characteristics of this heterogeneity are largely unknown. We assessed the frequency of symptom phenotypes across a variety of clinical and non-clinical populations and found a consistent, long-tailed distribution. This distribution represents a mixture of a few very commonly expressed phenotypes and the sum of many, each only rarely displayed ones. As a consequence, the non-normality of this distribution induces a systematic bias, affecting all research and treatments relying on a symptom-based definition of mental disorders. | 1450/5743 | Secondary Analysis | Shared |
Antipsychotic Adherence and Weight Change | Background: The relationship between weight change and adherence to antipsychotic medications in the treatment of schizophrenia is unclear.
Methods: We used limited-access data from the Clinical Antipsychotic Trials of Intervention Effectiveness Project Schizophrenia Trial (CATIE-Sz) to estimate survival models predicting time to first and repeated discontinuation/switch of antipsychotics during the first 48 weeks of follow-up in CATIE-Sz. Explanatory variables included lagged percentage weight changes, lagged changes in Positive and Negative Syndrome Scale (PANSS) total scores, a lagged weight change/PANSS total score change interaction term, and other covariates that have been found to be associated with time to discontinuation/switch.
Results: Data from 1,148 participants were included in the analysis. 692 (60.3%) had a first discontinuation/switch during the 48 weeks and median time to discontinuation/switch was 197 days. For both first and repeated events, PANSS total score change (first event HR 1.37 per 10-point change, P<0.001, repeated event HR 1.34, P<0.001) was a significant predictor of longer time to discontinuation/switch while percentage weight change (first event HR 1.04 per 10 percent change, P=0.41; repeated event HR 1.04, P=0.46) was not. The Wald test for interaction was significant (P=0.0001) and the interaction’s hazard ratio was 1.12 for first and repeated events, P=0<0.001. Age (HR 0.89 per 10-year change, P=0.002), baseline PANSS score (HR 1.23 per 10-point change, P<0.001), previous antipsychotic use (HR 1.30, P=0.003), and previous hospitalization (HR 1.09, P=0.02) were also significant predictors.
Discussion: Weight change had a mixed effect on time to discontinuation/switch through its interaction with PANSS total score change, significantly increasing time to discontinuation/ switch for some and decreasing it for others. Participants with the best responses – decreases in both PANSS scores and weight – to antipsychotics were among those for whom time to discontinuation/switch was increased.
| 1460/1460 | Secondary Analysis | Shared |
Long-term Waist Circumference Changes with Olanzapine Treatment: A post-hoc analysis of CATIE Phase I Data | This study explores changes in waist circumference in patients with schizophrenia who were treated with olanzapine in the Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) study. In the CATIE study, 1493 patients were randomized to treatment with olanzapine, quetiapine, risperidone, perphenazine and later ziprasidone for up to 18 months. The primary outcome measure was time to all cause discontinuation. Olanzapine showed the lowest overall rate of discontinuation, but the highest rate of discontinuation due to weight gain or metabolic reasons. Over the 18 month trial, olanzapine was associated with the highest total weight gain and rate of weight gain compared to the other antipsychotics tested. Waist circumference was collected as a measure in this study but by-visit changes in waist circumference for the olanzapine treatment arm have not been previously reported. This study assesses the by-visit changes in waist circumference for patients treated with olanzapine over the18-month treatment period. | 1460/1460 | Secondary Analysis | Shared |
Bifactor Model of Cognition in Schizophrenia: Evidence for General and Specific Abilities | Background: Despite extensive study of cognition in schizophrenia, it remains unclear as to whether cognitive
deficits and their latent structure are best characterized as reflecting a generalized deficit, specific deficits, or
some combination of general and specific constructs.
Method: To clarify latent structure of cognitive abilities, confirmatory factor analysis was used to examine the
latent structure of cognitive data collected for the Clinical Antipsychotic Trials of Intervention Effectiveness
(CATIE) for Schizophrenia study. Baseline assessment data (n = 813) were randomly divided into calibration (n
= 413) and cross-validation samples (n = 400). To examine whether generalized or specific deficit models
provided better explanation of the data, we estimated first-order, hierarchical, and bifactor models.
Results: A bifactor model with seven specific factors and one general factor provided the best fit to the data for
both the calibration and cross-validation samples.
Conclusions: These findings lend support for a replicable bifactor model of cognition in schizophrenia, characterized by both a general cognitive factor and specific domains. This suggests that cognitive deficits in schizophrenia might be best understood by separate general and specific contributions. | 813/813 | Secondary Analysis | Shared |
Causal Pathways to Social and Occupational Functioning in the First Episode of Schizophrenia: Uncovering Unmet Treatment Needs | We aimed to identify unmet treatment needs for improving social and occupational functioning in early schizophrenia using a data-driven causal discovery analysis. Demographic, clinical, and psychosocial measures were obtained for 279 participants from the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) trial at baseline and six-months, along with measures of social and occupational functioning from the Quality of Life Scale. The Greedy Fast Causal Inference algorithm was used to learn a partial ancestral graph modeling causal relationships across baseline variables and six-month functioning. Effect sizes were estimated using a structural equation model. Results were validated in an independent dataset (N=187). In the data-generated model, greater baseline socio-affective capacity was a cause of greater baseline motivation (ES = 0.77), and motivation was a cause of greater baseline social and occupational functioning (ES = 1.5 and 0.96, respectively), which in turn were causes of their own six-month outcomes. Six-month motivation was also identified as a cause of occupational functioning (ES = 0.92). Cognitive impairment and duration of untreated psychosis were not direct causes of functioning at either timepoint. The graph for the validation dataset was less determinate, but otherwise supported the findings. Results from our data-generated model suggest baseline socio-affective capacity and motivation may be the most direct causes of occupational and social functioning six months after entering treatment in early schizophrenia. These findings indicate that social cognitive abilities and motivation are specific high-impact treatment needs that must be addressed in order to promote optimal social and occupational recovery. | 187/591 | Secondary Analysis | Shared |
Deep Learning Methods applied to Drug Concentration Prediction of Olanzapine from the CATIE Trials | Pharmacometrics and the utilization of population pharmacokinetics play an integral role in model-informed drug discovery and development (MIDD). Recently, there has been a growth in the application of deep learning approaches to aid in areas within MIDD. In this study, a deep learning model, LSTM-ANN, was developed to predict olanzapine drug concentrations from the CATIE study. A total of 1,527 olanzapine drug concentrations from 523 individuals along with eleven patient-specific covariates were used in model development. The hyperparameters of the LSTM-ANN model were optimized through a Bayesian optimization algorithm. A population pharmacokinetic model using the NONMEM model was constructed as a reference to compare to the performance of the LSTM-ANN model. The RMSE of the LSTM-ANN model was 29.566 in the validation set, while the RMSE of the NONMEM model was 31.129. Permutation importance revealed age, sex, and smoking were highly influential covariates in the LSTM-ANN model. The LSTM-ANN model showed potential in the application of drug concentration predictions as it was able to capture the relationships within a sparsely sampled pharmacokinetic dataset and perform comparably to the NONMEM model. | 405/522 | Secondary Analysis | Shared |