Relationship between exploratory eye movements and brain morphology in schizophrenia spectrum patients: voxel-based morphometry of three-dimensional magnetic resonance imaging

Diagnosis of schizophrenia by integrated saccade scores and associations with psychiatric symptoms, and functioning

Eye movement as a neurobiological biomarker of schizophrenia. We aim to estimate diagnostic accuracy of integrated pro/antisaccade eye movement measurements to discriminate between healthy individuals and schizophrenic patients. We compared the eye movement performance of 85 healthy individuals and 116 schizophrenia-stable patients during prosaccade and antisaccade tasks. The difference eye movement measurements were accumulated by stepwise discriminant analysis to produce an integrated score. Finally, the diagnostic value of the integrated score was calculated by the receiver operating characteristic (ROC) area under the curve (AUC), and the best sensitivity and specificity were calculated based on the given cutoff values. Using discriminant analysis, an integrated score included the residual gain and latency (step) during the prosaccade test, the error rate, and the corrected error rate during the antisaccade test. We found that the integrated score could well classify schizophrenia patients and healthy individuals with an accuracy of 80.6%. In the ROC, Youden's index was 0.634 (sensitivity = 81.0%, specificity = 82.4%) and AUC was 0.871. There were significant difference patterns of correlation between the severity of psychiatric symptoms and daily functioning and diagnostic eye movement measurements. Using only 2 saccade tasks to discriminate well between schizophrenia patients and healthy controls, suggesting that abnormalities in saccade behavior is a potential biomarker and efficient diagnostic tool for identifying schizophrenia. The underlying neuropathologic mechanisms associated with abnormal saccades may provide insights into the intervention and diagnosis of schizophrenia.

Recent updates of eye movement abnormalities in patients with schizophrenia: A scoping review

AIM

Although eye-tracking technology expands beyond capturing eye data just for the sole purpose of ensuring participants maintain their gaze at the presented fixation cross, gaze technology remains of less importance in clinical research. Recently, impairments in visual information encoding processes indexed by novel gaze metrics have been frequently reported in patients with schizophrenia. This work undertakes a scoping review of research on saccadic dysfunctions and exploratory eye movement deficits among patients with schizophrenia. It gathers promising pieces of evidence of eye movement abnormalities in attention-demanding tasks on the schizophrenia spectrum that have mounted in recent years and their outcomes as potential biological markers.

METHODS

The protocol was drafted based on PRISMA for scoping review guidelines. Electronic databases were systematically searched to identify articles published between 2010 and 2020 that examined visual processing in patients with schizophrenia and reported eye movement characteristics as potential biomarkers for this mental illness.

RESULTS

The use of modern eye-tracking instrumentation has been reported by numerous neuroscientific studies to successfully and non-invasively improve the detection of visual information processing impairments among the screened population at risk of and identified with schizophrenia.

CONCLUSIONS

Eye-tracking technology has the potential to contribute to the process of early intervention and more apparent separation of the diagnostic entities, being put together by the syndrome-based approach to the diagnosis of schizophrenia. However, context-processing paradigms should be conducted and reported in equally accessible publications to build comprehensive models.

Free viewing exploration in schizophrenia: Review of evidence from laboratory settings to natural environment

Several studies have investigated visual processing impairment in schizophrenia. The literature on visual exploration has described restricted scanning in schizophrenia patients. This gaze behavior is characterized by increased fixation duration, a reduced scan path length and avoidance of salient features of the face with emotional content. The aim of this paper is to give an insight on the latest update on scan path deficit. Abnormal gaze exploration was replicated in various visual stimuli. This review describes gaze patterns with stimuli that imply minimal to high cognitive process: figures, objects, faces, and scenes. Interestingly, schizophrenia patients have shown cognitive flexibility by modulating gaze scanning when they are involved in an active assignment. We will also consider scanning abnormalities in real-life environment and discuss the potential therapeutic use of eye tracking in schizophrenia. The therapeutic application of eye tracking in schizophrenia is a young emerging field in psychiatry research. The recent remediation program is based on the reorientation of visual attention on the salient features of faces. For now, this program has shown encouraging results. Further studies are needed to explore behavior in real-world situations to complement laboratory measurements to move toward a full understanding of the mechanisms underlying atypical scanning in patients with schizophrenia.

Eye movement characteristics in schizophrenia: A recent update with clinical implications

Eye movements are indispensable for the collection of visual information in everyday life. Many findings regarding the neural basis of eye movements have been accumulated from neurophysiological and psychophysical studies. In the field of psychiatry, studies on eye movement characteristics in mental illnesses have been conducted since the early 1900s. Participants with schizophrenia are known to have characteristic eye movements during smooth pursuit, saccade control, and visual search. Recently, studies evaluating eye movement characteristics as biomarkers for schizophrenia have attracted considerable attention. In this article, we review the neurophysiological basis of eye movement control and eye movement characteristics in schizophrenia. Furthermore, we discuss the prospects for eye movements as biomarkers for mental illnesses.

Correlations between exploratory eye movement, hallucination, and cortical gray matter volume in people with schizophrenia

BACKGROUND

Widespread cortical gray matter alternations in people with schizophrenia are correlated with both psychotic symptoms and cognitive/behavioral abnormalities, including the impairments of exploratory eye movement (EEM). Particularly, the loss of gray matter density is specifically related to deficits of the responsive search score (RSS) of EEM in schizophrenia. It is unknown, however, whether the schizophrenia-related RSS deficits are associated with certain psychotic symptoms, such as hallucinations.

METHODS

In 33 participants with schizophrenia, the measurement of EEM, assessment of the hallucination severity using Positive and Negative Syndrome Scale (PANSS) and a voxel-based morphometric analysis of cortical gray matter volume (GMV) were conducted to investigate the relationships between the RSS of EEM, symptom severity, and GMV. In 29 matched healthy controls, the measurement of EEM and a voxel-based morphometric analysis of cortical GMV were also conducted to investigate the relationship between the RSS of EEM and GMV.

RESULTS

In participants with schizophrenia, the hallucination severity was significantly negatively correlated with both the RSS and the GMV of a large number of brain regions in the frontal, temporal, parietal, orbitofrontal, calcarine, cingulate, and insular cortices, and rolandic operculum, hippocampus, parahippocampal gyrus, and thalamus. Also in participants with schizophrenia, the RSS was significantly positively correlated with the GMV in the left supplementary motor area (SMA), left superior frontal cortex (SFG), bilateral precentral gyri, bilateral postcentral gyri, and bilateral middle frontal cortices. More importantly, the GMV of the SMA, SFG, and precentral gyrus in the left hemisphere was not only significantly negatively correlated with the hallucination severity but also significantly positively correlated with the RSS. No significant correlation could be revealed between the RSS and the GMV of any brain regions in healthy controls.

CONCLUSIONS

There was a significantly negative association between the hallucination severity and the RSS of EEM, suggesting that the RSS may be a potential biomarker for predicting the hallucination severity of schizophrenia. Also, the GMV of the left SMA, SFG, and precentral gyrus may be the common substrates underlying both hallucination induction and the RSS in people with schizophrenia.

Association of DISC1, BDNF, and COMT polymorphisms with exploratory eye movement of schizophrenia in a Chinese Han population

BACKGROUND

Previous studies suggested that exploratory eye movement (EEM) dysfunction appears to be a biological marker specific to schizophrenia, with an unknown molecular mechanism. Genetic studies indicate that disrupted-in-schizophrenia-1 (DISC1), brain-derived neurotrophic factor (BDNF), and catechol-O-methyl transferase (COMT) genes might be implicated in the etiology of schizophrenia, but not in all populations.

OBJECTIVES

The present study aimed to explore associations between these candidate genes and EEM endophenotypes for schizophrenia in a Chinese Han population.

METHODS

EEM recordings were examined in 139 patients with schizophrenia and 143 healthy control participants.

RESULTS

All five EEM parameters, responsive search score, cognitive search score, number of eye fixations, total eye scanning length, and mean eye scanning length, of schizophrenic patients differed significantly from those of healthy controls (P<0.001). The DISC1 SerCys, BDNF ValMet, and COMT ValMet were genotyped in a total sample of 818 schizophrenic patients and 827 healthy control participants, including the above EEM samples. We found that DISC1 Cys and BDNF Met were associated with an increased risk of developing schizophrenia (P<0.001). Furthermore, responsive search score scores of BDNF Met/Met carriers were significantly lower than those of Val allele carriers (P=0.022), which remained modest after Bonferroni correction.

CONCLUSION

The BDNF MetMet polymorphism might be associated with the EEM dysfunction of schizophrenia.

Making Brains run Faster: are they Becoming Smarter?

A brief overview of structural and functional brain characteristics related to g is presented in the light of major neurobiological theories of intelligence: Neural Efficiency, P-FIT and Multiple-Demand system. These theories provide a framework to discuss the main objective of the paper: what is the relationship between individual alpha frequency (IAF) and g? Three studies were conducted in order to investigate this relationship: two correlational studies and a third study in which we experimentally induced changes in IAF by means of transcranial alternating current stimulation (tACS). (1) In a large scale study (n = 417), no significant correlations between IAF and IQ were observed. However, in males IAF positively correlated with mental rotation and shape manipulation and with an attentional focus on detail. (2) The second study showed sex-specific correlations between IAF (obtained during task performance) and scope of attention in males and between IAF and reaction time in females. (3) In the third study, individuals’ IAF was increased with tACS. The induced changes in IAF had a disrupting effect on male performance on Raven’s matrices, whereas a mild positive effect was observed for females. Neuro-electric activity after verum tACS showed increased desynchronization in the upper alpha band and dissociation between fronto-parietal and right temporal brain areas during performance on Raven’s matrices. The results are discussed in the light of gender differences in brain structure and activity.

Insights to the schizophrenia continuum: A systematic review of saccadic eye movements in schizotypy and biological relatives of schizophrenia patients

Myles, J.B., S. Rossell, A. Phillipou, Thomas, E and C. Gurvich. A systematic review of saccadic eye movements across the schizophrenia continuum: Characterisation, pathophysiology and genetic associations. NEUROSCI BIOBEHAV REV 21(1) XXX-XXX, 2015. One of the cognitive hallmarks of schizophrenia is impaired eye movements, particularly for the antisaccade task. Less saccade research has been conducted in relation to the broader schizophrenia continuum, that is, people with high schizotypy or first-degree relatives of people with schizophrenia. This systematic review sought to identify, collate and appraise prosaccade, antisaccade and memory-guided saccade studies involving behavioural, neuroimaging and genetic data published between 1980 and September 2016 in individuals with high schizotypy and first-degree relatives. A systematic literature search was conducted, using Ovid MEDLINE, PsycINFO, PubMed and SCOPUS databases. Of 913 references screened, 18 schizotypy, 29 family studies and two schizotypy and relatives articles studies were eligible for inclusion. Antisaccade error rate was the most consistent deficit found for high schizotypy. Relatives had intermediate antisaccade error rates between patients and healthy controls. Results from the limited genetic and neuroimaging studies echoed schizophrenia findings. Confounds were also identified. It was concluded that future research is required to refine the saccade endophenotype and to expand genetic and neuroimaging research.

Association of chromosome 5q21.3 polymorphisms with the exploratory eye movement dysfunction in schizophrenia

Schizophrenia patients show abnormalities in many eye movement tasks. Among them, exploratory eye movements (EEM) dysfunction seems to be specific to schizophrenia. However the mechanism of EEM disturbances in schizophrenia patients remains elusive. We investigate the relationship between EEM and single nucleotide polymorphisms (SNPs) or genes to identify susceptibility loci for EEM in schizophrenia. We firstly performed EEM test, then performed a genome-wide association study (GWAS) and gene-based association study of EEM in 128 individuals with schizophrenia and 143 healthy control subjects. Comparing to healthy controls, schizophrenia patients show significant decrease in NEF (22.99 ± 3.96 vs. 26.02 ± 5.72, P <0.001), TESL (368.78 ± 123.57 vs. 603.12 ± 178.63, P <0.001), MESL (16.86 ± 5.27 vs. 24.42 ± 6.46, P <0.001), RSS (8.22 ± 1.56 vs. 10.92 ± 1.09, P <0.001), and CSS (5.06 ± 0.97 vs. 6.64 ± 0.87, P <0.001). Five SNPs of the MAN2A1, at 5q21.3, were associated with EEM abnormalities (deceased CSS) and satisfied the criteria of GWAS significance threshold. One is localized near 5'-UTR (rs17450784) and four are in intron (rs1438663, rs17162094, rs6877440 and rs10067856) of the gene. Our findings suggest that the identified loci may control the schizophrenia-related quantitative EEM trait. And the identified gene, associated with the EEM phenotype, may lead to new insights into the etiology of schizophrenia.

Face recognition in schizophrenia disorder: A comprehensive review of behavioral, neuroimaging and neurophysiological studies

Facial emotion processing has been extensively studied in schizophrenia patients while general face processing has received less attention. The already published reviews do not address the current scientific literature in a complete manner. Therefore, here we tried to answer some questions that remain to be clarified, particularly: are the non-emotional aspects of facial processing in fact impaired in schizophrenia patients? At the behavioral level, our key conclusions are that visual perception deficit in schizophrenia patients: are not specific to faces; are most often present when the cognitive (e.g. attention) and perceptual demands of the tasks are important; and seems to worsen with the illness chronification. Although, currently evidence suggests impaired second order configural processing, more studies are necessary to determine whether or not holistic processing is impaired in schizophrenia patients. Neural and neurophysiological evidence suggests impaired earlier levels of visual processing, which might involve the deficits in interaction of the magnocellular and parvocellular pathways impacting on further processing. These deficits seem to be present even before the disorder out-set. Although evidence suggests that this deficit may be not specific to faces, further evidence on this question is necessary, in particularly more ecological studies including context and body processing.

Neuroanatomical circuitry associated with exploratory eye movement in schizophrenia: a voxel-based morphometric study

Schizophrenic patients present abnormalities in a variety of eye movement tasks. Exploratory eye movement (EEM) dysfunction appears to be particularly specific to schizophrenia. However, the underlying mechanisms of EEM dysfunction in schizophrenia are not clearly understood. To assess the potential neuroanatomical substrates of EEM, we recorded EEM performance and conducted a voxel-based morphometric analysis of gray matter in 33 schizophrenic patients and 29 well matched healthy controls. In schizophrenic patients, decreased responsive search score (RSS) and widespread gray matter density (GMD) reductions were observed. Moreover, the RSS was positively correlated with GMD in distributed brain regions in schizophrenic patients. Furthermore, in schizophrenic patients, some brain regions with neuroanatomical deficits overlapped with some ones associated with RSS. These brain regions constituted an occipito-tempro-frontal circuitry involved in visual information processing and eye movement control, including the left calcarine cortex [Brodmann area (BA) 17], the left cuneus (BA 18), the left superior occipital cortex (BA 18/19), the left superior frontal gyrus (BA 6), the left cerebellum, the right lingual cortex (BA 17/18), the right middle occipital cortex (BA19), the right inferior temporal cortex (BA 37), the right dorsolateral prefrontal cortex (BA 46) and bilateral precentral gyri (BA 6) extending to the frontal eye fields (FEF, BA 8). To our knowledge, we firstly reported empirical evidence that gray matter loss in the occipito-tempro-frontal neuroanatomical circuitry of visual processing system was associated with EEM performance in schizophrenia, which may be helpful for the future effort to reveal the underlying neural mechanisms for EEM disturbances in schizophrenia.

Alertness can be improved by an interaction between orienting attention and alerting attention in schizophrenia

BACKGROUND

Attention is impaired in schizophrenia. Early attention components include orienting and alerting, as well as executive control networks. Previous studies have shown mainly executive control deficits, while few of them found orienting and alerting abnormalities. Here we explore the different attentive networks, their modulation and interactions in patients with schizophrenia.

METHODS

Twenty-one schizophrenic patients (DSMIV), compared to 21 controls, performed a modified version of the Attention Network Task, in which an orienting paradigm (with valid, invalid and no cues) was combined with a flanker task (congruent/incongruent) and an alerting signal (tone/no tone), to assess orienting, executive control and alerting networks independently.

RESULTS

Patients showed an abnormal alerting effect and slower overall reaction time compared to controls. Moreover, there was an interaction between orienting and alerting: patients are helped more than controls by the alerting signal in a valid orientation to solve the incongruent condition.

CONCLUSION

These results suggest that patients with schizophrenia have altered alerting abilities. However, the orienting and alerting cues interact to improve their attention performance in the resolution of conflict, creating possibilities for cognitive remediation strategies.

Useful visual field in patients with schizophrenia: a choice reaction time study

This study examined the size of the useful visual field in patients (9 men, 6 women) with schizophrenia. A choice reaction task was conducted, and performances at 2.5, 5, 7, 10, and 25 degrees in both visual fields were measured. Three key findings were shown. First, patients had slower choice reaction times (choice RTs) than normal controls. Second, patients had slower choice RTs in the right visual field than in the left visual field. Third, patients and normal controls showed the same U-shaped choice RT pattern. The first and second findings were consistent with those of other studies. The third finding was a clear indication of the patients' performance in peripheral vision, and a comparison with normal controls suggested that there was no difference in the size of the useful visual field, at least within

Clair DM, Benson PJ. Atypical scanpaths in schizophrenia: evidence of a trait- or state-dependent phenomenon?

The development of trait markers of schizophrenia would represent an important advance in understanding the genetic architecture of the disease. To date, no candidate markers have satisfied all of the trait marker criteria, and many are not specific to the schizophrenia spectrum. Abnormalities in visual scanpaths are frequently reported in patients with schizophrenia and are emerging as a novel candidate for a schizophrenia biomarker. Here we review the suitability of scanpath measures as a target for trait marker research in schizophrenia. Papers reporting scanpath patterns in patients with schizophrenia were identified by PubMed and Google Scholar searches and by scanning reference lists in relevant articles. Search terms included "schizophrenia," "psychosis," "scanpath," "scan path," "fixation," "saccade" and "eye movement." Scanpath abnormalities afford impressive sensitivity and specificity and appear largely independent of psychotropic medications. Scanpaths may demonstrate some fluctuation with symptomatology and may be useful in illuminating illness state or subtypes. However, there is evidence that viewing behaviours remain atypical regardless of symptom remission and may be present in unaffected relatives of individuals with schizophrenia. This research is in its early stages, and further investigation regarding patterns of inheritance is required. Our findings support scanpath measures as a favourable topic for further investigation as a trait marker.

Deficit of inhibition motor control in untreated patients with schizophrenia: further support from visually guided saccade paradigms

In addition to classical delusional, negative, and cognitive deficit, schizophrenia has consistently been associated with impairments in saccadic eye movements, e.g., an increased error rate in the antisaccade task. We hypothesized that a deficit in inhibitory control is a core defect in untreated patients with schizophrenia leading to impairment in different oculomotor paradigms. Ten drug-free or drug-naïve patients with schizophrenia were matched in age and gender to 11 healthy controls with no psychoactive substance use or abuse. They were explored using reflexive saccades with unpredictable targets with or without the gap procedure, predictive saccades and a fixation/distracter paradigm. Patients with schizophrenia displayed shorter latency in reflexive and predictive saccades. In the GAP condition, patients made more anticipatory saccades, fewer regular saccades, and had a shorter latency of express saccades than controls. In addition, patients had an increased error rate in the fixation/distracters task. Altogether, these results provide new evidence of reduced prefrontal inhibitory regulation of subcortical and brainstem systems involved in the control of saccades.

Studies on exploratory eye movement

This paper describes the pioneering studies on eye movements by Prof. Takuya Kojima, which clarified the scarcity of adjustability of alertness level in schizophrenia. Shimazono first thought that closed-eye eye movement may provide objective and physiological indicator for brain activities during awake state. Prof. Kojima thought that depressive patients may also have latent inner tension and was also intrigued by the contrast of the scarcity of exploratory eye movement in schizophrenic patients. He found out that depressive patients are tense at rest but that accustomization takes place in them, while accustomization does not take place in schizophrenic patients. Isse researched on closed-eye eye movements in relation with alertness and disturbance of consciousness. Prof. Kojima invented eye camera to measure the exploratory eye movement and created Responsive Search Score (RSS), an indicator of the parts which the subject covers during the responsive search. Prof. Kojima's research on differentiation of schizophrenic patients was carried out as WHO and the result was replicated in different ethnicities. Clinical molecular genetic studies suggest that RSS reflects the disposition of susceptibility for schizophrenia and possible linkage between RSS and chromosome 22q. Brain imaging studies showed correlation between RSS and the volume of the right parietal eye field, right frontal eye field including the right supplementary eye field and the right inferior frontal gyrus. Based on these findings Prof. Kojima invented an apparatus which can monitor eye movements and show diagnostic sensitivity 75% and specificity 80% for schizophrenia. The apparatus is expected to be applied clinically in the future.

The tell-tale tasks: a review of saccadic research in psychiatric patient populations

This review focuses on saccade research with adult psychiatric patients. It begins with an introduction of the various types of saccades and the tasks used to evoke them. The functional significance of the different types of eye movements is briefly discussed. Research findings regarding the saccadic performance of different adult psychiatric patient populations are discussed in detail, with particular emphasis on findings regarding error rates, response latencies, and any specific task parameters that might affect those variables. Findings regarding the symptom, neurocognitive, and neural correlates of saccadic performance and the functional significance of patients' saccadic deficits are also discussed. We also discuss the saccadic deficits displayed by various patient groups in terms of circuitry (e.g. cortical/basal ganglia circuits) that may be implicated in the underlying pathophysiology of several of these disorders. Future directions for research in this growing area are offered.

Eye movement and random number in NP lupus evaluation

We evaluated the vulnerability of central nervous system (CNS) in patients with systemic lupus erythematosus (SLE) using exploratory eye movement analysis and random number generation (RNG), and compared the tests in evaluating CNS vulnerability. Nineteen patients received the tests more than a month after SLE onset in nonpsychotic status. Exploratory eye movements were analyzed using an eye-mark recorder that detects corneal reflection of infrared light, and numbers of eye fixations were counted to calculate responsive search score (RSS). Using digits 0 through 9, 100 numbers were vocally generated at a random fashion. "Seriality score" was calculated from the recorded 100 numbers. RSS of SLE patients was similar to that of normal individuals, irrespective of neuropsychiatric lupus history. Seriality score of patients having a history of neuropsychiatric lupus was higher than that of never having it (p < 0.05). No relations were confirmed between RSS and seriality score. The current study suggested heterogeneous nature of SLE in CNS vulnerability when evaluating with seriality score, but not with RSS. There seemed to be a difference between exploratory eye movement analysis and RNG in evaluating CNS vulnerability. Each test seemed to evaluate different aspects of brain function.