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Krzyściak W, Szwajca M, Śmierciak N, Chrzan R, Turek A, Karcz P, Bryll A, Pilecki M, Morava E, Ligęzka A, Kozicz T, Mazur P, Batko B, Skalniak A, Popiela T. From periphery immunity to central domain through clinical interview as a new insight on schizophrenia. Sci Rep 2024; 14:5755. [PMID: 38459093 PMCID: PMC10923880 DOI: 10.1038/s41598-024-56344-3] [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: 11/18/2023] [Accepted: 03/05/2024] [Indexed: 03/10/2024] Open
Abstract
Identifying disease predictors through advanced statistical models enables the discovery of treatment targets for schizophrenia. In this study, a multifaceted clinical and laboratory analysis was conducted, incorporating magnetic resonance spectroscopy with immunology markers, psychiatric scores, and biochemical data, on a cohort of 45 patients diagnosed with schizophrenia and 51 healthy controls. The aim was to delineate predictive markers for diagnosing schizophrenia. A logistic regression model was used, as utilized to analyze the impact of multivariate variables on the prevalence of schizophrenia. Utilization of a stepwise algorithm yielded a final model, optimized using Akaike's information criterion and a logit link function, which incorporated eight predictors (White Blood Cells, Reactive Lymphocytes, Red Blood Cells, Glucose, Insulin, Beck Depression score, Brain Taurine, Creatine and Phosphocreatine concentration). No single factor can reliably differentiate between healthy patients and those with schizophrenia. Therefore, it is valuable to simultaneously consider the values of multiple factors and classify patients using a multivariate model.
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Affiliation(s)
- Wirginia Krzyściak
- Department of Medical Diagnostic, Faculty of Pharmacy, Jagiellonian University Medical College, 30-688, Krakow, Poland.
| | - Marta Szwajca
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Jagiellonian University Medical College, 31-501, Krakow, Poland
| | - Natalia Śmierciak
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Jagiellonian University Medical College, 31-501, Krakow, Poland
| | - Robert Chrzan
- Department of Radiology, Faculty of Medicine, Jagiellonian University Medical College, 31-503, Krakow, Poland
| | - Aleksander Turek
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Jagiellonian University Medical College, 31-501, Krakow, Poland
| | - Paulina Karcz
- Department of Electroradiology, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126, Krakow, Poland
| | - Amira Bryll
- Department of Radiology, Faculty of Medicine, Jagiellonian University Medical College, 31-503, Krakow, Poland
| | - Maciej Pilecki
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Jagiellonian University Medical College, 31-501, Krakow, Poland
| | - Eva Morava
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Anna Ligęzka
- Department of Research Immunology, Mayo Clinic, Arizona, USA
| | - Tamas Kozicz
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Paulina Mazur
- Department of Medical Diagnostic, Faculty of Pharmacy, Jagiellonian University Medical College, 30-688, Krakow, Poland
| | - Bogna Batko
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Jagiellonian University Medical College, 31-501, Krakow, Poland
| | - Anna Skalniak
- Division of Molecular Biology and Clinical Genetics, Department of Medicine, Jagiellonian University Medical College, Skawińska 8, 31-066, Krakow, Poland
| | - Tadeusz Popiela
- Department of Radiology, Faculty of Medicine, Jagiellonian University Medical College, 31-503, Krakow, Poland
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Bartolomeo LA, Wright AM, Ma RE, Hummer TA, Francis MM, Visco AC, Mehdiyoun NF, Bolbecker AR, Hetrick WP, Dydak U, Barnard J, O'Donnell BF, Breier A. Relationship of auditory electrophysiological responses to magnetic resonance spectroscopy metabolites in Early Phase Psychosis. Int J Psychophysiol 2019; 145:15-22. [PMID: 31129143 DOI: 10.1016/j.ijpsycho.2019.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 12/19/2022]
Abstract
Both auditory evoked responses and metabolites measured by magnetic resonance spectroscopy (MRS) are altered in schizophrenia and other psychotic disorders, but the relationship between electrophysiological and metabolic changes are not well characterized. We examined the relation of MRS metabolites to cognitive and electrophysiological measures in individuals during the early phase of psychosis (EPP) and in healthy control subjects. The mismatch negativity (MMN) of the auditory event-related potential to duration deviant tones and the auditory steady response (ASSR) to 40 Hz stimulation were assessed. MRS was used to quantify glutamate+glutamine (Glx), N-Acetylasparate (NAA), creatine (Cre), myo-inositol (Ins) and choline (Cho) at a voxel placed medially in the frontal cortex. MMN amplitude and ASSR power did not differ between groups. The MRS metabolites Glx, Cre and Cho were elevated in the psychosis group. Partial least squares analysis in the patient group indicated that elevated levels of MRS metabolites were associated with reduced MMN amplitude and increased 40 Hz ASSR power. There were no correlations between the neurobiological measures and clinical measures. These data suggest that elevated neurometabolites early in psychosis are accompanied by altered auditory neurotransmission, possibly indicative of a neuroinflammatory or excitotoxic disturbance which disrupts a wide range of metabolic processes in the cortex.
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Affiliation(s)
- Lisa A Bartolomeo
- Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Bloomington, IN, United States of America
| | - Andrew M Wright
- School of Health Sciences, Purdue University, Lafayette, IN, United States of America
| | - Ruoyun E Ma
- School of Health Sciences, Purdue University, Lafayette, IN, United States of America; Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Tom A Hummer
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States of America; Department of Psychiatry, Prevention and the Recovery Center for Early Psychosis, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Michael M Francis
- Department of Psychiatry, Prevention and the Recovery Center for Early Psychosis, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Andrew C Visco
- Department of Psychiatry, Prevention and the Recovery Center for Early Psychosis, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Nicole F Mehdiyoun
- Department of Psychiatry, Prevention and the Recovery Center for Early Psychosis, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Amanda R Bolbecker
- Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Bloomington, IN, United States of America
| | - William P Hetrick
- Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Bloomington, IN, United States of America
| | - Ulrike Dydak
- School of Health Sciences, Purdue University, Lafayette, IN, United States of America; Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - John Barnard
- Section of Biostatistics, Cleveland Clinic, Cleveland, OH, United States of America
| | - Brian F O'Donnell
- Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Bloomington, IN, United States of America.
| | - Alan Breier
- Department of Psychiatry, Prevention and the Recovery Center for Early Psychosis, Indiana University School of Medicine, Indianapolis, IN, United States of America
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Gut microbiome and magnetic resonance spectroscopy study of subjects at ultra-high risk for psychosis may support the membrane hypothesis. Eur Psychiatry 2018; 53:37-45. [DOI: 10.1016/j.eurpsy.2018.05.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/07/2018] [Accepted: 05/25/2018] [Indexed: 12/11/2022] Open
Abstract
AbstractBackground:The microbiota-gut-brain axis and membrane dysfunction in the brain has attracted increasing attention in the field of psychiatric research. However, the possible interactive role of gut microbiota and brain function in the prodromal stage of schizophrenia has not been studied yet.Methods:To explore this, we collected fecal samples and performed Magnetic Resonance Spectroscopy (MRS) scans in 81 high risk (HR) subjects, 19 ultra-high risk (UHR) subjects and 69 health controls (HC). Then we analyzed the differences in gut microbiota and choline concentrations in the anterior cingulate cortex (ACC).Results:Presences of the orders Clostridiales, Lactobacillales and Bacteroidales were observed at increase levels in fecal samples of UHR subjects compared to the other two groups. The composition changes of gut microbiota indicate the increased production of Short Chain Fatty Acids (SCFAs), which could activate microglia and then disrupt membrane metabolism. Furthermore, this was confirmed by an increase of choline levels, a brain imaging marker of membrane dysfunction, which is also significantly elevated in UHR subjects compared to the HR and HC groups.Conclusion:Both gut microbiome and imaging studies of UHR subjects suggest the membrane dysfunction in the brain and hence might support the membrane hypothesis of schizophrenia.
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Structural and functional abnormalities in the caudate nucleus of schizophrenic patients with and without obsessive symptoms. MIDDLE EAST CURRENT PSYCHIATRY 2015. [DOI: 10.1097/01.xme.0000461750.94661.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Natsubori T, Inoue H, Abe O, Takano Y, Iwashiro N, Aoki Y, Koike S, Yahata N, Katsura M, Gonoi W, Sasaki H, Takao H, Kasai K, Yamasue H. Reduced frontal glutamate + glutamine and N-acetylaspartate levels in patients with chronic schizophrenia but not in those at clinical high risk for psychosis or with first-episode schizophrenia. Schizophr Bull 2014; 40:1128-39. [PMID: 24023251 PMCID: PMC4133658 DOI: 10.1093/schbul/sbt124] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Changes in brain pathology as schizophrenia progresses have been repeatedly suggested by previous studies. Meta-analyses of previous proton magnetic resonance spectroscopy ((1)H MRS) studies at each clinical stage of schizophrenia indicate that the abnormalities of N-acetylaspartate (NAA) and glutamatergic metabolites change progressively. However, to our knowledge, no single study has addressed the possible differences in (1)H MRS abnormalities in subjects at 3 different stages of disease, including those at ultrahigh risk for psychosis (UHR), with first-episode schizophrenia (FES), and with chronic schizophrenia (ChSz). In the current study, 24 patients with UHR, 19 FES, 25 ChSz, and their demographically matched 3 independent control groups (n = 26/19/28 for the UHR, FES, and ChSz control groups, respectively) underwent (1)H MRS in a 3-Tesla scanner to examine metabolites in medial prefrontal cortex. The analysis revealed significant decreases in the medial prefrontal NAA and glutamate + glutamine (Glx) levels, specifically in the ChSz group as indexed by a significant interaction between stage (UHR/FES/ChSz) and clinical status (patients/controls) (P = .008). Furthermore, the specificity of NAA and Glx reductions compared with the other metabolites in the patients with ChSz was also supported by a significant interaction between the clinical status and types of metabolites that only occurred at the ChSz stage (P = .001 for NAA, P = .004 for Glx). The present study demonstrates significant differences in (1)H MRS abnormalities at different stages of schizophrenia, which potentially correspond to changes in glutamatergic neurotransmission, plasticity, and/or excitotoxicity and regional neuronal integrity with relevance for the progression of schizophrenia.
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Affiliation(s)
- Tatsunobu Natsubori
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideyuki Inoue
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yosuke Takano
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Norichika Iwashiro
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuta Aoki
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinsuke Koike
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Noriaki Yahata
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaki Katsura
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Sasaki
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidemasa Takao
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidenori Yamasue
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;
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Schwerk A, Alves FDS, Pouwels PJW, van Amelsvoort T. Metabolic alterations associated with schizophrenia: a critical evaluation of proton magnetic resonance spectroscopy studies. J Neurochem 2013; 128:1-87. [DOI: 10.1111/jnc.12398] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 07/31/2013] [Accepted: 08/03/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Anne Schwerk
- Department of Neurology; Charité - University Medicine; Berlin Germany
| | - Fabiana D. S. Alves
- Department of Psychiatry; Academic Medical Centre; Amsterdam The Netherlands
| | - Petra J. W. Pouwels
- Department of Physics& Medical Technology; VU University Medical Centre; Amsterdam The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Psychology; Maastricht University; Maastricht The Netherlands
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T2 relaxation effects on apparent N-acetylaspartate concentration in proton magnetic resonance studies of schizophrenia. Psychiatry Res 2013; 213:142-53. [PMID: 23769421 PMCID: PMC3748739 DOI: 10.1016/j.pscychresns.2013.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 03/18/2013] [Accepted: 03/20/2013] [Indexed: 11/24/2022]
Abstract
Over the past two decades, many magnetic resonance spectroscopy (MRS) studies reported lower N-acetylaspartate (NAA) in key brain regions of patients with schizophrenia (SZ) compared to healthy subjects. A smaller number of studies report no difference in NAA. Many sources of variance may contribute to these discordant results including heterogeneity of the SZ subject populations and methodological differences such as MRS acquisition parameters, and post-acquisition analytic methods. The current study reviewed proton MRS literature reporting measurements of NAA in SZ with a focus on methodology. Studies which reported lower NAA were significantly more likely to have used longer echo times (TEs), while studies with shorter TEs reported no concentration difference. This suggests that NAA quantitation using MRS was affected by the choice of TE, and that published MRS literature reporting NAA in SZ using a long TE is confounded by apparent differential T2 relaxation effects between SZ and healthy control groups. Future MRS studies should measure T2 relaxation times. This would allow for spectral concentration measurements to be appropriately corrected for these relaxation effects. In addition, as metabolite concentration and T2 relaxation times are completely independent variables, this could offer distinct information about the metabolite of interest.
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Szulc A, Galińska-Skok B, Tarasów E, Konarzewska B, Waszkiewicz N, Hykiel R, Walecki J. Clinical and cognitive correlates of the proton magnetic resonance spectroscopy measures in chronic schizophrenia. Med Sci Monit 2012; 18:CR390-8. [PMID: 22648255 PMCID: PMC3560721 DOI: 10.12659/msm.882909] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Proton magnetic resonance spectroscopy (1H MRS) allows for examining brain functions in vivo in schizophrenic patients. Correlations between N-acetylaspartate (NAA) level in the frontal lobe and cognitive functions and clinical symptoms have been observed. The aim of the present study was evaluation of relationship between clinical symptoms, cognitive outcomes and brain function in 1H MRS measures in schizophrenic patients. Material/Methods The study included a group of 47 patients with chronic schizophrenia. Patients were assessed by means of PANSS, CGI, and a battery of cognitive tests: WCST, TMT, and verbal fluency test. MRI and MRS procedures were performed. Regions of interest were located in the left frontal lobe, temporal lobe and thalamus. Metabolite (NAA, choline, myoinositol and Glx complex) ratios to creatine were calculated. Results We observed a significant negative correlation between myoinositol level in the frontal lobe and WSCT test performance. These data were confirmed by further analysis, which showed a significant correlation between WCST outcome, negative symptoms score, education level and myoinositol ratio in the frontal lobe. When analyzing negative symptoms as independent variables, the analysis of regression revealed a significant relationship between negative symptoms score and verbal fluency score, together with choline level in the thalamus. Conclusions The above data seem to confirm a significant role of the thalamus – a “transmission station” involved in connections with the prefrontal cortex – for psychopathology development (especially negative) in schizophrenia. Moreover, our results suggest that a neurodegenerative process may be involved in schizophrenia pathogenesis.
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Affiliation(s)
- Agata Szulc
- Psychiatry Clinic of Medical University of Bialystok, Bialystok, Poland.
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Neurometabolites in schizophrenia and bipolar disorder - a systematic review and meta-analysis. Psychiatry Res 2012; 203:111-25. [PMID: 22981426 PMCID: PMC3466386 DOI: 10.1016/j.pscychresns.2012.02.003] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/02/2012] [Accepted: 02/08/2012] [Indexed: 01/10/2023]
Abstract
This meta-analysis evaluates alterations of neurometabolites in schizophrenia and bipolar disorder. PubMed was searched to find controlled studies evaluating N-acetylaspartate (NAA), Choline (Cho) and Creatine (Cr) assessed with ((1))H-MRS (proton magnetic resonance spectroscopy) in patients with schizophrenia and bipolar disorder up to September 2010. Random effects meta-analyses were conducted to estimate pooled standardized mean differences. The statistic was used to quantify inconsistencies. Subgroup analyses were conducted to explore potential explanations for inconsistencies. The systematic review included 146 studies with 5643 participants. NAA levels were affected in schizophrenia and bipolar disorder. Decreased levels in the basal ganglia and frontal lobe were the most consistent findings in schizophrenia; decreased levels in the basal ganglia were the most consistent findings in bipolar disorder. Cho and Cr levels were not altered in either disorder. Findings for Cr were most consistent in the thalamus, frontal lobe and dorsolateral prefrontal cortex in schizophrenia and the basal ganglia and frontal lobe in bipolar disorder. Findings for Cho were most consistent in the thalamus, frontal lobe and anterior cingulate cortex in schizophrenia and basal ganglia in bipolar disorder. Large, carefully designed studies are needed to better estimate the extent of alterations in neurometabolites.
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Allen PJ. Creatine metabolism and psychiatric disorders: Does creatine supplementation have therapeutic value? Neurosci Biobehav Rev 2012; 36:1442-62. [PMID: 22465051 PMCID: PMC3340488 DOI: 10.1016/j.neubiorev.2012.03.005] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 03/07/2012] [Accepted: 03/14/2012] [Indexed: 12/12/2022]
Abstract
Athletes, body builders, and military personnel use dietary creatine as an ergogenic aid to boost physical performance in sports involving short bursts of high-intensity muscle activity. Lesser known is the essential role creatine, a natural regulator of energy homeostasis, plays in brain function and development. Creatine supplementation has shown promise as a safe, effective, and tolerable adjunct to medication for the treatment of brain-related disorders linked with dysfunctional energy metabolism, such as Huntington's Disease and Parkinson's Disease. Impairments in creatine metabolism have also been implicated in the pathogenesis of psychiatric disorders, leaving clinicians, researchers and patients alike wondering if dietary creatine has therapeutic value for treating mental illness. The present review summarizes the neurobiology of the creatine-phosphocreatine circuit and its relation to psychological stress, schizophrenia, mood and anxiety disorders. While present knowledge of the role of creatine in cognitive and emotional processing is in its infancy, further research on this endogenous metabolite has the potential to advance our understanding of the biological bases of psychopathology and improve current therapeutic strategies.
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Affiliation(s)
- Patricia J Allen
- Department of Psychology, Tufts University, Psychology Building, 490 Boston Ave., Medford, MA 02155, USA.
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Seese RR, O’Neill J, Hudkins M, Siddarth P, Levitt J, Tseng B, Wu KN, Caplan R. Proton magnetic resonance spectroscopy and thought disorder in childhood schizophrenia. Schizophr Res 2011; 133:82-90. [PMID: 21872444 PMCID: PMC3229835 DOI: 10.1016/j.schres.2011.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 07/05/2011] [Accepted: 07/09/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Although magnetic resonance spectroscopy has identified metabolic abnormalities in adult and childhood schizophrenia, no prior studies have investigated the relationship between neurometabolites and thought disorder. This study examined this association in language-related brain regions using proton magnetic resonance spectroscopic imaging ((1)H MRSI). METHOD MRSI was acquired bilaterally from 28 youth with childhood-onset schizophrenia and 34 healthy control subjects in inferior frontal, middle frontal, and superior temporal gyri at 1.5T and short echo time (TR/TE = 1500/30 ms). CSF-corrected "total NAA" (tNAA; N-acetyl-aspartate + N-acetyl-aspartyl-glutamate), glutamate + glutamine (Glx), creatine + phosphocreatine (Cr + PCr), choline compounds (Cho), and myo-inositol (mI) were assayed in manually drawn regions-of-interest partitioned into gray matter, white matter, and CSF and then coregistered with MRSI. Speech samples of all subjects were coded for thought disorder. RESULTS In the schizophrenia group, the severity of formal thought disorder correlated significantly with tNAA in the left inferior frontal and superior temporal gyri and with Cr + PCr in left superior temporal gyrus. CONCLUSIONS Neurometabolite concentrations in language-related brain regions are associated with thought disorder in childhood-onset schizophrenia.
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Affiliation(s)
- Ronald R. Seese
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
| | - Joseph O’Neill
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
| | - Matthew Hudkins
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
| | - Prabha Siddarth
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
| | - Jennifer Levitt
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
| | - Ben Tseng
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
| | - Keng Nei Wu
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
| | - Rochelle Caplan
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1759
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1 H-MR spectroscopy in ultra-high risk and first episode stages of schizophrenia. J Psychiatr Res 2011; 45:1135-9. [PMID: 21397254 DOI: 10.1016/j.jpsychires.2011.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 01/13/2011] [Accepted: 02/10/2011] [Indexed: 11/22/2022]
Abstract
Using proton magnetic resonance spectroscopy biochemical characteristics in early stages of schizophrenia were examined. N-acetylaspartate, choline and creatine were measured in hippocampus, anterior cingulate gyrus (ACC) and medial prefrontal cortex (mPFC) of 24 first episode and 30 ultra-high risk patients. Careful LCModel analyses revealed no differences between the patient groups and 31 healthy controls, casting doubt upon the idea of metabolic changes in early stages of psychosis.
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13
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Capizzano AA, Toscano JLN, Ho BC. Magnetic resonance spectroscopy of limbic structures displays metabolite differences in young unaffected relatives of schizophrenia probands. Schizophr Res 2011; 131:4-10. [PMID: 21705196 PMCID: PMC3485075 DOI: 10.1016/j.schres.2011.05.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 05/19/2011] [Accepted: 05/23/2011] [Indexed: 01/25/2023]
Abstract
Imaging studies of schizophrenia patients showed fronto-temporal brain volume deficits, while magnetic resonance spectroscopy (MRS) studies of patients and unaffected biological relatives have found a decrement of the neuronal marker N-acetyl-aspartate (NAA) in the hippocampus and frontal lobes, and increased choline-containing phospholipids. Using a 3T MR scanner, we determined the metabolite profile within limbic regions (anterior cingulate cortex (ACC) and left hippocampus) of 36 unaffected, adolescent/young adult relatives of schizophrenia probands (first-degree=16, second-degree=20) and 25 healthy controls with no family history of schizophrenia. Significant main effects of group were found on NAA/Cho ratios for both the left hippocampus (F = 6.11, p ≤ 0.02) and ACC (F = 4.89, p ≤ 0.03) as well as for the left hippocampus Cho/Cr ratio (F = 5.55, p ≤ 0.02). Compared to age and sex matched healthy controls without a family history of schizophrenia, first-degree relatives of probands had greater MRS metabolite deviations than second-degree relatives. Greater familial proximity to the schizophrenia proband (or higher schizophrenia susceptibility) among biological relatives was associated with stepwise lowering of NAA/Cho and elevations in Cho/Cr ratios. The observed limbic metabolite changes among young, nonpsychotic biological relatives are likely related to shared genetic vulnerability factors, and may assist in the early identification of schizophrenia for primary and secondary prevention.
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Affiliation(s)
- Aristides A. Capizzano
- Department of Radiology, Division of Neuroradiology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
,Corresponding author. Tel.: +1 319 384 8795; fax: +1 319 353 6275. (A.A. Capizzano), (J.L. Nicoll Toscano), (B.-C. Ho)
| | - Juana L. Nicoll Toscano
- Department of Family Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Beng-Choon Ho
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
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Fuente-Sandoval CDL, León-Ortiz P, Favila R, Stephano S, Mamo D, Ramírez-Bermúdez J, Graff-Guerrero A. Higher levels of glutamate in the associative-striatum of subjects with prodromal symptoms of schizophrenia and patients with first-episode psychosis. Neuropsychopharmacology 2011; 36:1781-91. [PMID: 21508933 PMCID: PMC3154101 DOI: 10.1038/npp.2011.65] [Citation(s) in RCA: 190] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The glutamatergic and dopaminergic systems are thought to be involved in the pathophysiology of schizophrenia. Their interaction has been widely documented and may have a role in the neurobiological basis of the disease. The aim of this study was to compare, using proton magnetic resonance spectroscopy ((1)H-MRS), glutamate levels in the precommissural dorsal-caudate (a dopamine-rich region) and the cerebellar cortex (negligible for dopamine) in the following: (1) 18 antipsychotic-naïve subjects with prodromal symptoms and considered to be at ultra high-risk for schizophrenia (UHR), (2) 18 antipsychotic-naïve first- episode psychosis patients (FEP), and (3) 40 age- and sex- matched healthy controls. All subjects underwent a (1)H-MRS study using a 3Tesla scanner. Glutamate levels were quantified and corrected for the proportion of cerebrospinal fluid and percentage of gray matter in the voxel. The UHR and FEP groups showed higher levels of glutamate than controls, without differences between UHR and FEP. In the cerebellum, no differences were seen between the three groups. The higher glutamate level in the precommissural dorsal-caudate and not in the cerebellum of UHR and FEP suggests that a high glutamate level (a) precedes the onset of schizophrenia, and (b) is present in a dopamine-rich region previously implicated in the pathophysiology of schizophrenia.
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Affiliation(s)
- Camilo de la Fuente-Sandoval
- Experimental Psychiatry Laboratory, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico,Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Pablo León-Ortiz
- Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Rafael Favila
- MR Advanced Applications, GE Healthcare, Mexico City, Mexico
| | - Sylvana Stephano
- Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - David Mamo
- Multimodal Neuroimaging Schizophrenia Group, PET Centre, Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jesús Ramírez-Bermúdez
- Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Ariel Graff-Guerrero
- Multimodal Neuroimaging Schizophrenia Group, PET Centre, Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Multimodal Neuroimaging Schizophrenia Group, PET Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada M5T 1R8. Tel: +1 416 535 8501 Ext 7376, Fax: +1 416 979 3855, E-mail:
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15
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Brugger S, Davis JM, Leucht S, Stone JM. Proton magnetic resonance spectroscopy and illness stage in schizophrenia--a systematic review and meta-analysis. Biol Psychiatry 2011; 69:495-503. [PMID: 21145039 DOI: 10.1016/j.biopsych.2010.10.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 09/14/2010] [Accepted: 10/05/2010] [Indexed: 01/12/2023]
Abstract
BACKGROUND It is not known whether regional brain N-acetyl aspartate (NAA) changes in the progression from prodrome to chronic schizophrenia. We used effect size meta-analysis to determine which brain regions show the most robust reductions in NAA first episode and chronic schizophrenia as measured by proton magnetic resonance spectroscopy and to determine whether these changes are present in individuals at high risk of developing schizophrenia. METHODS We identified 131 articles, of which 97 met inclusion criteria. Data were separated by stage of illness (at risk, first episode schizophrenia, chronic schizophrenia) and by brain region. For each region, mean and SD of the NAA measure was extracted. RESULTS Significant reductions in NAA levels were found in frontal lobe, temporal lobe, and thalamus in both patient groups (effect size > .3; p < .01). In individuals at high risk of schizophrenia (of whom approximately 20% would be expected to undergo transition to psychosis), significant NAA reductions were present in thalamus (effect size = .78; p < .05), with reductions at trend level only in temporal lobe (effect size = .32; p < .1), and no reductions in frontal lobe (effect size = .05; p = .5). CONCLUSIONS These data suggest that schizophrenia is associated with loss of neuronal integrity in frontal and temporal cortices and in the thalamus and suggest that these changes in the frontal and temporal lobe might occur in the transition between the at-risk phase and the first episode.
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Affiliation(s)
- Stefan Brugger
- Institute of Psychiatry, King's College London, London, United Kingdom
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16
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Kumra S, Asarnow R, Grace A, Keshavan M, McClellan J, Sikich L, Wagner A. From bench to bedside: translating new research from genetics and neuroimaging into treatment development for early-onset schizophrenia. Early Interv Psychiatry 2009; 3:243-58. [PMID: 22642727 DOI: 10.1111/j.1751-7893.2009.00142.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Children and adolescents with schizophrenia share a similar pattern of phenomenological, genetic and cognitive abnormalities to adults with schizophrenia. However, an early-onset of schizophrenia (EOS) (prior to 18 years of age) is associated with a higher frequency of risk indicators associated with schizophrenia (e.g. developmental delays and familial spectrum disorders) and a worse long-term outcome. This overview examines recent research on the neurobiological alterations, possible causes, developmental trajectory and treatment of EOS and attempts to identify gaps in the field. METHOD The authors provide a selective review of major findings from genetics, neuroimaging and treatment studies of pediatric schizophrenia that were presented at a workshop sponsored by the National Institute of Mental Health. These data are synthesized in conjunction with preclinical studies into a model of the pathophysiology of EOS. RESULTS EOS is associated with a high frequency of cytogenetic abnormalities (e.g. velocardiofacial syndrome, sex chromosome anomalies) and other rare denovo chromosomal aberrations. Brain imaging research in adolescents with EOS has revealed a progressive loss of cortical grey matter post-onset of psychosis and subtle abnormalities in white matter microstructure. Although EOS patients are more likely to be treatment-refractory than their adult counterparts, there are substantial data that this subgroup is particularly responsive to clozapine. CONCLUSIONS Genetic or environmental factors operating during adolescence that reduce frontal capacity might contribute to an EOS in susceptible individuals. Additional longitudinal studies of adolescents with schizophrenia are needed to better understand the relationship between structural changes in fronto-limbic regions, stress responsivity, and cognitive and neurochemical development.
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Affiliation(s)
- Sanjiv Kumra
- Division of Child and Adolescent Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota 55454, USA.
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17
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Neuroimaging studies of normal brain development and their relevance for understanding childhood neuropsychiatric disorders. J Am Acad Child Adolesc Psychiatry 2008; 47:1233-51. [PMID: 18833009 PMCID: PMC2759682 DOI: 10.1097/chi.0b013e318185e703] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review the maturational events that occur during prenatal and postnatal brain development and to present neuroimaging findings from studies of healthy individuals that identify the trajectories of normal brain development. METHOD Histological and postmortem findings of early brain development are presented, followed by a discussion of anatomical, diffusion tensor, proton spectroscopy, and functional imaging findings from studies of healthy individuals, with special emphasis on longitudinal data. RESULTS Early brain development occurs through a sequence of major events, beginning with the formation of the neural tube and ending with myelination. Brain development at a macroscopic level typically proceeds first in sensorimotor areas, spreading subsequently and progressively into dorsal and parietal, superior temporal, and dorsolateral prefrontal cortices throughout later childhood and adolescence. These patterns of anatomical development parallel increasing activity in frontal cortices that subserves the development of higher-order cognitive functions during late childhood and adolescence. Disturbances in these developmental patterns seem to be involved centrally in the pathogenesis of various childhood psychiatric disorders including childhood-onset schizophrenia, attention-deficit/hyperactivity disorder, developmental dyslexia, Tourette's syndrome, and bipolar disorder. CONCLUSIONS Advances in imaging techniques have enhanced our understanding of normal developmental trajectories in the brain, which may improve insight into the abnormal patterns of development in various childhood psychiatric disorders.
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Martínez-Granados B, Brotons O, Martínez-Bisbal MC, Celda B, Martí-Bonmati L, Aguilar EJ, González JC, Sanjuán J. Spectroscopic metabolomic abnormalities in the thalamus related to auditory hallucinations in patients with schizophrenia. Schizophr Res 2008; 104:13-22. [PMID: 18650068 DOI: 10.1016/j.schres.2008.05.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 02/25/2008] [Accepted: 05/25/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Previous studies have found neurochemical abnormalities in thalamic nuclei in patients with schizophrenia. These abnormalities have been associated with information processing deficiencies and symptom formation. There are no metabolic spectroscopy studies in patients with schizophrenia attending to auditory hallucinations. The aim of the present study is to explore metabolic Magnetic Resonance Spectroscopy (MRS) ratio differences in the thalamus between schizophrenic patients with and without auditory hallucinations and control subjects. METHODS MRS studies (MRI 1.5 T unit) were performed in 49 patients with schizophrenia (30 with auditory hallucinations and 19 without auditory hallucinations) and 37 controls. (1)H MRS imaging was used to acquire 2 transverse slices (TR/TE 2700/272 ms, region of interest 110 x 100 x 23 mm). In the quantitative analysis four elements of volume (9.2 x 9.2 x 23 x 4 mm), added into one spectrum representative of each thalamus, were chosen in the slice passing through the main body of the thalamus. The areas of metabolites were integrated with the jMRUI program. RESULTS The patients with schizophrenia had significantly lower bilateral NAA/Cho ratios when compared with healthy subjects. There was also a lower NAA/Cho ratio in the right thalamus in patients with auditory hallucinations compared to patients without auditory hallucinations and control subjects. Significant correlations were found between metabolic ratios and BPRS, PANSS and PSYRATS scores, age of onset of auditory hallucinations, and age of subjects. CONCLUSIONS Choline and NAA ratio abnormalities determined by thalamic spectroscopy may be related to the pathogenesis of auditory hallucinations in patients with schizophrenia.
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Affiliation(s)
- B Martínez-Granados
- Department of Physical Chemistry, University of Valencia, C/ Dr Moliner 50, 46100 Burjassot, Valencia, Spain.
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Margari F, Presicci A, Petruzzelli MG, Ventura P, Di Cuonzo F, Palma M, Margari L. Very early onset and greater vulnerability in schizophrenia: A clinical and neuroimaging study. Neuropsychiatr Dis Treat 2008; 4:825-30. [PMID: 19043525 PMCID: PMC2536548 DOI: 10.2147/ndt.s2484] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although schizophrenia has been diagnosed in children, this group of disorders has received too little attention in the clinical and research literature. Preliminary data suggest that early onset schizophrenia (EOS) and very early onset schizophrenia (VEOS) tend to have a worse outcome than adult onset schizophrenia, and seem to be related to a greater familial vulnerability, due to genetic, psychosocial, and environmental factors. Recently, advanced neuroimaging techniques have revealed structural and functional brain abnormalities in some cerebral areas. This paper reports on a case diagnosed as VEOS, with premorbid year-long psychopathological history. The patient showed atypical proton magnetic resonance spectroscopy findings, and normal brain and spine computer tomography and brain magnetic resonance images.
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Affiliation(s)
- Francesco Margari
- Department of Neurologic and Psychiatry Sciences, Psychiatry Unit, University of Bari Italy
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20
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Torres G, Hallas BH, Gross KW, Spernyak JA, Horowitz JM. Magnetic resonance imaging and spectroscopy in a mouse model of schizophrenia. Brain Res Bull 2007; 75:556-61. [PMID: 18355631 DOI: 10.1016/j.brainresbull.2007.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 09/07/2007] [Accepted: 09/20/2007] [Indexed: 11/17/2022]
Abstract
Metabolic brain abnormalities, as demonstrated by (1)H-magnetic resonance spectroscopy, are common occurrences in adult schizophrenia. As mice share important biochemical and genomic similarities with humans, we tested whether brain metabolic abnormalities also occur in a transgenic mouse model of schizophrenia. In vivo(1)H-magnetic resonance spectroscopy at 4.7T of the chakragati mouse brain revealed abnormalities in relative levels of choline and N-acetylaspartate compounds. These results are consistent with a prior proposal that deficits in metabolite ratios may be common features of psychotic disorders. Thus, chakragati mice recapitulate certain aspects of the human disease phenotype and further support the utility of this animal model for understanding causal factors underlying uniquely human brain diseases.
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Affiliation(s)
- German Torres
- Department of Neuroscience, New York College of Osteopathic Medicine of New York Institute of Technology, Old Westbury, NY 11568, USA
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21
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Zabala A, Sánchez-González J, Parellada M, Moreno DM, Reig S, Burdalo MT, Robles O, Desco M, Arango C. Findings of proton magnetic resonance spectometry in the dorsolateral prefrontal cortex in adolescents with first episodes of psychosis. Psychiatry Res 2007; 156:33-42. [PMID: 17764911 DOI: 10.1016/j.pscychresns.2006.12.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 12/14/2006] [Accepted: 12/26/2006] [Indexed: 11/23/2022]
Abstract
Knowledge of the neurobiology of early onset psychosis is limited. We used proton magnetic resonance spectroscopy to investigate the possible existence of dorsolateral prefrontal brain biochemical abnormalities in adolescents with psychosis and to determine possible differential effects related to specific psychotic diagnoses. We measured the ratios of N-acetyl-aspartate (NAA), choline (Cho), and creatine (Cr) to water in two groups of adolescents with a first episode of psychosis (schizophrenia n=8; non-schizophrenia n=15) and in 32 healthy controls matched for age, gender, and years of education. Proton magnetic resonance spectroscopy at 1.5 T was used to study two 6.75-cc voxels placed in the left and right dorsolateral prefrontal region. The schizophrenia patients presented statistically significant reductions in NAA/water levels in the left dorsolateral prefrontal voxel as compared with non-schizophrenia patients and healthy controls. No significant differences were detected between groups for NAA/water in the right dorsolateral prefrontal voxel or for Cho/water and Cr/water levels in any hemisphere. A reduction of the NAA/water level in the left dorsolateral prefrontal region may be selectively present at the onset of psychosis during adolescence in patients who later progress to schizophrenia, but not in those who later progress to other psychotic disorders.
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Affiliation(s)
- Arantzazu Zabala
- Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain.
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22
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Stanley JA, Vemulapalli M, Nutche J, Montrose DM, Sweeney JA, Pettegrew JW, MacMaster FP, Keshavan MS. Reduced N-acetyl-aspartate levels in schizophrenia patients with a younger onset age: a single-voxel 1H spectroscopy study. Schizophr Res 2007; 93:23-32. [PMID: 17498928 PMCID: PMC2921910 DOI: 10.1016/j.schres.2007.03.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Revised: 03/18/2007] [Accepted: 03/21/2007] [Indexed: 11/26/2022]
Abstract
Schizophrenia is widely considered a neurodevelopmental disorder. The timing of psychosis onset may determine the degree of functional and biological deficits. In this study, the association between age of onset of psychosis and in vivo biochemical levels was assessed in first-episode, antipsychotic-naive (FEAN) schizophrenia subjects. We hypothesized greater biochemical deficits in the younger-onset FEAN subjects. In vivo, (1)H spectroscopy measurements of the left dorsolateral prefrontal cortex (DLPFC) were conducted on FEAN subjects (15 schizophrenia and 3 schizoaffective subjects) and healthy comparison subjects of comparable age and gender distribution (N=61). N-acetyl-aspartate was significantly lower in the left DLPFC of FEAN subjects as compared to healthy comparison subjects. However, there was a significant subject group-by-age interaction for N-acetyl-aspartate. Early-onset FEAN subjects showed lower N-acetyl-aspartate levels compared to the younger healthy comparison subjects, while adult-onset FEAN and older healthy comparison subjects did not differ. The lower N-acetyl-aspartate levels in the DLPFC of early-onset subjects suggest a reduction in functioning neurons or specifically a reduction in the proliferation of dendrites and synaptic connections, which is not apparent in the adult-onset schizophrenia subjects.
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Affiliation(s)
- Jeffrey A Stanley
- Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, 48201, United States.
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23
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Woo DC, Kim BS, Jung SL, Park HJ, Rhim HS, Jahng GH, Choe BY. Development of a cone-shape phantom for multi-voxel MR spectroscopy. J Neurosci Methods 2007; 162:101-7. [PMID: 17292479 DOI: 10.1016/j.jneumeth.2006.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 11/23/2006] [Accepted: 12/17/2006] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to develop a cone-shape phantom for multi-voxel magnetic resonance spectroscopy (MRS) and to evaluate MR spectra using the cone-shape phantom we developed in this study. A cone-shape MRS phantom was developed with a combination of cone-shape vials. The cylindrical main body was made of acrylic resin and the cone-shape vials were fabricated from poly-ethylene cones. Each cone of the phantom was filled with various metabolite materials. 1.5T GE and 3T Philips systems were used for the single voxel spectroscopy (SVS) as well as for the multi-voxel spectroscopy (MVS). Identification and quantification of the metabolite materials in the cone-shape phantom were done by the SAGE post-program. The MR images and spectra of the cone-shape phantom were obtained from the assigned slice position. The high order shimming control provided enhanced resolution in the SVS and MVS. The area and amplitude were proportional to the metabolite volume in the voxel. The present study demonstrated that the cone-shape phantom was useful for the metabolite quantification. Thus, we propose that the cone-shape phantom can be used for the evaluation of quality control of the MR spectra obtained from SVS and MVS.
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Affiliation(s)
- Dong-Cheol Woo
- Department of Biomedical Engineering, College of Medicine, The Catholic University of Korea, #505 Banpo-Dong, Seocho-Gu, Seoul 137-040, South Korea
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Jayakumar PN, Venkatasubramanian G, Keshavan MS, Srinivas JS, Gangadhar BN. MRI volumetric and 31P MRS metabolic correlates of caudate nucleus in antipsychotic-naïve schizophrenia. Acta Psychiatr Scand 2006; 114:346-51. [PMID: 17022794 DOI: 10.1111/j.1600-0447.2006.00836.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the volumetric and metabolic correlates of caudate nucleus in antipsychotic-naïve schizophrenia patients in comparison with healthy controls. METHOD Twelve antipsychotic-naïve schizophrenia patients and 13 healthy controls underwent (31)P magnetic resonance spectroscopy of basal ganglia. Magnetic resonance imaging volume of caudate nuclei was measured using scion image software. RESULTS Patients had significantly smaller caudate volume than healthy controls. Phosphocreatine (PCr)/total phosphorous and PCr/total adenosine tri-phosphate ratios of both caudate nuclei were significantly lower in patients than controls. Significant negative correlation was found between the left caudate volume and left PCr/total phosphorus ratio in the patients. Age at onset of psychosis had i) significant negative correlation with right and left caudate volumes and ii) significant positive correlation with left PCr/total phosphorus ratio. CONCLUSION The metabolic and volumetric abnormalities of caudate nucleus in antipsychotic-naïve schizophrenia patients support neurodevelopmental etiopathogenesis.
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Affiliation(s)
- P N Jayakumar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
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Jessen F, Scherk H, Träber F, Theyson S, Berning J, Tepest R, Falkai P, Schild HH, Maier W, Wagner M, Block W. Proton magnetic resonance spectroscopy in subjects at risk for schizophrenia. Schizophr Res 2006; 87:81-8. [PMID: 16842971 DOI: 10.1016/j.schres.2006.06.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 06/07/2006] [Accepted: 06/08/2006] [Indexed: 12/01/2022]
Abstract
We used proton magnetic resonance spectroscopy (1H MRS) to examine biochemical characteristics of the brain tissue in subjects at risk for schizophrenia. Nineteen participants fulfilling research criteria for an early (n=10) or a late (n=9) at-risk syndrome, 21 patients with full disease according to DSM IV and 31 healthy control subjects were included in the study. Single-voxel 1H MRS was performed in the left frontal lobe, the anterior cingulate gyrus and the left superior temporal lobe. Subjects were followed longitudinally to detect conversion to schizophrenia. We observed a significant reduction of the metabolic ratios NAA/Cr and NAA/Cho in the left frontal lobe and of NAA/Cr in the anterior cingulate gyrus in both at-risk groups and in the schizophrenic patients compared with healthy controls. Those at-risk subjects, who converted to schizophrenia within the observation period, had a higher Cho/Cr and a lower NAA/Cho ratio in the anterior cingulate gyrus compared with non-converters. NAA/Cr did not differ between converters and non-converters. Six at-risk subjects were taking antidepressants, two were taking antipsychotics. There was no difference in any metabolic ratio in any region between at-risk subjects with and without medication. We conclude that the reduction of the neuronal marker NAA in the left prefrontal lobe and the anterior cingulate gyrus may represent a vulnerability indicator for schizophrenia in at-risk subjects, while elevated Cho in the anterior cingulate gyrus may be a predictor for conversion from the prodromal state to the full disease.
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Affiliation(s)
- Frank Jessen
- Department of Psychiatry, University of Bonn Sigmund-Freud-Str. 25 53105 Bonn, Germany.
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Frazier JA, Breeze JL, Makris N, Giuliano AS, Herbert MR, Seidman L, Biederman J, Hodge SM, Dieterich ME, Gerstein ED, Kennedy DN, Rauch SL, Cohen BM, Caviness VS. Cortical gray matter differences identified by structural magnetic resonance imaging in pediatric bipolar disorder. Bipolar Disord 2005; 7:555-69. [PMID: 16403181 PMCID: PMC2072813 DOI: 10.1111/j.1399-5618.2005.00258.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Few magnetic resonance imaging (MRI) studies of bipolar disorder (BPD) have investigated the entire cerebral cortex. Cortical gray matter (GM) volume deficits have been reported in some studies of adults with BPD; this study assessed the presence of such deficits in children with BPD. METHODS Thirty-two youths with DSM-IV BPD (mean age 11.2 +/- 2.8 years) and 15 healthy controls (HC) (11.2 +/- 3.0 years) had structured and clinical interviews, neurological examinations, neurocognitive testing, and MRI scanning on a 1.5 T GE Scanner. Image parcellation divided the neocortex into 48 gyral-based units per hemisphere, and these units were combined into frontal (FL), temporal (TL), parietal (PL), and occipital (OL) lobe volumes. Volumetric differences were examined using univariate linear regression models with alpha = 0.05. RESULTS Relative to controls, the BPD youth had significantly smaller bilateral PL, and left TL. Analysis of PL and TL gyri showed significantly smaller volume in bilateral postcentral gyrus, and in left superior temporal and fusiform gyri, while the parahippocampal gyri were bilaterally increased in the BPD group. Although the FL overall did not differ between groups, an exploratory analysis showed that the right middle frontal gyrus was also significantly smaller in the BPD group. CONCLUSIONS Children with BPD showed deficits in PL and TL cortical GM. Further analyses of the PL and TL found differences in areas involved in attentional control, facial recognition, and verbal and declarative memory. These cortical deficits may reflect early age of illness onset.
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Affiliation(s)
- Jean A Frazier
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Steen RG, Hamer RM, Lieberman JA. Measurement of brain metabolites by 1H magnetic resonance spectroscopy in patients with schizophrenia: a systematic review and meta-analysis. Neuropsychopharmacology 2005; 30:1949-62. [PMID: 16123764 DOI: 10.1038/sj.npp.1300850] [Citation(s) in RCA: 209] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A systematic review of the literature identified 64 published English-language papers that used proton (1H) magnetic resonance spectroscopy to measure N-acetylaspartate (NAA) concurrently in healthy controls and in patients with a diagnosis of schizophrenia (SZ). A total of 1209 controls and 1256 patients have been evaluated, with 88% of studies carried out at 1.5 T field strength, and 77% of studies focused on patients with chronic SZ. There is consistent evidence that NAA is reduced in a broad range of tissues in the SZ brain. Broad consensus (> or =10 studies) is emerging that NAA levels are reduced > or =5% in hippocampus and in both cortical gray matter (GM) and white matter (WM) of the frontal lobe. There is no evidence to support a hypothesis that relative NAA levels are reduced to a different degree in frontal lobe GM and WM, nor is there robust evidence of a difference in NAA levels between patients with first-episode and chronic SZ. Study reliability may be a problem, as most studies appear to be underpowered. With simple assumptions about the inherent difference in NAA levels between patients and controls, it can be calculated that a minimum sample size of approximately 39 patients and 39 controls is required for acceptable statistical power. Only three of 64 studies included enough subjects to have 80% power to detect a 10% NAA reduction in patients, and no studies were adequately powered to detect a 5% NAA reduction with 80% power.
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Affiliation(s)
- R Grant Steen
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7160, USA.
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Sim K, Cullen T, Ongur D, Heckers S. Testing models of thalamic dysfunction in schizophrenia using neuroimaging. J Neural Transm (Vienna) 2005; 113:907-28. [PMID: 16252070 DOI: 10.1007/s00702-005-0363-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Accepted: 07/23/2005] [Indexed: 01/03/2023]
Abstract
Neural models of schizophrenia have implicated the thalamus in deficits of early sensory processing and multimodal integration. We have reviewed the existing neuroimaging literature for evidence in support of models that propose abnormalities of thalamic relay nuclei, the mediodorsal thalamic nucleus, and large-scale cortico-thalamic networks. Thalamic volume reduction was found in some but not all studies. Studies of the early stages of schizophrenia suggest that thalamic volume reduction is present early in the course of the illness. Functional imaging studies have revealed task related abnormalities in several cortical and subcortical areas including the thalamus, suggesting a disruption of distributed thalamocortical networks. Chemical imaging studies have provided evidence for a loss of thalamic neuronal integrity in schizophrenia. There is, at present, inadequate data to support the hypothesis that schizophrenia is associated with abnormalities of sensory relay or association nuclei. There is evidence for a perturbation of cortico-thalamic networks, but further research is needed to elucidate the underlying mechanisms at the cellular and systems levels. The challenges ahead include better delineation of thalamic structure and function in vivo, the combination of genetic and imaging techniques to elucidate the genetic contributions to a thalamic phenotype of schizophrenia, and longitudinal studies of thalamic structure and function.
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Affiliation(s)
- K Sim
- Schizophrenia and Bipolar Disorder Program, McLean Hospital/Harvard Medical School, Belmont, MA 02478, USA.
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Jakary A, Vinogradov S, Feiwell R, Deicken RF. N-acetylaspartate reductions in the mediodorsal and anterior thalamus in men with schizophrenia verified by tissue volume corrected proton MRSI. Schizophr Res 2005; 76:173-85. [PMID: 15949650 DOI: 10.1016/j.schres.2005.02.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Revised: 02/17/2005] [Accepted: 02/21/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Deficits in the mediodorsal and anterior nuclei of the thalamus may contribute to the psychopathological symptoms of schizophrenia. These thalamic nuclei have been found to be abnormal in schizophrenia and have close connections with other brain structures implicated in the disorder. We therefore examined schizophrenia-related alterations in brain metabolite levels specifically in the mediodorsal and anterior thalamic subregions. METHOD We used in vivo proton magnetic resonance spectroscopic imaging ((1)H MRSI) to measure N-acetylaspartate (NAA), choline-containing compounds (Cho), and creatine+phosphocreatine (Cr) in the mediodorsal and anterior thalamus in 22 male patients with schizophrenia and 22 male controls. Magnetic resonance imaging (MRI) tissue segmentation and thalamic volume mask techniques were performed to distinguish the thalamus, extrathalamic gray and white matter, and CSF within the spectroscopic voxels. RESULTS Compared to healthy subjects, patients with schizophrenia had significantly lower NAA in the mediodorsal and anterior thalamus bilaterally. No significant differences in Cho or Cr levels were seen. NAA was significantly higher in the left thalamus relative to the right in both groups. We found a strong negative correlation between left thalamic NAA and duration of illness, even after partialling out the effect of age. Tissue segmentation and thalamic volume mask techniques detected no group or lateralized differences in tissue type or CSF percentages, demonstrating that the metabolite reductions were not an artifact of spectroscopic voxel heterogeneity. CONCLUSIONS These findings suggest diminished function and/or structure in the mediodorsal and anterior thalamus in male patients with schizophrenia and support earlier research demonstrating schizophrenia-related abnormalities in the thalamus and its circuitry.
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Affiliation(s)
- Angela Jakary
- Psychiatry Service, 116-N, Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA
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Abstract
Magnetic resonance spectroscopy is a noninvasive investigative technique for in vivo detection of biochemical changes in neuropsychiatric disorders for which especially proton (1H-MRS) and phosphorus (31P-MRS) magnetic resonance spectroscopy have been used. In this review we explain the principles of MRS and summarize the studies in schizophrenia. A systematic literature review was carried out for 1H-MRS studies investigating schizophrenic patients compared to controls. The inconsistent results in the cited studies may be due to different study population, specific neuroimaging technique, and selected brain regions. Frequent findings are decreased PME and increased PDE concentrations (31P-MRS) linked to altered metabolism of membrane phospholipids and decreased N-acetylaspartate (NAA) or NAA/choline ratio (1H-MRS) linked to neuronal damage in frontal (DLPFC) or temporal regions in patients with schizophrenia. These results contribute to the disturbed frontotemporal-thalamic network assumed in schizophrenia and are supported by additional functional neuroimaging, MRI morphometry, and neuropsychological evaluation. The combination of the described investigative techniques with MRS in follow-up studies may provide more specific clues for understanding the pathogenesis and disease course in schizophrenia.
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Affiliation(s)
- T Wobrock
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum des Saarlandes, Homburg/Saar.
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