Publications by authors named "Alan Breier"

Schizophrenia is a complex syndrome with taxing symptoms and for which treatment challenges remain. Current dopamine Dreceptor-blocking antipsychotics have well-known limitations, including ineffectively treating across all symptom domains and generating common side effects such as motor disturbances, weight gain, and metabolic dysfunction. New approaches are sorely needed to address the continued unmet treatment needs for individuals living with schizophrenia.

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  • The Human Connectome Project for Early Psychosis (HCP-EP) studies how the brain works in people who are starting to experience psychosis, which is when someone has trouble telling what's real and what's not.
  • They collected detailed information from 303 participants aged 16-35 across different hospitals in Massachusetts and Indiana.
  • The study aims to help researchers understand and compare different types of psychosis, and all the data is available for other scientists to use.
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Background: Neurocognitive impairment is a well-known phenomenon in schizophrenia that begins prior to psychosis onset. Connectome-wide association studies have inconsistently linked cognitive performance to resting-state functional magnetic resonance imaging. We hypothesized that a carefully selected cognitive instrument and refined population would allow identification of reliable brain-behavior associations with connectome-wide association studies.

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Structural neuroimaging data have been used to compute an estimate of the biological age of the brain (brain-age) which has been associated with other biologically and behaviorally meaningful measures of brain development and aging. The ongoing research interest in brain-age has highlighted the need for robust and publicly available brain-age models pre-trained on data from large samples of healthy individuals. To address this need we have previously released a developmental brain-age model.

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  • There is a critical demand for new antipsychotic medications that are more effective and have fewer side effects; xanomeline, a new muscarinic receptor agonist, shows promise in this area, especially when paired with trospium chloride to minimize side effects.
  • The EMERGENT-3 trial tested xanomeline-trospium against a placebo in adults with schizophrenia experiencing acute psychosis, taking place at multiple sites in the US and Ukraine from April to December 2022.
  • The study aimed to measure changes in psychiatric symptoms using the Positive and Negative Syndrome Scale (PANSS) and assess safety, with results expected to contribute to new treatment options for schizophrenia.
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  • Despite decades of drug development, finding effective treatments for schizophrenia remains tough, with most antipsychotics providing only modest benefits.
  • Most currently approved medications mainly target dopamine D receptors, showing limited effectiveness, especially for cognitive and negative symptoms.
  • There is growing interest in developing new treatments that target muscarinic acetylcholine receptors, with promising research suggesting that drugs like xanomeline may improve outcomes for people with schizophrenia.
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Decades of psychosis research highlight the prevalence and the clinical significance of negative emotions, such as fear and anxiety. Translational evidence demonstrates the pivotal role of the amygdala in fear and anxiety. However, most of these approaches have used hypothesis-driven analyses with predefined regions of interest.

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Background: Psychomotor disturbances are observed across psychiatric disorders and often manifest as psychomotor slowing, agitation, disorganized behavior, or catatonia. Psychomotor function includes both cognitive and motor components, but the neural circuits driving these subprocesses and how they relate to symptoms have remained elusive for centuries.

Methods: We analyzed data from the HCP-EP (Human Connectome Project for Early Psychosis), a multisite study of 125 participants with early psychosis and 58 healthy participants with resting-state functional magnetic resonance imaging and clinical characterization.

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  • New treatments for schizophrenia are needed, as current options mostly block dopamine receptors, whereas xanomeline offers a different approach as a muscarinic receptor agonist without this blockade.
  • The EMERGENT-2 trial tested KarXT, a combination of xanomeline and trospium, for efficacy and safety in hospitalized patients experiencing acute psychosis, assessing changes in the PANSS score over 5 weeks.
  • Participants received varying doses of KarXT or a placebo, with results analyzed to determine the effectiveness of the treatment in improving symptoms compared to the placebo group.
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We present an empirically benchmarked framework for sex-specific normative modeling of brain morphometry that can inform about the biological and behavioral significance of deviations from typical age-related neuroanatomical changes and support future study designs. This framework was developed using regional morphometric data from 37,407 healthy individuals (53% female; aged 3-90 years) following a comparative evaluation of eight algorithms and multiple covariate combinations pertaining to image acquisition and quality, parcellation software versions, global neuroimaging measures, and longitudinal stability. The Multivariate Factorial Polynomial Regression (MFPR) emerged as the preferred algorithm optimized using nonlinear polynomials for age and linear effects of global measures as covariates.

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  • - The study focused on individuals with early phase psychosis (EPP) and found that a significant portion (about 25%) reported a history of legal issues like arrests or incarceration shortly after joining a treatment clinic.
  • - Data analysis revealed that 39% of participants had multiple traffic violations or criminal convictions, which is more than double the national average, with drug and alcohol-related offenses being the most frequent types.
  • - The findings suggest that specialty clinics should collaborate with experts in criminal behavior management, and future research should look into the risk factors associated with criminal convictions in individuals with EPP.
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  • The study investigates the combination of xanomeline and trospium (KarXT) to reduce side effects associated with xanomeline, which has shown promise in treating conditions like schizophrenia and Alzheimer's.
  • In a phase 1 clinical trial with healthy volunteers, KarXT significantly reduced the incidence of specific cholinergic adverse events compared to xanomeline alone, without affecting the drug's pharmacokinetics.
  • Results suggest that KarXT offers a better safety profile, as it lowered rates of nausea, dizziness, and other side effects while showing no significant changes in vital signs or ECGs.
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The choroid plexus (ChP) is part of the blood-cerebrospinal fluid barrier, regulating brain homeostasis and the brain's response to peripheral events. Its upregulation and enlargement are considered essential in psychosis. However, the timing of the ChP enlargement has not been established.

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  • The study evaluated the effectiveness of the oral medication KarXT (xanomeline-trospium) in treating schizophrenia by analyzing response rates using the Positive and Negative Syndrome Scale (PANSS) over a 5-week period.
  • A significant number of patients treated with KarXT showed improvements above the placebo group at various thresholds for symptom reduction, with early response noted as soon as two weeks into treatment.
  • The analysis highlighted that KarXT not only had a higher percentage of responders compared to placebo but also demonstrated consistent benefits across various symptom domains throughout the treatment period.
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Brain morphology differs markedly between individuals with schizophrenia, but the cellular and genetic basis of this heterogeneity is poorly understood. Here, we sought to determine whether cortical thickness (CTh) heterogeneity in schizophrenia relates to interregional variation in distinct neural cell types, as inferred from established gene expression data and person-specific genomic variation. This study comprised 1849 participants in total, including a discovery (140 cases and 1267 controls) and a validation cohort (335 cases and 185 controls).

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Linguistic abnormalities can emerge early in the course of psychotic illness. Computational tools that quantify similarity of responses in standardized language-based tasks such as the verbal fluency test could efficiently characterize the nature and functional correlates of these disturbances. Participants with early-stage psychosis (n=20) and demographically matched controls without a psychiatric diagnosis (n=20) performed category and letter verbal fluency.

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  • A 5-week randomized double-blind study (EMERGENT-1) tested the safety and effectiveness of KarXT, a treatment for schizophrenia, using remote ratings from audio-recorded PANSS interviews with patients experiencing acute psychosis.
  • Independent raters showed a high correlation between their ratings and site-based assessments, reinforcing the validity of the findings.
  • The study found that the KarXT group had significantly greater improvement in symptoms compared to the placebo group, and the method of remote assessment may benefit future studies aiming to enhance rating accuracy.
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  • * Conducted over 5 weeks with 182 patients, results indicated that those receiving xanomeline-trospium experienced a significantly greater reduction in schizophrenia symptoms, as measured by the PANSS score, compared to the placebo group.
  • * While the combination therapy showed improved effectiveness in several secondary measures, there were still some adverse events, although specific common adverse effects were not detailed in the text.
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Delineating the association of age and cortical thickness in healthy individuals is critical given the association of cortical thickness with cognition and behavior. Previous research has shown that robust estimates of the association between age and brain morphometry require large-scale studies. In response, we used cross-sectional data from 17,075 individuals aged 3-90 years from the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Consortium to infer age-related changes in cortical thickness.

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Age has a major effect on brain volume. However, the normative studies available are constrained by small sample sizes, restricted age coverage and significant methodological variability. These limitations introduce inconsistencies and may obscure or distort the lifespan trajectories of brain morphometry.

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Cognitive deficits are a central feature of schizophrenia whose etiology is not fully understood. Epstein Barr Virus (EBV) is a potentially neurotropic infectious agent that can generate persistent infections with immunomodulatory effects. Previous studies have found an association between EBV antibodies and cognitive functioning in different populations, but there has been limited investigation in schizophrenia.

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