Dursun Hakan DELİBAŞ, ÖMER KARTI, Esin ERDOĞAN, Tuba SAHİN, Omer BİLGİC, Almıla EROL

Şizofrenide retina sinir lifi ve ganglion hücre-iç pleksiform tabaka kalınlıklarındaki azalma, iç görü ile ilişkisi: Kontrollü bir çalışma

Amaç: Bu çalışmada, kontrol grubu ile karşılaştırarak iç görüsü olan ve olmayan şizofreni hastalarında retina sinir lifi (RSL) ve ganglion hücre-iç pleksiform (GHIP) tabaka kalınlıklarındaki değişikliklerin araştırılması amaçlanmıştır. Yöntem: Psikiyatri polikliniğine başvuran, 63 şizofreni hastası ve 39 sağlıklı kontrol çalışmaya alındı. Hastalar, iç görüsü olan (s=31) ve iç görüsüz (s=32) olarak iki gruba ayrıldı. Şizofreni grubuna Pozitif ve Negatif Sendrom Ölçeği (PNSÖ), Akıl Hastalığına İçgörüsüzlük Ölçeği (AHİÖ) uygulandı. Tüm deneklerin RSL ve GHIP tabaka değişiklikleri spektral optik koherans tomografi (OKT) ile değerlendirildi. Bulgular: İç görüsü olan ve iç görüsüz şizofreni hastaları, hastalık başlangıç yaşı, hastalık süresi ortalaması, hastaneye yatış sayısı, kullanılan eşdeğer klorpromazin ilaç dozu açısından benzerdi. Şizofreni hastaları ile kontrol grubu arasında yaş ve cinsiyet açısından fark yoktu. Şizofreni hastalarında RSL tabakasının tüm kadranları, GHIP tabakasının superior temporal, superior, inferior kadranları kontrol grubuna göre daha inceydi. İç görüsüz şizofreni hastalarının GHIP tabakasının, inferior, inferior nazal ve RSL nazal kadranı hariç tüm kadranları, iç görüsü olan şizofreni hastaları ve kontrollere göre daha ince saptandı. Sonuç: Şizofreni hastalarında nörodejenerasyonun saptanması için OKT kullanılabilir. GHIP tabakasının, diğer retina katmanlarına göre daha duyarlı bir biyobelirteç olabileceği, bu alanda daha fazla araştırma yapılması gerektiği öne sürülebilir.

Decreases in retinal nerve fiber layer and ganglion cell-inner plexiform layer thickness in schizophrenia, relation to insight: a controlled study

Objective: The present study aimed to examine retinal nerve fiber layer (RNFL) and ganglion cell inner plexiform layer (GCIPL) thicknesses in schizophrenia patients according to the control group and in schizophrenia patients with good and poor insight. Methods: Sixty-three patients with schizophrenia recruited from the outpatient clinic of psychiatry and 39 healthy controls were included in the study. Patients were separated to two groups: good insight (n=31) and poor insight (n=32) schizophrenia. Group with schizophrenia were evaluated by using Positive and Negative Symptoms Scale (PANSS), Scale to Assess Unawareness of Mental Disorder. Changes in RNFL and GCIPL of all participants were analyzed with spectral optical coherence tomography (OCT). Results: Schizophrenia patients with good and poor insight were similar according to mean age of onset for illness, mean duration of illness, mean number of hospitalizations and mean daily used antipsychotic doses equivalent to chlorpromazine. There was no difference between the schizophrenia patients and the control group in terms of age and gender. In patients with schizophrenia all quadrants of RNFL, superior temporal (ST), superior (S), and inferior (I) quadrants of GCIPL were thinner than the controls. Inferior, inferior nasal quadrants of GCIPL and all quadrants of RNFL except nasal quadrant in schizophrenia patients with poor insight was found to be thinner than the schizophrenia patients with good insight and controls. Discussion: OCT can be used to detect neurodegeneration in schizophrenic patients. It can be argued that the GCIP layer may be a more sensitive biomarker than other retinal layers, requiring further investigation in this area.

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1. Erkmen T, Sahin C, Aricioglu F. The Inflammatory Mechanisms in Schizophrenia. J Marmara Univ Inst Heal Sci 2015; 5(2):134-139. 2. Lieberman JA, Stroup TS, Perkins DO. The American Psychiatric Publishing Textbook of Schizophrenia. Washington: American Psychiatric Publishing, 2007.
3. Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W, et al. Optical coherence tomography. Science 1991; 254(5035):1178- 1181.
4. Schönfeldt-Lecuona C, Schmidt A, Pinkhardt EH, Lauda F, Connemann BJ, Freudenmann RW, et al. Optical Coherence Tomography (OCT)--a new diagnostic tool in psychiatry? Fortschr Neurol Psychiatr 2014; 82(10):566-571.
5. Silverstein SM, Rosen R. Schizophrenia and the eye. Schizophr Res Cogn 2015; 2:46-55.
6. Tian T, Zhu X-H, Liu Y-H. Potential role of retina as a biomarker for progression of Parkinson's disease. Int J Ophthalmol 2011; 4(4):433-438.
7. Chu EM-Y, Kolappan M, Barnes TRE, Joyce EM, Ron MA. A window into the brain: an in vivo study of the retina in schizophrenia using optical coherence tomography. Psychiatry Res 2012; 203(1):89-94.
8. Gupta S, Zivadinov R, Ramanathan M, Weinstock-Guttman B. Optical coherence tomography and neurodegeneration: are eyes the windows to the brain? Expert Rev Neurother 2016; 7175:1-11.
9. Frohman EM, Fujimoto JG, Frohman TC, Calabresi PA, Cutter G, Balcer LJ. Optical coherence tomography: a window into the mechanisms of multiple sclerosis. Nat Clin Pract Neurol 2008; 4(12):664-675.
10. Cunha LP, Almeida ALM, Costa-Cunha LVF, Costa CF, Monteiro MLR. The role of optical coherence tomography in Alzheimer's disease. Int J Retin Vitr 2016; 2(1):24.
11. Garcia-Martin E, Rodriguez-Mena D, Satue M, Almarcegui C, Doz I, Alarcia R, et al. Electrophysiology and optical coherence tomography to evaluate Parkinson disease severity. Invest Ophthalmol Vis Sci 2014; 55(2):696-705.
12. Dhillon B, Dhillon N. The retina as a window to the brain. Arch Neurol 2008; 65(11):1547-8.
13. Ascaso FJ, Rodriguez-Jimenez R, Cabezón L, López-Antón R, Santabárbara J, De la Cámara C, et al. Retinal nerve fiber layer and macular thickness in patients with schizophrenia: Influence of recent illness episodes. Psychiatry Res 2015; 229(1-2):230-236.
14. Ascaso FJ, Lobo A. Retinal nerve fiber layer thickness measured by optical coherence tomography in patients with schizophrenia: A short report. Eur J Psychiat 2010; 24:227-235.
15. Celik M, Kalenderoglu A, Sevgi Karadag A, Bekir Egilmez O, Han-Almis B, Şimşek A. Decreases in ganglion cell layer and inner plexiform layer volumes correlate better with disease severity in schizophrenia patients than retinal nerve fiber layer thickness: Findings from spectral optic coherence tomography. Eur Psychiatry 2016; 32:9- 15.
16. Cabezon L, Ascaso F, Ramiro P, Quintanilla MA, Gutierrez L, Lobo A, et al. Optical coherence tomography: a window into the brain of schizophrenic patients. Acta Ophthalmol 2012; 90:249.
17. Lee WW, Tajunisah I, Sharmilla K, Peyman M, Subrayan V. Retinal nerve fiber layer structure abnormalities in schizophrenia and its relationship to disease state: evidence from optical coherence tomography. Invest Ophthalmol Vis Sci 2013; 54(12):7785-7792.
18. Schonfeldt-Lecuona C, Kregel T, Schmidt A, Pinkhardt EH, Lauda F, Kassubek J, et al. From Imaging the Brain to Imaging the Retina: Optical Coherence Tomography (OCT) in Schizophrenia. Schizophr Bull 2016; 42(1):9-14.
19. Buckley PF, Wirshing DA, Bhushan P, Pierre JM, Resnick S, Wirshing WC. Lack of insight in schizophrenia: impact on treatment adherence. CNS Drugs 2007; 21(2):129-141.
20. Amador XF, Gorman JM. Psychopathologic domains and insight in schizophrenia. Psychiatr Clin North Am 1998; 21(1):27-42.
21. Erol A, Delibas H, Bora O, Mete L. The impact of insight on social functioning in patients with schizophrenia. Int J Soc Psychiatry 2015; 61(4):379-385.
22. Langer KG. Babinski's anosognosia for hemiplegia in early twentieth-century French neurology. J Hist Neurosci 2009; 18:387-405.
23. Rosen HJ. Anosognosia in neurodegenerative disease. Neurocase 2011;17(3):231-241.
24. Lehrer DS, Lorenz J. Anosognosia in schizophrenia: hidden in plain sight. Innov Clin Neurosci 2014; 11(5-6):10-17.
25. Osatuke K, Ciesla J, Kasckow JW, Zisook S, Mohamed S. Insight in schizophrenia: a review of etiological models and supporting research. Compr Psychiatry 2008; 49(1):70-77.
26. Antonius D, Prudent V, Rebani Y, D'Angelo D, Ardekani BA, Malaspina D, et al. White matter integrity and lack of insight in schizophrenia and schizoaffective disorder. Schizophr Res 2011; 128(1-3):76-82.
27. Cooke MA, Fannon D, Kuipers E, Peters E, Williams SC, Kumari V. Neurological basis of poor insight in psychosis: A voxel-based MRI study. Schizophr Res 2008; 103(1-3):40-51.
28. Bergé D, Carmona S, Rovira M, Bulbena A, Salgado P, Vilarroya O. Gray matter volume deficits and correlation with insight and negative symptoms in first-psychotic-episode subjects. Acta Psychiatr Scand 2011; 123(6):431-439.
29. Emami S, Guimond S, Mallar Chakravarty M, Lepage M. Cortical thickness and low insight into symptoms in enduring schizophrenia. Schizophr Res 2016; 170(1):66-72.
30. Sapara A, Ffytche DH, Cooke MA, Williams SC, Kumari V. Voxel-based magnetic resonance imaging investigation of poor and preserved clinical insight in people with schizophrenia. World J Psychiatry 2016; 6(3):311.
31. Cooke MA, Peters ER, Kuipers E, Kumari V. Disease, deficit or denial? Models of poor insight in psychosis. Acta Psychiatr Scand 2005; 112(1):4-17.
32. Gardner DM, Murphy AL, O'Donnell H, Centorrino F, Baldessarini RJ. International consensus study of antipsychotic dosing. Am J Psychiatry 2010; 167(6):686-693.
33. Lysaker P, Bell M. Insight and interpersonal function in schizophrenia. J Nerv Ment Dis 1998; 186(7):432-436.
34. Mattila T, Koeter M, Wohlfarth T, Storosum J, Van den Brink W, Derks E, et al. The impact of second generation antipsychotics on insight in schizophrenia: Results from 14 randomized, placebo controlled trials. Eur Neuropsychopharmacol 2017; 27(1):82-86.
35. First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview for DSM-IV Clinical Version (SCID-I/CV). Washington D.C.: American Psychiatric Press, 1997.
36. Çorapçıoğlu A, Aydemir Ö, Yıldız M, Esen A, Köroğlu E. DSM-IV Eksen I Bozuklukları için Yapılandırılmış Klinik Görüşme, Klinik Versiyon. Ankara: Hekimler Yayın Birliği, 1999.
37. Kay SR, Fiszbein A, Opler LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13(2):261-276.
38. Kostakoğlu AE, Batur S, Tiryaki A, Göğüş A. Pozitif ve Negatif Sendrom Ölçeğinin (PANSS) Türkçe uyarlamasının geçerlilik ve güvenilirliği. Türk Psikoloji Dergisi 1999; 14:23-32.
39. Amador XF, Strauss DH, Yale SA, Gorman JM. Awareness of Illness in Schizophrenia. Schizophr Bull 1991; 17(1):113-132.
40. Bora E, Özdemir F, Özaşkınlı S. Akıl hastalığına içgörüsüzlük ölçeğinin kısaltılmış Türkçe formunun geçerlilik ve güvenilirliği. Türkiyede Psikiyatri 2006; 8:74-80.
41. Haijma SV, Van HN, Cahn W, Koolschijn PCMP, Hulshoff HE, Kahn RS. Brain volumes in schizophrenia: A meta-analysis in over 18 000 subjects. Schizophr Bull 2013; 39(5):1129-1138.
42. Glahn DC, Laird AR, Ellison-Wright I, Thelen SM, Robinson JL, Lancaster JL, et al. Meta-analysis of gray matter anomalies in schizophrenia: application of anatomic likelihood estimation and network analysis. Biol Psychiatry 2008; 64(9):774-781.
43. Van Haren N, Cahn W, Hulshoff Pol H, Kahn R. The course of brain abnormalities in schizophrenia: can we slow the progression? J Psychopharmacol 2012; 26(5_suppl):8-14.
44. Olabi B, Ellison-Wright I, McIntosh AM, Wood SJ, Bullmore E, Lawrie SM. Are there progressive brain changes in schizophrenia? A meta-analysis of structural magnetic resonance imaging studies. Biol Psychiatry 2011; 70(1):88-96.
45. İnan S. Retina anatomisi. Kocatepe Tıp Derg 2014; 15(3):355-359.
46. London A, Benhar I, Schwartz M. The retina as a window to the brain from eye research to CNS disorders. Nat Rev Neurol 2012; 9(1):44-53.
47. Kalenderoglu A, Sevgi-Karadag A, Celik M, Egilmez OB, Han-Almis B, Ozen ME. Can the retinal ganglion cell layer (GCL) volume be a new marker to detect neurodegeneration in bipolar disorder? Compr Psychiatry 2016; 67:66-72.
48. Rebolleda G, Diez-Alvarez L, Casado A, Sánchez-Sánchez C, De Dompablo E, GonzálezLópez, JJ, et al. OCT: New perspectives in neuroophthalmology. Saudi J Ophthalmol 2015; 29(1):9-25.
49. Saidha S, Syc SB, Durbin MK, Eckstein C, Oakley JD, Meyer SA, et al. Visual dysfunction in multiple sclerosis correlates better with optical coherence tomography derived estimates of macular ganglion cell layer thickness than peripapillary retinal nerve fiber layer thickness. Mult Scler J 2011; 17(12):1449-1463.