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Sheehan N, Bannai D, Silverstein SM, Lizano P. Neuroretinal Alterations in Schizophrenia and Bipolar Disorder: An Updated Meta-analysis. Schizophr Bull 2024; 50:1067-1082. [PMID: 38954839 PMCID: PMC11349028 DOI: 10.1093/schbul/sbae102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Schizophrenia (SZ) and bipolar disorder (BD) are characterized by major symptomatic, cognitive, and neuroanatomical changes. Recent studies have used optical coherence tomography (OCT) to investigate retinal changes in SZ and BD, but their unique and shared changes require further evaluation. Articles were identified using PubMed and Google Scholar. 39 studies met the inclusion criteria. Diagnostic groups were proband (SZ/BD combined), SZ, BD, and healthy control (HC) eyes. Meta-analyses utilized fixed and random effects models when appropriate, and publication bias was corrected using trim-and-fill analysis ("meta" package in R). Results are reported as standardized mean differences with 95% CIs. Data from 3145 patient eyes (1956 SZ, 1189 BD) and 3135 HC eyes were included. Studies identified thinning of the peripapillary retinal nerve fiber layer (pRNFL, overall and in 2 subregions), m-Retina (overall and all subregions), mGCL-IPL, mIPL, and mRPE in SZ patients. BD showed thinning of the pRNFL (overall and in each subregion), pGCC, and macular Retina (in 5 subregions), but no changes in thickness or volume for the total retina. Neither SZ nor BD patients demonstrated significant changes in the fovea, mRNFL, mGCL, mGCC, mINL, mOPL, mONL, or choroid thicknesses. Moderating effects of age, illness duration, and smoking on retinal structures were identified. This meta-analysis builds upon previous literature in this field by incorporating recent OCT studies and examining both peripapillary and macular retinal regions with respect to psychotic disorders. Overall, this meta-analysis demonstrated both peripapillary and macular structural retinal abnormalities in people with SZ or BD compared with HCs.
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Affiliation(s)
- Nora Sheehan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Deepthi Bannai
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
| | - Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Cai J, Xie M, Liang S, Gong J, Deng W, Guo W, Ma X, Sham PC, Wang Q, Li T. Dysfunction of thalamocortical circuits in early-onset schizophrenia. Cereb Cortex 2024; 34:bhae313. [PMID: 39106176 DOI: 10.1093/cercor/bhae313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/30/2024] [Accepted: 07/21/2024] [Indexed: 08/09/2024] Open
Abstract
Previous studies have demonstrated that the thalamus is involved in multiple functional circuits in participants with schizophrenia. However, less is known about the thalamocortical circuit in the rare subtype of early-onset schizophrenia. A total of 110 participants with early-onset schizophrenia (47 antipsychotic-naive patients) and 70 matched healthy controls were recruited and underwent resting-state functional and diffusion-weighted magnetic resonance imaging scans. A data-driven parcellation method that combined the high spatial resolution of diffusion magnetic resonance imaging and the high sensitivity of functional magnetic resonance imaging was used to divide the thalamus. Next, the functional connectivity between each thalamic subdivision and the cortex/cerebellum was investigated. Compared to healthy controls, individuals with early-onset schizophrenia exhibited hypoconnectivity between subdivisions of the thalamus and the frontoparietal network, visual network, ventral attention network, somatomotor network and cerebellum, and hyperconnectivity between subdivisions of thalamus and the parahippocampal and temporal gyrus, which were included in limbic network. The functional connectivity between the right posterior cingulate cortex and 1 subdivision of the thalamus (region of interest 1) was positively correlated with the general psychopathology scale score. This study showed that the specific thalamocortical dysconnection in individuals with early-onset schizophrenia involves the prefrontal, auditory and visual cortices, and cerebellum. This study identified thalamocortical connectivity as a potential biomarker and treatment target for early-onset schizophrenia.
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Affiliation(s)
- Jia Cai
- Mental Health Center, West China Hospital of Sichuan University, No. 28th Dianxin Nan Str. Chengdu, Sichuan, 610041, China
| | - Min Xie
- Mental Health Center, West China Hospital of Sichuan University, No. 28th Dianxin Nan Str. Chengdu, Sichuan, 610041, China
| | - Sugai Liang
- Affiliated Mental Health Centre and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, No. 305th Tianmushan Road, Xihu District, Hangzhou, Zhejiang 310013, China
| | - Jinnan Gong
- School of Computer Science, Chengdu University of Information Technology, No. 2006th, Xiyuan Road, Pidu District, Chengdu, Sichuan 611700, China
| | - Wei Deng
- Affiliated Mental Health Centre and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, No. 305th Tianmushan Road, Xihu District, Hangzhou, Zhejiang 310013, China
| | - Wanjun Guo
- Affiliated Mental Health Centre and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, No. 305th Tianmushan Road, Xihu District, Hangzhou, Zhejiang 310013, China
| | - Xiaohong Ma
- Mental Health Center, West China Hospital of Sichuan University, No. 28th Dianxin Nan Str. Chengdu, Sichuan, 610041, China
| | - Pak C Sham
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Central and Western District, Hong Kong, Special Administrative Region, 999077, China
- Centre for PanorOmic Sciences, The University of Hong Kong, Pokfulam, Central and Western District, Hong Kong, Special Administrative Region, 999077, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Central and Western District, Hong Kong, Special Administrative Region, 999077, China
| | - Qiang Wang
- Mental Health Center, West China Hospital of Sichuan University, No. 28th Dianxin Nan Str. Chengdu, Sichuan, 610041, China
| | - Tao Li
- Affiliated Mental Health Centre and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, No. 305th Tianmushan Road, Xihu District, Hangzhou, Zhejiang 310013, China
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Boudriot E, Gabriel V, Popovic D, Pingen P, Yakimov V, Papiol S, Roell L, Hasanaj G, Xu S, Moussiopoulou J, Priglinger S, Kern C, Schulte EC, Hasan A, Pogarell O, Falkai P, Schmitt A, Schworm B, Wagner E, Keeser D, Raabe FJ. Signature of Altered Retinal Microstructures and Electrophysiology in Schizophrenia Spectrum Disorders Is Associated With Disease Severity and Polygenic Risk. Biol Psychiatry 2024:S0006-3223(24)01262-9. [PMID: 38679358 DOI: 10.1016/j.biopsych.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 03/30/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Optical coherence tomography and electroretinography studies have revealed structural and functional retinal alterations in individuals with schizophrenia spectrum disorders (SSDs). However, it remains unclear which specific retinal layers are affected; how the retina, brain, and clinical symptomatology are connected; and how alterations of the visual system are related to genetic disease risk. METHODS Optical coherence tomography, electroretinography, and brain magnetic resonance imaging were applied to comprehensively investigate the visual system in a cohort of 103 patients with SSDs and 130 healthy control individuals. The sparse partial least squares algorithm was used to identify multivariate associations between clinical disease phenotype and biological alterations of the visual system. The association of the revealed patterns with individual polygenic disease risk for schizophrenia was explored in a post hoc analysis. In addition, covariate-adjusted case-control comparisons were performed for each individual optical coherence tomography and electroretinography parameter. RESULTS The sparse partial least squares analysis yielded a phenotype-eye-brain signature of SSDs in which greater disease severity, longer duration of illness, and impaired cognition were associated with electrophysiological alterations and microstructural thinning of most retinal layers. Higher individual loading onto this disease-relevant signature of the visual system was significantly associated with elevated polygenic risk for schizophrenia. In case-control comparisons, patients with SSDs had lower macular thickness, thinner retinal nerve fiber and inner plexiform layers, less negative a-wave amplitude, and lower b-wave amplitude. CONCLUSIONS This study demonstrates multimodal microstructural and electrophysiological retinal alterations in individuals with SSDs that are associated with disease severity and individual polygenic burden.
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Affiliation(s)
- Emanuel Boudriot
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany
| | - Vanessa Gabriel
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - David Popovic
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany
| | - Pauline Pingen
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Vladislav Yakimov
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Munich, Germany
| | - Sergi Papiol
- Max Planck Institute of Psychiatry, Munich, Germany; Institute of Psychiatric Phenomics and Genomics, LMU Munich, Munich, Germany
| | - Lukas Roell
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; NeuroImaging Core Unit Munich, LMU University Hospital, LMU Munich, Munich, Germany
| | - Genc Hasanaj
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Evidence-Based Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Simiao Xu
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Joanna Moussiopoulou
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christoph Kern
- Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Eva C Schulte
- Institute of Psychiatric Phenomics and Genomics, LMU Munich, Munich, Germany; Institute of Human Genetics, University Hospital, Faculty of Medicine, University of Bonn, Bonn, Germany; Department of Psychiatry and Psychotherapy, University Hospital, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany; German Center for Mental Health, partner site Munich-Augsburg, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany; German Center for Mental Health, partner site Munich-Augsburg, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany; German Center for Mental Health, partner site Munich-Augsburg, Germany; Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Benedikt Schworm
- Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Elias Wagner
- Evidence-Based Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Augsburg, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; NeuroImaging Core Unit Munich, LMU University Hospital, LMU Munich, Munich, Germany; Munich Center for Neurosciences, LMU Munich, Planegg-Martinsried, Germany
| | - Florian J Raabe
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany.
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Komatsu H, Onoguchi G, Silverstein SM, Jerotic S, Sakuma A, Kanahara N, Kakuto Y, Ono T, Yabana T, Nakazawa T, Tomita H. Retina as a potential biomarker in schizophrenia spectrum disorders: a systematic review and meta-analysis of optical coherence tomography and electroretinography. Mol Psychiatry 2024; 29:464-482. [PMID: 38081943 PMCID: PMC11116118 DOI: 10.1038/s41380-023-02340-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Abnormal findings on optical coherence tomography (OCT) and electroretinography (ERG) have been reported in participants with schizophrenia spectrum disorders (SSDs). This study aims to reveal the pooled standard mean difference (SMD) in retinal parameters on OCT and ERG among participants with SSDs and healthy controls and their association with demographic characteristics, clinical symptoms, smoking, diabetes mellitus, and hypertension. METHODS Using PubMed, Scopus, Web of Science, and PSYNDEX, we searched the literature from inception to March 31, 2023, using specific search terms. This study was registered with PROSPERO (CRD4202235795) and conducted according to PRISMA 2020. RESULTS We included 65 studies in the systematic review and 44 in the meta-analysis. Participants with SSDs showed thinning of the peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell layer- inner plexiform cell layer, and retinal thickness in all other segments of the macula. A meta-analysis of studies that excluded SSD participants with diabetes and hypertension showed no change in results, except for pRNFL inferior and nasal thickness. Furthermore, a significant difference was found in the pooled SMD of pRNFL temporal thickness between the left and right eyes. Meta-regression analysis revealed an association between retinal thinning and duration of illness, positive and negative symptoms. In OCT angiography, no differences were found in the foveal avascular zone and superficial layer foveal vessel density between SSD participants and controls. In flash ERG, the meta-analysis showed reduced amplitude of both a- and b-waves under photopic and scotopic conditions in SSD participants. Furthermore, the latency of photopic a-wave was significantly shorter in SSD participants in comparison with HCs. DISCUSSION Considering the prior report of retinal thinning in unaffected first-degree relatives and the results of the meta-analysis, the findings suggest that retinal changes in SSDs have both trait and state aspects. Future longitudinal multimodal retinal imaging studies are needed to clarify the pathophysiological mechanisms of these changes and to clarify their utility in individual patient monitoring efforts.
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Affiliation(s)
- Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan.
- Miyagi Psychiatric Center, Natori, Japan.
| | - Goh Onoguchi
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Stefan Jerotic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Atsushi Sakuma
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuhisa Kanahara
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Yoshihisa Kakuto
- Miyagi Psychiatric Center, Natori, Japan
- Department of Community Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Takeshi Yabana
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Tomita
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
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Shew W, Zhang DJ, Menkes DB, Danesh-Meyer HV. Optical Coherence Tomography in Schizophrenia Spectrum Disorders: A Systematic Review and Meta-analysis. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:19-30. [PMID: 38021252 PMCID: PMC10654004 DOI: 10.1016/j.bpsgos.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 12/01/2023] Open
Abstract
Background Inner retinal atrophy has been demonstrated in schizophrenia spectrum disorder (SSD) using optical coherence tomography (OCT). This systematic review and meta-analysis investigated the role of contemporary Fourier domain OCT devices in SSD. Methods MEDLINE, PubMed, Scopus, Embase, PsycInfo, PYSNDEX, World Health Organization, and Cochrane databases were searched from inception until May 2022. All peer-reviewed adult SSD case-control studies using Fourier domain OCT were included. Ocular pathologies known to affect retinal OCT scans were excluded. Search, data appraisal, and summary data extraction were independently performed by 2 authors. Results The review criteria was met by k = 36 studies, with k = 24 studies (1074 cases, 854 controls) suitable for meta-analysis. The SSD group exhibited a thinner global peripapillary retinal nerve fiber layer (-3.26 μm, 95% CI, -5.07 to -1.45, I2 = 64%, k = 21), thinner average macular layer (-7.88 μm, 95% CI, -12.73 to -3.04, I2 = 65%, k = 11), and thinner macular ganglion cell-inner plexiform sublayer (-2.44 μm, 95% CI, -4.13 to -0.76, I2 = 30%, k = 8) compared with the control group. Retinal nerve fiber layer findings remained significant after exclusion of metabolic disease, low quality, outlier, and influential studies. Studies involving eye examinations to exclude eye disease were associated with greater atrophy in SSD. Except for cardiometabolic disease, most studies did not report clinically significant covariate data known to influence retinal thickness. Conclusions Individuals with SSD generally exhibited retinal atrophy, possibly paralleling reduced brain volumes documented in clinical imaging. Prospective longitudinal studies that collect clinical data, including various illness phases, and control for confounders will be necessary to evaluate retinal atrophy as a biomarker in SSD.
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Affiliation(s)
- William Shew
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Daniel J. Zhang
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - David B. Menkes
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Helen V. Danesh-Meyer
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
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Blose BA, Lai A, Crosta C, Thompson JL, Silverstein SM. Retinal Neurodegeneration as a Potential Biomarker of Accelerated Aging in Schizophrenia Spectrum Disorders. Schizophr Bull 2023; 49:1316-1324. [PMID: 37459382 PMCID: PMC10483469 DOI: 10.1093/schbul/sbad102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND HYPOTHESES Several biological markers are believed to reflect accelerated aging in schizophrenia spectrum disorders; however, retinal neural changes have not yet been explored as potential CNS biomarkers of accelerated aging in this population. The aim of this study was to determine whether retinal neural layer thinning is more strongly related to age in schizophrenia and schizoaffective disorder patients (SZ) than in a psychiatrically healthy control group (CON). STUDY DESIGN Schizophrenia (n = 60) and CON participants (n = 69) underwent spectral domain optical coherence tomography (OCT) scans to examine the following variables in both eyes: retinal nerve fiber layer (RNFL) thickness, macula central subfield (CSF) thickness, macula volume, ganglion cell layer-inner plexiform layer (GCL-IPL) thickness, optic cup volume, and cup-to-disc ratio. Eleven participants in each group had diabetes or hypertension. STUDY RESULTS Significant negative relationships between age and RNFL thickness, macula volume, and GCL-IPL thickness were observed in the SZ group, while no significant relationships were observed in the CON group. However, many of the findings in the SZ group lost significance when participants with diabetes/hypertension were removed from analyses. A notable exception to this was that the age × SZ interaction accounted for a unique proportion of variance in GCL-IPL thinning over and above the effect of diabetes/hypertension. CONCLUSIONS The results suggest that retinal atrophy occurs at an increased rate in schizophrenia spectrum disorders, potentially reflecting accelerated aging inherent to these conditions, with considerable contributions from systemic medical diseases closely linked to this population.
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Affiliation(s)
- Brittany A Blose
- Department of Psychology, University of Rochester, Rochester, NY, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Adriann Lai
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- University Behavioral Health Care, Rutgers University, Piscataway, NJ, USA
| | - Christen Crosta
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, USA
| | - Judy L Thompson
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, NJ, USA
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- University Behavioral Health Care, Rutgers University, Piscataway, NJ, USA
- Department of Psychiatry, Rutgers University, Piscataway, NJ, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
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Gonzalez-Diaz JM, Radua J, Sanchez-Dalmau B, Camos-Carreras A, Zamora DC, Bernardo M. Mapping Retinal Abnormalities in Psychosis: Meta-analytical Evidence for Focal Peripapillary and Macular Reductions. Schizophr Bull 2022; 48:1194-1205. [PMID: 35810337 PMCID: PMC9673251 DOI: 10.1093/schbul/sbac085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Several studies have suggested that the retina structure is affected in schizophrenia spectrum disorders (SSD). We aimed to investigate the location and size of the potential differences between patients and healthy controls (HC) in several thickness and volume measures across the retina. STUDY DESIGN We included cross-sectional studies comparing peripapillary retinal nerve fiber layer (pRNFL) thickness, macular volume, macular thickness (MT), foveal thickness, ganglion cell and inner plexiform layer thickness (GCL+IPL), cup volume, and cup/disc ratio (C/D) in the right and/or left eyes and/or the pRNFL and MT quadrants between patients with SSD and HC. Search databases were MEDLINE, Web of Science, PsycINFO, Cochrane Central, and medrxiv.org. Risk of bias was assessed with the Newcastle-Ottawa Scale. Standardized mean differences (SMD), subgroup analysis, and meta-regression with several variables were computed using the dmetar package in R. PROSPERO: CRD42021287873. STUDY RESULTS Data from 22 reports (942 patients, 742 HC) were included. We found a retinal thinning in pRNFL (-0.30; 95% CI: -0.46, -0.14), macula (-0.37; 95% CI: -0.61, -0.13), and GCL+IPL (-0.33; 95% CI: -0.57, -0.10). The retinal thinning was especially pronounced in the superior and inferior quadrants of the inner ring of the macula. We also observed a decrease of macular volume (-0.44; 95% CI: -0.68, -0.20) and an increase in C/D ratio (0.35; 95% CI: 0.03, 0.67). CONCLUSIONS Current evidence demonstrates retinal thinning in SSD, affecting both axonal and cellular structures, specially focused in the inner ring of the macula.
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Affiliation(s)
- Jairo M Gonzalez-Diaz
- Universitat de Barcelona, Barcelona, Spain,UR Center for Mental Health—CERSAME, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia,Clinica Nuestra Señora de la Paz, Bogota, Colombia
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain,Early Psychosis: Interventions and Clinical-detection Lab, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,Department of Clinical Neuroscience, Stockholm Health Care Services, Stockholm County Council, Karolinska Institutet, Stockholm, Sweden
| | - Bernardo Sanchez-Dalmau
- Institut Clínic d’Oftalmologia, Hospital Clínic, Barcelona, Spain,Visual Lab. Ocular Inflammation Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Anna Camos-Carreras
- Institut Clínic d’Oftalmologia, Hospital Clínic, Barcelona, Spain,Visual Lab. Ocular Inflammation Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Diana C Zamora
- UR Center for Mental Health—CERSAME, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Miquel Bernardo
- To whom correspondence should be addressed; Department of Psychiatry and Psychology, Clinical Institute of Neuroscience. Hospital Clinic of Barcelona, Villarroel, 170. 08036. Barcelona, Spain; tel: +34 93 227 54 00 Ext. 3142, e-mail:
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Adámek P, Langová V, Horáček J. Early-stage visual perception impairment in schizophrenia, bottom-up and back again. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:27. [PMID: 35314712 PMCID: PMC8938488 DOI: 10.1038/s41537-022-00237-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/17/2022] [Indexed: 01/01/2023]
Abstract
Visual perception is one of the basic tools for exploring the world. However, in schizophrenia, this modality is disrupted. So far, there has been no clear answer as to whether the disruption occurs primarily within the brain or in the precortical areas of visual perception (the retina, visual pathways, and lateral geniculate nucleus [LGN]). A web-based comprehensive search of peer-reviewed journals was conducted based on various keyword combinations including schizophrenia, saliency, visual cognition, visual pathways, retina, and LGN. Articles were chosen with respect to topic relevance. Searched databases included Google Scholar, PubMed, and Web of Science. This review describes the precortical circuit and the key changes in biochemistry and pathophysiology that affect the creation and characteristics of the retinal signal as well as its subsequent modulation and processing in other parts of this circuit. Changes in the characteristics of the signal and the misinterpretation of visual stimuli associated with them may, as a result, contribute to the development of schizophrenic disease.
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Affiliation(s)
- Petr Adámek
- Third Faculty of Medicine, Charles University, Prague, Czech Republic. .,Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Klecany, Czech Republic.
| | - Veronika Langová
- Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Klecany, Czech Republic
| | - Jiří Horáček
- Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Klecany, Czech Republic
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Zhuo C, Xiao B, Chen C, Jiang D, Li G, Ma X, Li R, Wang L, Xu Y, Zhou C, Lin X. Antipsychotic agents deteriorate brain and retinal function in schizophrenia patients with combined auditory and visual hallucinations: A pilot study and secondary follow-up study. Brain Behav 2020; 10:e01611. [PMID: 32285647 PMCID: PMC7303384 DOI: 10.1002/brb3.1611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/13/2020] [Accepted: 03/10/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Schizophrenia patients often experience auditory hallucinations (AHs) and visual hallucinations (VHs). However, the degree and type of brain and retinal alterations associated with combined AHs and VHs in schizophrenia patients remain unknown. There is an urgent need for a study that investigates the trajectory of brain and retinal alterations in patients with first-episode untreated schizophrenia accompanied by combined AHs and VHs (FUSCHAV). METHODS FUSCHAV patients (n = 120), divided into four groups according to AH and VH symptom severity (severe AHs combined with severe VHs [FUSCHSASV, 20 patients]; middle-to-moderate AHs combined with severe VHs [FUSCHMASV, 23 patients]; severe AHs combined with middle-to-moderate VHs [FUSCHSAMV, 28 patients]; and middle-to-moderate AHs combined with middle-to-moderate VHs [FUSCHMAMV, 26 patients]), were compared to healthy controls (n = 30). Gray matter volume (GMV) was adopted for brain structural alteration assessment. Total retinal thickness was adopted as a measure of retinal thickness impairment. RESULTS In the pilot study, the rate of GMV reduction showed an inverted U-shaped pattern across the different FUSCHAV patient groups according to AH and VH severity. The degree of retinal impairment remained stable across the groups. More notably, in the secondary follow-up study, we observed that, after 6 months of treatment with antipsychotic agents, all the GMV reduction-related differences across the different patient groups disappeared, and both GMV and retinal thickness demonstrated a tendency to deteriorate. CONCLUSIONS These findings indicate the need for heightened alertness on brain and retinal impairments in patients with FUSCHAV. Further deteriorations induced by antipsychotic agent treatment should be monitored in clinical practice.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychiatry Pattern Recognition, Laboratory of Schizophrenia, School of Mental Health, Jining Medical University, Jining, China.,Department of Genetics, Laboratory of Schizophrenia, School of Mental Health, Jining Medical University, Jining, China.,Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, China.,Department of Psychiatric-Neuroimaging-Genetics and Co-morbidity Laboratory (PNGC_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin Medical University Mental Health Teaching Hospital, Tianjin Medical University, Tianjin, China.,Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China.,MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Bo Xiao
- Department of OCT, Tianjin Eye Hospital, Tianjin, China
| | - Ce Chen
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Deguo Jiang
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Gongying Li
- Department of Psychiatry Pattern Recognition, Laboratory of Schizophrenia, School of Mental Health, Jining Medical University, Jining, China.,Department of Genetics, Laboratory of Schizophrenia, School of Mental Health, Jining Medical University, Jining, China
| | - Xiaoyan Ma
- Department of Psychiatric-Neuroimaging-Genetics and Co-morbidity Laboratory (PNGC_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin Medical University Mental Health Teaching Hospital, Tianjin Medical University, Tianjin, China
| | - Ranli Li
- Department of Psychiatric-Neuroimaging-Genetics and Co-morbidity Laboratory (PNGC_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin Medical University Mental Health Teaching Hospital, Tianjin Medical University, Tianjin, China
| | - Lina Wang
- Department of Psychiatric-Neuroimaging-Genetics and Co-morbidity Laboratory (PNGC_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin Medical University Mental Health Teaching Hospital, Tianjin Medical University, Tianjin, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China.,MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chunhua Zhou
- Department of Pharmacology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaodong Lin
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, China
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